Two birds with one stone Financially Clearing a Patient ...

© 2011 DCS Global Systems, Inc. All Rights Reserved.

Manoj Chhabra

DCS Global Systems, Inc.

Two birds with one stone – Financially Clearing a Patient & and Improving Patient satisfaction at the same time

© 2011 DCS Global Systems, Inc. All Rights Reserved. 15:24 PM

Presentation Agenda

Objectives

Problem Defined

Patient Access Technology

Patient Access KPI’s

DCS Global Solutions


Objectives

• Develop a patient financial clearance strategy

• How to Financially clear an insured and a Self-pay patient

• System automation to Collect money at POS

• Understand the usage of basic and advanced credit check at registration

• Understand the necessity to target alternative financial clearance methods at time of registration

• Leverage automation tools to measure Wait time and Patient Satisfaction

• How to measure the wait time and gather a Patient Survey at POS


Goals

• Increase POS Cash and Maximize Patient Satisfaction

• An automated workflow System with paperless process • Advanced Eligibility – 10 minutes

• Medical Necessity - 5 minutes

• Authorizations- 10 minutes

• e-Forms & e-Signature - 5 minutes

• Estimates & POS Collection - 10 minutes

• Charity Care & Propensity to Pay - 5 minutes

• Patient Wait time & Patient Satisfaction surveys- 10 minutes

• Self Service - 5 minutes


Increasing Challenges…..Significant Opportunities

• “Hospitals are 60% less likely to receive payment once the patient leaves the hospital.” –Wall Street Journal

• Healthcare Reform threatens your bottom line

• To achieve game changing performance

• Reduce denials

• Improve patient access experience

• Increase POS collections

• In short….Integrated Patient Access!


Advanced Eligibility & Authorizations


The Problem

• Eligibility accounts for about 20% of denials encountered in patient access

• Over 100+ industry standard benefit codes

• Non standard and inconsistent responses from payor

• Facility needs benefits rather than “YES” or “NO”

• Easy to read responses

• Lost efficiencies due to multiple payor websites for coverage information

29: The Problem


Revenue Leakage - %age of Total Lost Revenue

• The Max OOP has doubled in last five years

• More Insurances require pre-certs for services.


Top 10 Insurance Eligibility Denials

• Incorrect Plan Name

• Patient is not eligible for that DOS

• Medicare Denials • Patient Name Mismatch

• Patient DOB Mismatch

• Patient Gender Mismatch

• Subscriber ID Mismatch

• Non-covered Services

• Medicare HMO Plan

• MSP

• Hospice


How do you process error claims? • Run Edits on data prior to 270 submission

• Like bad Subscriber ID

• Future date submission based on Payor

• Run Edits Post Eligibility

• Find the correct Plan Code

• Highlight Subscriber ID and Name mismatches

• Run error accounts automatically based on • System Errors ( N42, N80)

• User Defined errors like N63, Invalid Subscriber ID etc.

• Notify the user after n attempts – Unable to obtain eligibility

• Keep Copies of 271 for n year (s) for appeals.


Detailed Medicare Results

• Medicare Information most required

• # of days remaining

• Lifetime limitations/remaining

• Reserves

• Remaining deductibles

• MSP enrollment

• PPO enrollment

• HMO’s

• Home Health Care

• Hospice

• Procedure Limitations based off of CPT codes


Authorizations

In-Patient Hospital Notifications.


Authorizations–Successful approaches

• Evaluates payor specific rules and determines if auth is needed • ER-->in patient

• Procedure codes etc..

• Based on Rule auth rules\Auth_Rules.xls

• Continuous monitoring and alerting via worklists

• Evaluates auths with changes in patient type

• Achieved via • Payor websites

• Third party websites

• EDI via 278

• Fax

56: Authorizations–Successful approaches

auth rules/Auth guidelines_payer_specific.xls

auth rules/Auth_Rules.xls




Sample Submission Rules

•Evaluates payor specific rules and determines if auth is needed

ER-->in patient ( Evaluates auths with changes in patient

type)

Procedure codes etc..

•Based on Rule auth rules\Auth_Rules.xls

•Continuous monitoring and alerting via worklists

auth rules/Auth guidelines_payer_specific.xls





Sample Fax Forms


Hospital Authorization Process Flow

Facility receives the Order

Obtain Demographics

Verify Insurance benefits

Schedule the Patient

AuditLogix QA Identifies

if the account needs Pre-

cert/Auth or not.

System marks

Account with notes

such NPR (No Pre-

cert Required)

Is Pre-cert

Needed?

DCS Auto

initiates the Auth

enquiry via

•278 I

•278 N

•Screen Scrape

•call

If auth Obtained

If Auth is Pending,

Update Account and

check back again.

If Auth is not initiated

notify Physician office

System

Automatically

creates a Worklist

based on accts

missing Auths

Update Patient Account

with Auth# information

yes

yes

ON

no

System provides several canned reports to see missing Auths


How does DCS Achieve Auths

• Electronic Notification of admission via 278 N

• Inpatient

• Supported by few Payors

• Electronic Auth Enquiry by facility via 278I

• Out Patient Procedures

• Supported by Few Payors

• Auth Enquiry by Screen Scrape

• All Payors which support Auths via a website

• Auth Enquiry by Phone for exceptions


SCREEN SCRAPE TECHNOLOGY

auth rules/


Medical Necessity (ABN & Waiver forms)

Medicare and Commercial carriers


Medical Necessity -Successful approaches

• Procedure/Diagnosis matching & non coverage

• Permissive coverage notifications

• Textual warning notifications

• Frequency notifications

• ABN modifier rules

• Allows for Custom Rules

57: Medical Necessity -Successful approaches


Medical Necessity - ABN


Coder Worklist

Between Patient Discharge to Bill Drop


Sample Type of Edits

• Medical Necessity Edits (MN***)

• Correct Coding Initiative Validation (CCI**)

• Procedure Validation (CPT**)

• Diagnosis Validation (ICD**)

• Modifier Validation (MOD**)

• Place of Service Validation (POS**)

• Modifier/Procedure Validation (MP***)

• Usage Validation (USG**)

• Place of Service/Procedure Validation (PPR**)


E-forms & E-Signature


E-forms -Successful approaches

• Document Creation /Generation

• Bar Code Generation

• Document Grouping & Printing

• Document Storage via scanning / uploading

• Auto Indexing & Document Retrieval

• Rules based Routing and workflow

67: E-forms -Successful approaches

FORMS.xls


Sample Process Flow

70: Sample Process Flow


Patient reads the form online and signs on

the signature pad

OR

Patient reads the form on a tablet and signs

on the screen

Improved Process Flow

71: Slide71


Patient Bill Estimator


Patient Estimator - Successful Approaches

• Increase transparency with automated comprehensive estimates

• Easy to understand Patient Statement • Provides deductible met, copay, co-insurance & final amount

based on facility specific contracts & historical data • The statement can be delivered electronically & securely


Propensity to Pay, Charity Care and Financial Counseling


Best practice


Financial Counseling - Successful Approaches

• Identification of Patients who will have trouble paying balances

• Standard processes for Counseling staff

• Charity care Screening and automated form filling

• Payment Plan options

64: Financial Counseling - Successful Approaches


Scheduling Pre-Reg Portal Pre-Reg (Phone) Registration

• Verify Benefits • Collect Order • Notify Patient of

Estimate & prior balance

• Verify Demographics

• Verify Benefits • Present Estimate • Collect Estimate • Present Payment

options

• Verify Patient Info

• Notify Patient of Estimate

• Discuss Payment Options

• Validate Demographics

• Present Estimate • Collect Payment • Discuss Payment

Options • Review Charity

Status

Maximizing Collection Opportunities


Patient Wait Time & Surveys


Goal

• The average time patients spend waiting to see a health-care provider is 22 minutes, according to a 2009 report by Press Ganey Associates.

• The report also noted that patient satisfaction dropped significantly with each five minutes of waiting time.

• Our goal at was to reduce the time between a patient’s scheduled appointment and placement in an exam room to 10 minutes or less for a minimum of 90% of all outpatients.


Identify Problem Areas

Process Key Indicator Trigger Point (Goal)

Current Performance

Need to Address?

Patient Arrival Patient Wait Time in Lobby

6.5 minutes 7 minutes Yes / No

Registration Time

Time to Register a Patient

10 minutes 9 minutes Yes / No

Pre-Service Time Time patient waits prior to service

10 minutes 18 minutes Yes / No

Service Time Service Time 30 minutes 30 minutes Yes / No


Outcome Goals

• Reduction of wait time

• Instant feedback with customer surveys

• Real-time reaction to negative feedback


Wait Time


Walk-In Patient

Greeter Flow

DCS

SurveyCube

Schedule

d Patient

Patient Assigned Coaster

Greeter Assigns Coaster


Kiosk Flow

Walk-In Patient

Scheduled Patient

Kiosk with Touch Pad,

Card Reader and Printer

Get a Ticket#


Text Messages

Please come to booth# 3


Registrar paged patient

Pager – Buzzes and Beeps


Kiosk/Tablets going to Patient


Satisfaction Surveys


Survey Reports (107)

Sample Survey Report


Wait time Reports


Vendor Selection


Vendor Selection

• When choosing a wait time solution, vendor selection is vital.

– Partnership with your Hospital/Health system

– Ability to develop new features

– Knowledgeable of processes, product lines and industry standards

– Pre and post go-live support

– Continued support for current areas as well as future rollouts

– Capital vs. operational budget


Vendor Selection


What does DCS GLOBAL do ?


iPAS- Integrated Patient Access System


Contact Information

• Lance Mills

• [email protected]

• 972-781-2030 xtn 121

• Manoj Chhabra

• [email protected]

• 972-781-2030 xtn 102

mailto:[email protected]

mailto:[email protected]


Thank you!

Two birds with one stone Financially Clearing a Patient ...

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