o rders & s cheduling : jump-starting the revenue cycle and the patient experience west virginia...
TRANSCRIPT
ORDERS & SCHEDULING:
Jump-Starting the Revenue Cycle and the Patient Experience
WEST VIRGINIA CHAPTER
HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION
September 10, 2015
Ryan Howell
Product Director|OrderSmart
Paige Popp
Product Director| ScheduleSmartMember, NAHAM Industry Standards Committee (ISC)
OBJECTIVE:
Optimize and streamline your organization’s pre-service processes through integrated orders management, patient scheduling and financial clearance to create a win-win situation that benefits your organization and your patients.
OUTCOMES:
• Partnering with physicians to manage physician orders, enhance patient scheduling and ensure financial clearance across the enterprise.
• Integrating workflows to foster a more collaborative working environment between physicians and hospitals, and among departments and facilities within the health system.
• Improving patient satisfaction through streamlined pre-service processes by effectively managing physician orders, enhancing patient scheduling and ensuring financial clearance.
• Decreasing payment delays and denials by eliminating lost or incomplete orders, improving scheduling accuracy, and improving the patient experience.
• Physician Orders Management Solution - to allow for real time receipt and importing of orders into the centralized order tracking system so that key stakeholders, including clinical areas, are able to easily access order information.
• Patient Scheduling Solution - leveraged to ensure a consistent scheduling format across the organization and to enhance staff cross-training for effectively meeting the demands of volume fluctuations as needed.
OPTIMIZING ORDERS & SCHEDULING
FRONT-END OF THE REVENUE CYCLE =PRE-SERVICES
• Orders Management
• Patient Scheduling
• Pre-Registration
• Financial Clearance Insurance Eligibility Determination
Insurance Benefit Verification
Pre-Certification/Authorization
Medical Necessity Screening
• Upfront Estimation (communication and collection of patient’s financial responsibility)
• Financial Counseling (package pricing, payment arrangements, charity, medical assistance screening, etc.)
WHY PRE-SERVICES?
• Set the tone for the patient’s hospital experience and launch both the clinical encounter and the Revenue Cycle.
• Separate the clinical process from the financial clearance process and shift the focus of the revenue cycle from point-of-service and post-service to prior-to-service.
• Generate “a fundamental change in how facilities manage capacity, patient access and competitive positioning in the outpatient market”.
• Support effective competition within markets with Pre-Service processes that are consolidated, streamlined, and highly integrated.
NAHAM’S PRE-SERVICES(PRE-REGISTRATION TASKS AND
TIERS)
SAD, BUT TRUE…
• A significant portion of patients are not authorized prior to service resulting in potential delays, cancellations and/or denials, which impacts patient satisfaction.
• Patient calls to schedule do not consistently include the full pre-registration, which requires additional patient contacts to obtain the necessary information.
• Pre-registration is likely not completed according to industry standards or better.
• Incomplete or missing physician orders cause patient delays on the day of service.
ORDERS MANAGEMENT
“The Milbank Quarterly found that 63 percent of primary care providers are dissatisfied with the referral and orders process.
To compound these problems, paper orders can be illegible, lost, forgotten by the patient and not meet regulatory requirements. When the circle is broken, it causes problems that reverberate throughout a healthcare community with a potentially negative impact on patient outcomes, scheduled resources, reimbursement and compliance.” – Katherine Murphy
ORDERS & FINANCIAL CLEARANCE
Improving order acquisition and data quality helps to get a jump-start on the downstream revenue cycle process.
• Complete eligibility and benefits verification
• Obtain appropriate documentation for authorization inquiry & submission
• Screen Medical Necessity
• Identify and collects appropriate financial papers such as booking sheets, waiver forms, ABNs, etc.
PHYSICIAN ALIGNMENTImplement centralized outpatient order system to connect hospital, health system or stand-alone clinics with employed and community physicians to create loyalty.
• Reduce paper-driven processes
• Points of order acquisition: Physician portal
EMR
Fax
• Real-time/daily communication: Orders receipt
Messaging
Results
PATIENT ENGAGEMENT
Growth in consumer-driven healthcare services and emphasis on patient satisfaction.
• Automation for very manual labor intensive process
• Timely orders submission and results communication
• Elimination of unnecessary phone calls and paper transactions
• Improvement to overall care coordination and patient satisfaction
• Reduction in delayed/rescheduled/canceled services
PATIENT SCHEDULING
• Scheduled patients are often dissatisfied with:
Receiving multiple phone calls from different contacts to complete the necessary pre-services.
Experiencing a potentially lengthy registration process on the day of service.
• When outpatient scheduling calls are routed to individual departments to complete the scheduling process:
The timeliness of pre-registration and the financial clearance process may be impacted.
Staff in the departments are distracted from their clinical and/or other departmental responsibilities.
FLEXIBLE PROCESSES
Adjust your process according to the source of the scheduling call:
• From Physician/Offices Quick and dirty
Senior, more experienced staff
• From Patients Thorough and flexible
Include the full pre-registration
CENTRALIZING PRE-SERVICES
• Increases Pre-Registration
• Reduces No-Shows
• Optimizes Appointment Management/Resource Allocation
• Minimizes Patient Bottlenecks on the Day of Service
• Revenue Cycle best practices include the benefits derived from: Dedicated staff
Quantifiable quality metrics
Telephone-focused customer service training
BENEFITS OF CENTRALIZING
• In accordance with best practice studies, dedicated Pre-Service teams are highly effective at:
• Initiating the Revenue Cycle and Clinical Encounter
• Consistently delivering superior patient-centric services
• Access Management experts contend that:
• “Operating fewer but larger patient contact centers makes good economic sense and warrants the resources to achieve better service levels…
• Larger FTE budgets better justify the expense of an improved infrastructure, such as feature-rich telecom and call management systems”.
LEVERAGING TECHNOLOGYPre-Service teams should utilize all available technology to streamline processes to achieve more efficient real-time results.
• Call Management System to route calls based on determined priority, generate call KPI reports and record calls for monitoring quality
• Medicare outpatient services will be screened for medical necessity at the point of scheduling to mitigate Medicare denials and patient delays
• Upfront patient payment estimation tool to accurately estimate the patient’s financial responsibility prior to service
• Automated registration quality assurance system to audit the accuracy of pre-registration information
• Automated reminders to reduce no-shows
• “Trying to navigate the maze of outpatient orders without a strong technology platform can be a futile effort. Instead of creating clarity and continuity from order placement to scheduling, results and reimbursement, you can end up with disjointed parts that may not always lead you on a direct path to full reimbursement.” – Katherine Murphy
• According to HFMA, effectively managing all aspects of pre-services “can provide acute care hospitals with accessibility and service levels equal to freestanding facilities. As a result, previously lost market share can be recaptured”.
Sources:
• Altman, S. (Sept. 2009). Appointment Scheduling and Beyond. Access Management, Retrieved May 2012.
• Barnett, S, Shields, B (Feb. 2012). Centralizing Patient Access Services. NCO Healthcare Services, Presented Feb. 2012.
• Holdren, K, Snow, B & Snow, G. (no date). The MyVisit Program at Geisinger Health System. hfma.org Case Study, Retrieved Feb. 2009.
• Murphy, Katherine (April. 2014). Escape the Maze of Orders. Experian Health, Healthcare Blog, Retrieved Aug. 2015.
• O’Neill, D, & Kenniff P. (Sept. 2007). Centralized Scheduling: An Unanticipated Revenue Cycle Opportunity. Healthcare Financial Management, Retrieved February, 2009.