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Patient Access Management

Leveraging Best Practices

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Discussion Points

Best Practices within the Patient Access Process

•Core Fundamentals

• Are these part of your strategy?

•Best Practices

• Definition of the best practice• How a healthcare organization can support these best practices• How a vendor should support each of Best Practices

•Looking ahead into 2014 and beyond

• Where our focus may be in a few years

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Patient Access Best Practices

Assumptions:

• Your organization is committed to providing a high level of customer satisfaction

• Your organization is committed to and supportive of a financial clearance approach

• We recognize the following statements to be true

‘If you’ve seen one hospital, you’ve seen one hospital’

‘If you’ve seen one successful process, you’ve seen one successful process’

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Core Fundamentals

These are ‘must haves’ to be successful with Patient Access Best Practices

•Defined Patient Access Process

• Clearly documented and current• Belief

•Hiring the right individuals and appropriate wages

•Training

• Investment in a solid training process/unit• Adherence to new hire training• Regimented training(retraining) calendar for existing employees

• Consistency!!•Investment in technology

•Organizational ‘buy in’ to a financial clearance process

•Physician office relationships and scoring (accountability)

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Patient Access and its role in Financial Clearance

By leveraging sound best practices, Patient Access contributes to the accuracy and completeness of the patients account.

• Scheduling

• Pre-Registration/Pre-Visit Verification

• Authorizations/Certifications

• Point of Service

• Next day audit

• Discharge

Patient Accounting

• Pre Claim Submission

• Remittance Advice

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Patient Access and its role in Financial Clearance

Critical data element validation points throughout the Patient Access process.

• Benefit Information Insurance company Insured Patient share of cost

o CoPayso Deductibles o Estimated Patient Responsibility

• Address Information Current Address Static Address

• Employer Information

• Credit Score Fraud detection Payment sources

• Authorization Requirements

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Patient Access Best Practice WorkflowScheduling

The first interaction with the patient sets the tone for the rest of their experience.

• Demographic Information Accuracy Patient name Date of birth Social security number Address Telephone number

• Insurance Information Accuracy Insurance carrier identification Policy Number / Member ID / Subscriber Number Subscriber name Subscriber Relationship Pre-certification / Authorization Phone number

• Service accuracy Servicing Physician (or Nurse Practitioner) Location Referring Physician information

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Patient Access Best Practice WorkflowPre-Registration/Pre-Verification

The Pre-Registration process gives the organization the best opportunity to capture and validate.

• Insurance verification Determine coverage Service level Co-Pays and Deductibles Establish who is insured In Network and Out of Network benefits

• Address verification If not previously performed in last 90 days

• Patient Bill Estimation

• Payment capture of patient cost of share

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Patient Access Best Practice WorkflowPre-Registration/Pre-Verification

The Pre-Registration process gives the organization the best opportunity to capture and validate.

• Credit scoring Establishing patients likelihood to pay Fraud alerting Sources for payment Employer verification

• Establish Authorization Requirements Patient requirements Provider requirements

• Pursue funding options for uninsured or under-insured Charity Medicaid Local funding sources

• Identify Payer Readmission risks

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Patient Access Best Practice WorkflowPoint of Service

By establishing a Best Practice Pre-Registration process, the patients experience is that of CARE versus FINANCIAL.

• Re-verification of benefits: If greater than 24 hours since last verification First day of the month

• Form execution

• If ED patient or Urgent Admission: Insurance verification Address Verification Patient Bill Estimation Credit scoring Authorization requirements Uninsured funding Readmission Risk

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Patient Access Best Practice WorkflowNext Day Audit/Discharge

The best processes and technologies do not ensure end user compliancy.

• Identification of existing discrepancies Insurance benefit Name DOB SS# Member ID Address Diagnosis codes

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Technologies that Support Best Practice Workflow

A single solution is the key to preventing leakage and end user compliance/acceptance to the best practice workflow.

• End user familiarity and similar workflow

• Minimizes integration points with HIS and HER

• Central repository for data

• Centralized patient view

• Single source for data integrity

• Owned solutions versus multiple partnerships

• Data content leader Content is king!

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Beyond 2013……

The direction the industry is going………

• More automation……less people

• Voice enabled technology

• The patient will play a larger role in the registration process

• Kiosks/Smart screens

• Patient portals

• Increase in services to support ACA requirements

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Questions?