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Patient Access Management
Leveraging Best Practices
2Emdeon Proprietary & Confidential
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
3Emdeon Proprietary & Confidential
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’
4Emdeon Proprietary & Confidential
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)
5Emdeon Proprietary & Confidential
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
6Emdeon Proprietary & Confidential
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
7Emdeon Proprietary & Confidential
Patient Access Best Practice WorkflowScheduling
The 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
8Emdeon Proprietary & Confidential
Patient Access Best Practice WorkflowPre-Registration/Pre-Verification
The 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
9Emdeon Proprietary & Confidential
Patient Access Best Practice WorkflowPre-Registration/Pre-Verification
The 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 Service
By 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/Discharge
The 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!
13Emdeon Proprietary & Confidential
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?