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Patient Access Services Quality Assurance. Bon Secours Virginia. MEDICAL MANAGEMENT. MEDICAL RECORD & CODING. CHARGE CAPTURE & ENTRY. CLAIMS SUBMISSION. REGISTRATION & POS CASH COLLECTIONS. THIRD PARTY FOLLOW-UP. FINANCIAL COUNSELING. PAYMENT POSTING. INSURANCE

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Presentation Transcript
the revenue cycle

MEDICAL

MANAGEMENT

MEDICAL

RECORD &

CODING

CHARGE

CAPTURE

& ENTRY

CLAIMS

SUBMISSION

REGISTRATION

& POS CASH

COLLECTIONS

THIRD PARTY

FOLLOW-UP

FINANCIAL

COUNSELING

PAYMENT

POSTING

INSURANCE

VERIFICATION

REJECTION

PROCESSING

DENIAL &

APPEAL

MANAGEMENT

PRE-REG &

PRE-CERT

CONTRACT

MANAGEMENT

SCHEDULING

The Revenue Cycle

CDM

Metrics & KPIs

FOCUS AREA

EDI-capability

Regulatory

compliance

revenue cycle
Revenue cycle
  • Front End (Access Services)
    • Scheduling
    • Gathering PreReg/PreCert
    • Insurance Verification
    • Financial Counseling
    • Registration/Point of Service Collections
  • Patient Access Quality Assurance Audit
    • Sits between Data Capture/Data Entry and Insurance Claim generation
    • Provides timely, “accurate” billing
    • Reduces rework
case study bon secours virginia access services qa process
Case Study - Bon Secours VirginiaAccess Services – QA Process
  • Overview
    • Policy
    • Procedure
      • Daily
      • Monthly
      • As Needed
  • Questions
policy
Policy
  • Policy of Patient Access Department to provide quality control audits on a daily/monthly basis, using the reports and material provided so that all patients are registered accurately and consistently across the local system.
qa procedure
QA Procedure
  • Daily
    • Access Metaviewer and pull up the following reports for each facility:
      • 00000 Doctor Report
      • Patient/Guarantor Address Report
      • Employer Information Audit Report
      • Medicare Audit Report
      • Auditing Code Check Report
      • Backdated Admission Report
      • Insurance Auditing Report
    • Key errors into an Excel spreadsheet for each hospital.
    • Correct the errors into SMS for each hospital.
qa process cont d
QA Process cont’d
  • Monthly
    • Send the error spreadsheets out to each manager/supervisor before the 10th of each month to include in staff evaluations
  • As Needed
    • Assist in training of new employees
    • Notify Manager/Supervisor if you notice an employee is consistently making the same error
    • Re-train Employees in areas needed
    • Keep New Employee training material updated
contact info
Contact Info

Jillian B. Surace

Jill_Surace@bshsi.org

757-889-4385