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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 WorkflowSchedulingThe 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-VerificationThe 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-VerificationThe 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 ServiceBy 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/DischargeThe 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?