bridging the gap between patient access and patient financial services

Bridging the Gap Between Patient Access and Patient Financial Services

Lynn Otani, IHHIJulie 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

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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.

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Established 2005 with 4 hospitals in Central Orange County, California

Billed from one Central Business Office

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Western Medical Center Santa AnaWestern Medical Center AnaheimChapman Medical CenterCoastal 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

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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.

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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

NewslettersWith serious and fun topics

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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

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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

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COMMUNICATION11

Eliminate “email wars”

• Rewa Cooper, Director of Admitting, Western Medical, Santa Ana, CA (IHHI)

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Reduce Denials

• Christina Jimenez, Admitting Manger Western Medical Center, Anaheim, CA (IHHI)

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One Department – Different Locations

• Margie Fitzgerald, Director of Patient Services (DPS) / Admitting Manager , Chapman Medical Center, Orange• Case management, HIM, ED, and Admitting

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It Takes a Village

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• 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

TECHNOLOGY & AUTOMATION

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Technology

• Quality Assurance• Automated Eligibility & Benefits• Scanners

• ID• Advance Directives• Insurance Cards

• Patient Estimation

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Productivity and Accuracy Daily

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Opportunity to Make Corrections

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Details to Mentor

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Accurate Insurance

Plan Selection

Eligibility Integrity21

Automated Eligibility &

Benefits Associated

with Visit

Eligibility Integrity22

Opportunity to Collect

Prior Balances

Access Manager23

Accurate Patient

Estimates

CarePricer24

Automated Payment

Processing

eCash25

Scripting for Success

eCash26

Change

• Provides individual opportunity for growth• Improves overall revenue cycle results

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Final Outcomes & Results at IHHI

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Contact Information

• Lynn Otanilotani@gmail.com(310) 346-1958

• Julie Kayjkay@medassets.com

(972 )333-6454

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