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Bridging the Gap Between Patient Access and Patient Financial Services Lynn Otani, IHHI Julie Kay, MedAssets
| Date post: | 11-Jan-2016 |
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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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