Presentation on theme: "Patient Access Intake Center: Five Years in the Making"— Presentation transcript:
1 Patient Access Intake Center: Five Years in the Making Lynn Arrington & Alyssa CoralloManagers of Patient Access Intake Center
2 Patient Access Intake Center Five Years in the Making ConsolidationWhy consolidation was necessaryHow the Centralized Patient Access System came to beBenefits and results over last five yearsInsurance VerificationWork list & WorkflowDenials ReductionRevenue Cycle Communication and Trace TrackingInsurance BenefitsPre- RegistrationSecuring Days OutDialerPre-Service CollectionsQuality assurancePT Satisfaction SurveyScriptingBalancing Staff Accountability and RecognitionDepartment StandardsAccountability StepsRaise Morale through Team and Individual Recognition
3 Texas Health Resources… Mission, Vision and Values
4 ‘’It all starts with Patient Access and we truly do pave the road to success for our patients and our facilites ’’ Patti Consolver, Administrative Director -Patient Access Services
5 PAIC: Five Years in the Making… In 2006 Texas Health Resources analyzed industry and competitor trends, assessed strengths and weaknesses and develop ambitious strategies that would position Texas Health to transform itself faster than the rate of change in the environment, thereby transforming health care delivery in North Texas.In 2007 PAIC, the centralized function for verification and pre-registration, was created. The PAIC Pre-registration department takes care of all the preliminary steps in the patient’s registration via phone or online putting the case in motion prior to the patient arrival at the facility. While the insurance verification department will secure authorization requirements and benefits for both future and past patient cases.Texas Health Resources serves 16 counties in the Dallas-Fort Worth area of North Central Texas, home to more than 6.2 million people.The system includes more than 20,500 employees working in 24 acute-care and short-stay hospitals that are owned, operated, joint-ventured or affiliated with Texas Health Resources.
6 Why Centralize? Areas of Concern: THR was only Pre-Admitting 72% of Scheduled Admissions while the Benchmark was set at 90%.Not all facilities had the luxury of having a dedicated pre-admission department or staffed appropriately.Several entities pre-registered in between patients or not at all.For entities with designated pre-admission staff, the process was inconsistent and the focus was varied throughout the organization.Collections were not completed on all accounts consistently.Opportunity to avoid denials by communicating appointments lacking precertification prior to the date of service.Ability to review patient’s specific benefits for accurate coverage details helping to improve up front collections.Enables a more relaxed environment to discuss benefits and deposit prior to the patient’s visit and enables transfer to a Financial Counselor for financial follow up .Gives the advantage of setting service standards. To be able to deliver a consistent experience at all the Texas Health Resources’ locations delivering the same compassionate, individualized care every day, every time.Goals in creating the PAIC:Develop a streamlined Pre-Admission process to exceed the 90% benchmark.Develop a streamlined pre-certification and verification process to ensure timely notification and pre-certification.Develop an express check in concept for pre-registered patients at the entity.In 2006 the Strategic Revenue Cycle needed higher standards set for Texas Health Resources. At that time THR needed to compare industry standards and conducted a study to see where improvements were needed.
8 Benefits of a Centralized PAIC Opportunity to avoid denials by communicating appointments lacking pre-certification prior to the date of service.Ability to review patient’s specific benefits for accurate coverage details helping to improve up front collections.For improved efficiency the PAIC enables the possibility of implementation of an automated kiosk on sight at each entity in the registration area benefiting both the healthcare system and the patient.Gives the advantage of setting service standards. To be able to deliver a consistent experience at all the Texas Health Resources’ locations delivering the same compassionate, individualized care every day, every time.
9 Five Years of GrowthThe PAIC has grown in the last five years with management leading the staff to fulfill and exceed expectations set by our Central Business Office.We have made improvements to our :Communication scripting and verbiagePre-Service collectionsDenial ReductionWork flow via the Ontrac SystemIdentification process of limited benefits plans and ELAP plansOverall ability to secure future dates of service appointments out to 5-15 days prior to the patient’s arrival
10 THR Operations: A detailed look at the THR Pre-Registration and Insurance Verification The initial contact with our patients for information, updates, quoting and collections is performed by Pre-RegistrationThe initial contact and follow up with the insurance company , physcian and facility is perfomed by Insurance Verification DepartmentThe PAIC’s greatest impact is due to the centralized design and separation of the Pre-Registration process and Insurance Verification process
11 Insurance Verification Worklist & WorkflowStockamp Ontrac worklist toolEach worlklist contains NoVA (Notification Verification and Authorization) accountsThe Ontrac Worklist is split up in Urgent, Elective, Next Day, and Specialty.
12 Insurance Verification Denial Reduction :2008 average Denial for Precert was $ $450,785.002011 average Denial for Precert was $203,691.00
14 Insurance Verification ELAP and Limited Benefit Plans
15 Pre-Registration Securing Days Out- Work Flow Teams Focus System 2011 & 2012 Pre-Registration % Completed Rate100% attempted for 5 days out and 75% attempted on 6-15 days out for all service typesTeams Focus SystemUrgent Team- DOS within next 1-5 daysSurgery Team- 5 to 30 days outDiagnostic Team- 6 to 60 days out
16 Pre-Registration Ontario Dialer With over 1800 inbound calls weekly, we utilize Ontario Dialer technology to route and manage all calls. This helps us track the following user statistics and call volume:Wait TimeInbound VolumeOutbound VolumePassed to MessagingAbandoned RateIndividual Call Statistics
17 Pre-RegistrationThe Ontario Dialer allows management to visually monitor all representatives’ real time activity, as well as track their weekly statistics.
18 Pre-Registration Collection Process Calculate DepositScripting for CollectionsPayment SecuredIf Patient is unable to pay deposit50% upfront deposit is offered to patient.Patients that can not pay the minimum of 50% of the deposit amount will be transferred to the Entity Financial Counselor to discuss further payment options.
20 Pre-Registration Calculating Deposits Each patient’s benefits are verified and then entered into our CarePricer system, which populates the deposit amount on a form the patient signs upon Admission.During Pre-Registration each patient is screened for an outstanding balance, which is added onto the CarePricer estimate.
22 Pre-Registration Quality Assurance All calls and computer activity are recorded on our Centricity system, which management uses to perform monthly quality reviews. Centricity is able to capture the entire Pre-Registration process.Registration Data ElementsScriptingCollectionsCustomer Service
23 Pre-Registration Patient Satisfaction Each patient is asked to take a survey at the end of the pre-registration phone call to rate the representative’s customer service. The results of these surveys are monitored on a weekly basis and reported monthly as part of the department KPI standards.
26 Pre-Registration Scripting Uniformity is key. We provide scripting to all of our representatives to ensure that all patients are given a professional and courteous experience from beginning to end.Types of Scrpting:Introduction / ConclusionSurgeryCollectionsVoicSurvey
28 Accountability Recognition Balancing Accountability and Recognition will create Excellent Performance
29 Accountability Department Standards Productivity – 100 % weekly = 175 accounts for PreRegistration255 for Elective IV Accounts400 for Specialty IV Accounts275 for Urgent IV AccountsQuality Review- 2.7 or higher on a 3.0 scaleCollections- $45 per Patient
30 Accountability Accountabilty Steps Step 1: Documented Verbal Coaching Step 3: Written Counseling/ Corrective ActionDiscretionary Action Plan may be devisedStep 4: Written Counseling/ Corrective ActionStep 5: Termination
31 Team/Individual Recognition Monthly Team Contests – centered around KPI goalsBalloon Friday- Increasing Collections/ProductivityShout Outs – quick recognition with whole departmentAccomplishment Jar- Staff selects/sharesPass the Dino/Monkey – Peer to Peer Reward
35 Questions & Answers? AND TO THE PATIENTS WE SERVE…. At Texas Health Resources, a faith-based health care system, we combine clinical expertise, advanced technology, and compassionate individualized care to deliver the best possible outcomes for the patients we serve. We are proud to be a team working together continually improving our system as we transform ourselves by having Individuals Caring for Individuals, Together