1. Essential Aspects of a Successful Access Department Christine F. Collins Executive Director, Patient Access Services Brigham and Women’s and Faulkner Hospitals MAHAM Fall Event September 16, 2011

2. BWH Overview FY10 768 Operating Beds 793 Licensed Beds 45,995 Admissions 2,996 ATO’s (inpt bed) LOS 25.5 hours 31,526 Surgical Procedures 19,195 Inpatient Surgeries 11,013 Day Surgeries 1,318 Foxboro Surgeries 256,373 Patient Days 91% Occupancy 5.6 ALOS 783,544 Ambulatory Visits 9,252 Weiner Pre-op 7,894 Births 24,717 CDIC 58,466 ED Visits 5,370 EDOBS LOS 10.0 hours

3. Philosophy The overall philosophy within Patient Access Services is to maintain timely, accurate processing of every patient, focusing on the “up front” activities that will guarantee “back end” success.

4. and… There is No Magic Bullet

5. One Size Doesn’t Fit All just remember that…

6. Flexibility is the Key

7. Be Receptive to Change

8. What is Access? A means of approaching, entering, exiting, communicating with, or making use of Permission, liberty, or ability to enter, approach or pass to and from a place or to approach or communicate with a person or thing Freedom or ability to obtain or make use of something The state or quality of being approachable

9. What Should Access Encompass? Almost anything that you want One size doesn’t fit all Your department should be tailored to fit the needs of your institution Accept the challenges of the present health care environment and look at the changes as opportunities Embrace and willingly accept responsibility for non-traditional aspects of access

10. Customer Access Vision Customers should be able to gain access to services through an integrated system, which meets their needs and expectations, minimizes the number of transactions, and maximizes the use of resources and space allocated to these processes.

11. Keys to Success Develop and maintain outstanding relationships – use your personality to your advantage Stay current with government and industry changes Proactively respond to changes and current issues Accurate and timely identification of patients Contract participation Apply high standards for data collection and integrity Insurance verification/precertification Rapid follow-up on emergency admits Concurrent review Timely Billing Denial Management

12. Access Data Text Bed Management ADT Text Patient Financial and Business Services MD Connect Reservation Center Hospitality and Family Liaison ED Registration International Department Ruth & Carl J. Shapiro Pavilion Denial Management Access Data

13. Reservation Center Schedule surgical procedure and/or medical admission Schedule associated visit Obtain visit specific and demographic data Schedule Preadmission Test Center appointment ESP (on-line booking from MD’s office) Determine eligibility for admission

14. Patient Financial/Business Services Responsible for screening over 70,000 patients per year from time booked until bill cut Verify insurance benefits and data collected Notify payor of pending visit, submit case for precertification, if required Notify patient of any co-pay, deposit requirements, financial liability Verify approvals on-line Follow-up with payor requirements at time of admission Determine order to be billed for multiple plans Maintain accurate and complete documentation

15. Forwarding Account to Billing Patient Financial/Business Services completes all necessary requirements by payor Current financial class information and billing order is maintained on-line Issues are addressed and resolved Completed cases are forwarded to Billing.

16. MD Connect Process transfer requests from outside physicians Provide link between outside physician and appropriate BWH clinical consultant Collect/verify patient data and insurance Arrange for transfer of patient Establish priority level to facilitate patient flow Maintain correspondence with PCP’s and Referring MD’s to ensure closure of communication loop

17. Bed Management/ADT Maximize utilization of resources Facilitate flow of patients Collect/verify patient data and insurance Establish placement priorities Assign housestaff – load balance Maintain dynamic bed system Maintain accurate census Administrative responsibility for medico-legal cases

18. Hospitality - Family Liaison Track patients undergoing surgery/invasive procedures Serve as liaison between patients, their families and the medical staff Identify & register person to be notified and manner in which he/she can be reached Escort patients to Operating Room Suite Keep family up-to-date on patient’s progress Monitor patients’ personal belongings Assign and monitor beepers for families Inform family of room assignment, estimated time of arrival on unit and telephone number

19. ED Registration Greet and accurately identify patients in accordance with policy; initiate online visit Collect/verify patient demographics, including insurance details (bedside reg) Collect co-pay Refer uninsured and underinsured to appropriate staff Initiate notification as mandated by payor Obtain necessary signatures Distribute HIPAA notice and obtain signed acknowledgement of receipt from patients Ensure that patients have received notification of their rights to allow hospital to be in compliance with all city, state and federal regulations and mandates Keep family up-to-date on patient’s progress

20. International Department Coordinate all aspects for international patients Arrange for BWH Physician Consultant Collect/verify patient data and insurance details Responsible for financial arrangements from initial contact through collection – revenue producing Schedule all appointments Coordinate travel arrangements Provide concierge services from the time of 1 st appointment until discharge Provide interpreter services for all appointments, and on an as needed basis while patient is in the hospital

21. Denial Management Follow-up on denied claims, until resolved Formulate and submit appeals, meeting all applicable deadlines Work collaboratively with all hospital departments to minimize loss of revenue due to denials Initiate write-off policy Cultivate, maintain and enhance relationships with third party payors Watch for trends/new types of denials Follow-up with fixes whenever possible

22. The Ruth and Carl J. Shapiro Pavilion Liaison Administrative responsibility for Business Operations of Pavilion Fully responsible for cash collection management Obtain credit card details at the time of reservation to guarantee reimbursement of charges Post all charges within 24-48 of discharge Send patient Pavilion Statement Maintain strict controls and documentation Excellent interpersonal skills required to address issues and patients’ needs Point person for non-clinical issues Liaison with Development regarding key donors and potential donors

23. You can’t build a reputation on what you’re going to do. Henry Ford

24. Identify Improvement Opportunities Maintain and cultivate excellent working relationships Streamline your process, eliminate duplication Small changes can often produce big results Documentation is imperative for all aspects of compliance and reimbursement Preadmission screening is key in reducing denials Follow-up on all unresolved cases with third party payors, before they become denials Be creative

25. Technology to the Rescue Use technology to make improvements whenever possible Maintain all documentation online – scanners are our friends Use system prompts/drop down menus Improve data collection and integrity Integrate systems to provide maximum availability of necessary data Streamline process

26. Experience is not what happens to you; it’s what you do with what happens to you. Aldous Huxley

27. Thank you for your interest in this presentation. Christine F. Collins Executive Director, Patient Access Services Brigham and Women’s and Faulkner Hospitals Partners HealthCare System 75 Francis Street, Boston, MA 02115 Telephone: (617) 732-7453 Fax: (617) 264-6335 E-mail: cfcollins@partners.orgcfcollins@partners.org BWH Web Site: www.brighamandwomens.org