1. Jasmin Cruz Internship Work Product Advanced Medical Specialties

2.  Advanced Medical Specialties is a comprehensive oncology office made up of 3 doctors and 4 physician assistants (PA’s). Many patients come in to the office for treatment, but unfortunately a lot of them end up hospitalized because of cancer complications.

3.  The doctors and PA’s must follow up with their patients at the hospital in order to determine whether or not the patient needs further testing, what medications to prescribe, what laboratory tests to order. They must document their findings for medical records, but also for hospital billing purposes.

4.  When a patient is hospitalized and a doctor or physician assistant from Advanced Medical Specialties sees that patient, there are certain charges that must be assessed.  In order for the practice to bill the patient’s insurance company, they must have proper documentation that lists the charges for the doctor’s or physician assistant’s visit.

5.  Doctor or PA sees AMS patient in hospital  Doctor or PA writes down information pertaining to the patient.  Information is turned in to the Office Manager for billing.

6.  No standard form  Doctors and PA’s wrote information in their own notepads.  The doctors and PA’s would write down information, based on what they remembered to document, thus there was no uniform information documentation.

7.  Because there was no set process in place, the doctor’s would, often times, lose track of the information they documented.  The documentation of the doctor’s visit is supposed to be turned into the Office Manager so that the billing for each visit could be submitted to the Advanced Medical Specialties Headquarters in a timely manner.

8.  Hospital billing documentation not turned in on time  Information would be incomplete and further investigation would have to be conducted by office manager  Payment of hospital bills would be delayed  Hospital bill would not be submitted at all.

9.  The office employees and myself thought of ways in which the issues with hospital billing could be solved.  I came up with 3 areas that needed improvement by asking questions.  The office manager implemented the new process and the results were discussed.

10.  Question #1: How can doctors and PA’s document the same information?  Question #2: What can be done so that doctors and PA’s can remember to turn in documentation?  Question #3: How can we facilitate the collection of the documents?

11.  How can doctors and PA’s document the same information?  The answer to this was obvious to all of us. A standard form that asked for the same information for every patient should have been used by all doctors and PA’s in the practice.  Doctor’s tend to have a busy schedule and lot of different tasks to accomplish. Therefore, the form should be simple and to the point.

12.  How can doctors and PA’s document the same information?  We looked over the formal hospital billing form that is usually filled out by the office manager, and highlighted information that was most significant.

14.  After the manager approved of the highlighted items as most significant, we designed a basic template for the doctors and PA’s to use.  The template includes the most basic information that can be transcribed into the formal document which will be the final document submitted to AMS headquarters.

16.  What can be done so that doctors and PA’s can remember to turn in documentation?  Now that the doctors and PA’s had a small, convenient fee ticket to document their hospital visits, we were confident that they would remember to turn them in.  After consulting with the office manager, we came up with a solution: Have a deadline of end of the week for all tickets to be turned in, and a process to check that all tickets were turned in.

17.  What can be done so that doctors and PA’s can remember to turn in documentation?  The process of hospital billing was very disorganized, to say the least. This enabled errors and omissions to occur because the doctors would forget to turn in their documents on time, and a lot of necessary information was missing in order for the fee ticket to be completed.  At the last moment, the office manager would have to scramble to investigate information on the patient in order to submit hospital bills, and this, of course, was very time consuming, and inefficient.  To solve this problem, I proposed sending a message or some sort of communication to the doctors and PA’s to make sure that they turned in their mini fee tickets.

18.  How can we facilitate the collection of the documents?  After streamlining the hospital billing process by creating a compact version of the formal fee ticket, setting timelines, sending reminders to the doctors and PA’s, the final touch would be to have an easy way of turning in the documents.  I thought it was best that an accessible area be designated in the office especially for the fee tickets. I set up a bin by the manager’s office, where the doctors could drop their mini fee tickets in.

19.  Each doctor and PA received copies of the mini fee tickets.  The office manager explained that they were to fill each one out as completely as possible, and had a deadline of end of the week.  They were told that they could drop the tickets into the bin as they came and went.

20.  The office manager kept up with her Thursday reminder emails.  Since the mini fee tickets were implemented, the doctors and PA’s have been keeping up with turning them in by dropping them into the bin.  Although some have needed to be reminded more than once, the manager has been able to submit the hospital bills for payment on a timely basis, and nothing has gone unnoticed.