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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COMMUNICATION

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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 Kay

jkay@medassets.com

(972 )333-6454

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