1 southcoast hospitals group | charlton memorial hospital | st. luke’s hospital | tobey hospital...

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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital

Patient Access Intake Center

Transitioning Revenue Cycle Processes to the Front End

Kimberly Ryan- Manager of Education Mary Ann Rogers-Project I.T. Specialist

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The Goal

To create an Intake Center that will process all ancillary, surgical and inpatient scheduling, authorization, determine patient liability, pre register and collect patient liability.

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First Steps

• Combined the Centralized Scheduling staff & the Central Authorization Unit staff to one location

• Realigned leadership to 1 Manager & 2 Team Leaders

• Developed Career Ladders and combined the job descriptions to create the Patient Access Intake Specialist role

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First Steps (cont.)

• Involved HR in development of compensation plan • Institutued a competency test that would trigger the compensation plan upon successful completion

* Test designed to prepare staff for NAHAM ceritifcation exam

• Began an aggressive cross training plan to expand over

18 months

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New Moves

• Assumed the Surgical Scheduling for three hospitals and one free standing surgical center

• Existing periop staff were transferred to the Intake Center

• Alliances established with Periop Leadership and Surgeons

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New Moves (cont.)

• Standardized scheduling processes at the four sites

• Cross trained the schedulers to be able to book at all locations

• Trained the OR schedulers on insurance criteria * Status C screening

* Contracted Insurances * Some Medical Necessity

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Appeals Coordinator

• Identified need to have a position dedicated to review all denials and appeal as quickly as possible

• AC is able to identify reason for denial and feed this information to the Education Manager

• Reviews Insurance Newsletters & Bulletins to identify changes in authorization requirements and parses out to appropriate service lines as well as Access staff

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Patient Access Project IT Specialist

• Liason between Patient Access and the Southcoast IT department

• Handles all dictionary updates• Tracks and follows all Meditech issues and tasks• Troubleshoots software issues• Investigates new technology possibilities

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Accuracy & Accountability

• Implemented Davincian Guardian as our QA tool* customizable* allows staff to correct errors real time* serves as an education tool

* includes NEHEN eligibility

• Individual and department score cards* completed registrations* accuracy rates* frequency of error types

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Upfront Collections

• Collecting at most points of registration

• Dash Boards assist staff with determining co-pay, deductible & coinsurance:

• Surgery• ED• Imaging Therapies are next

• Track daily collection results on a score card

• Collected $3.2 million in 2011 * 28% of potential ED & 18% of potential Ancillaries * Staff incentive program – 65%

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Pre-Registration

• All scheduled appointments are pre-registered

• Collection attempt at time of pre-registration

• Self pay patients reviewed for HSN or other assistance• Training staff to estimate payment plans and

request initial payment at time of service

• Patient reports directly to appointment not Admitting

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Managed Care Enrollment

• Enroll Medicaid and Medicare patients into contracted Managed Care Plans

• Involved most points of registration

• Patient Financial Services hosts multiple community outreach events

• Completing Training to Physician Office staff

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Physician Practice Buy-In

• Must work cohesively with MD practices

• Absorbed high dollar Radiology Imaging authorization process

• Services 38 offices ( 148 physician’s)

• Provide options on method to access the Intake Center, i.e. phone, fax, electronic

• Customer Service visits

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Education Department

• Standardized education to all points of registration

• Provides all initial training - 2 week class* Mandatory annual in-services

• Computer Access must be approved by Education

• Maintains duplicate medical record data and recommends corrective action – HR approved

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Revenue Cycle Metrics

• Clean claim rate - 94.6%

• Days in AR - 32

• Administrative write off percentage - .02%

• Upfront collection - $3.2 million

• $30 million in documented HSN

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National Recognition…

Southcoast was named a Revenue Cycle Award Winner by the Revenue Cycle Academy .

Recognized for:

• Top Decile performance among all organizations surveyed in net A/R Days (32.0)

• Bad Debt write off’s as a percentage of net revenue (0.2%)

1 southcoast hospitals group | charlton memorial hospital | st. luke’s hospital | tobey hospital...

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