Bridging the Gap Between Patient Access and Patient Financial Services Lynn Otani, IHHI Julie Kay, MedAssets
Overview • Objectives • PFS vs. Patient Access • The Integrated Healthcare Holdings, Inc.(IHHI) Story • Real “work-lives” of IHHI • Bridging the Gap • Completing the Revenue Cycle • Communication • Technology • Change • Final Thoughts
Objectives • Identify communication process barriers between patient access and patient financial services; • Determine appropriate communication types that WORK; • Learn how technology can play a roll in building this bridge.
Established 2005 with 4 hospitals in Central Orange County, California Billed from one Central Business Office
Western Medical Center Santa Ana Western Medical Center Anaheim Chapman Medical Center Coastal Communities Hospital Total 762 beds: Acute Care, Cardiac, OB, NICU, Trauma, In and Outpatient Burn Units, In-Custody patients, Psych, Chemical Dependence, Obesity and SubAcute Units.
PFS vs. Patient Access • Patient Access is a vital part of the billing and collections process: • Percent of data needed for billing originating at registration: 70% • National average registration error rate: 46% • Percent of denials that could be prevented at registration: >50% • Often an adversarial relationship exists • Multiple communication barriers
Observations • CBO “tells” Patient Access management what is needed • 1) for United Health use new plan code 12346, 12345 has been deleted. • 2) MediCal procedure codes xxxxx through xxxxx require a TAR effective xx/xx/xx • Patient Access management sends emails or memos to the staff of the changes needed • Changes are made until new changes are required, the staff focus on the new changes and forget the old changes.
Bridging the Gap • Communication: • Regular face to face meetings: • Cross Department Director level • Management • Staff • Discuss controversial topics • Organized Communication for Reference • Shared Drives to file emails and documents • Binders by subject rather than date • Standard terminology Newsletters With serious and fun topics
Bridging the Gap • Training & Education • Quick PowerPoints that can be posted • Peer Review and Audit • Technology • Manual processes are labor intensive and often incomplete due to staff training and understaffing • Technology can “bridge the gap” by ensuring 100% compliance for fixed rules
Completing the Revenue Cycle • Treat as one department • Encourage relationships • Hold staff meetings with representatives from all revenue cycle areas • Contributions to agenda • Specific scenarios and role playing • Emphasize the “GOOD” clean account examples
Eliminate “email wars” • Rewa Cooper, Director of Admitting, Western Medical, Santa Ana, CA (IHHI)
Reduce Denials • Christina Jimenez, Admitting Manger Western Medical Center, Anaheim, CA (IHHI)
One Department – Different Locations • Margie Fitzgerald, Director of Patient Services (DPS) / Admitting Manager , Chapman Medical Center, Orange • Case management, HIM, ED, and Admitting
Email to Patient Access, Health Information Management and Case Management: “Zero Collectors worked this case: $120,000 PAID IN FULL 25 days from DISCHARGE!!! This case SCREAMS the undeniable KUDOS to our PATIENT ACCESS & CASE MANAGEMENT & BILLING teams for a job done ONCE, done right!!! THANK YOU ALL: Your great work has really paid off !!!” -Yaman Kahf, IHHI CBO Director It Takes a Village
Technology • Quality Assurance • Automated Eligibility & Benefits • Scanners • ID • Advance Directives • Insurance Cards • Patient Estimation
Accurate Insurance Plan Selection Eligibility Integrity 21
Automated Eligibility & Benefits Associated with Visit Eligibility Integrity 22
Opportunity to Collect Prior Balances Access Manager 23
Accurate Patient Estimates CarePricer 24
Automated Payment Processing eCash 25
Scripting for Success eCash 26
Change • Provides individual opportunity for growth • Improves overall revenue cycle results
Lynn Otani email@example.com (310) 346-1958 • Julie Kay firstname.lastname@example.org (972 )333-6454 Contact Information