Patient Access Intake Center: Five Years in the Making Lynn Arrington & Alyssa Corallo Managers of Patient Access Intake Center

Patient Access Intake Center Five Years in the Making Consolidation Why consolidation was necessary How the Centralized Patient Access System came to be Benefits and results over last five years Insurance Verification Work list & Workflow Denials Reduction Revenue Cycle Communication and Trace Tracking Insurance Benefits Pre- Registration Securing Days Out Dialer Pre-Service Collections Quality assurance PT Satisfaction Survey Scripting Balancing Staff Accountability and Recognition Department Standards Accountability Steps Raise Morale through Team and Individual Recognition

Texas Health Resources… Mission, Vision and Values

‘’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

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.

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.

Benefits of a Centralized PAIC

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.

Five Years of Growth The 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 verbiage Pre-Service collections Denial Reduction Work flow via the Ontrac System Identification process of limited benefits plans and ELAP plans Overall ability to secure future dates of service appointments out to 5-15 days prior to the patient’s arrival

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-Registration The initial contact and follow up with the insurance company , physcian and facility is perfomed by Insurance Verification Department The PAIC’s greatest impact is due to the centralized design and separation of the Pre-Registration process and Insurance Verification process

Insurance Verification Worklist & Workflow Stockamp Ontrac worklist tool Each worlklist contains NoVA (Notification Verification and Authorization) accounts The Ontrac Worklist is split up in Urgent, Elective, Next Day, and Specialty.

Insurance Verification Denial Reduction : 2008-2011 2008 average Denial for Precert was $ $450,785.00 2011 average Denial for Precert was $203,691.00

Insurance Verification Tracking Revenue Cycle Communication & Trace Trace Voice (PC Call) Trace Pixcert Trace Faxcert Trace Voicert

Insurance Verification ELAP and Limited Benefit Plans

Pre-Registration Securing Days Out- Work Flow Teams Focus System 2011 & 2012 Pre-Registration 93% Completed Rate 100% attempted for 5 days out and 75% attempted on 6-15 days out for all service types Teams Focus System Urgent Team- DOS within next 1-5 days Surgery Team- 5 to 30 days out Diagnostic Team- 6 to 60 days out

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 Time Inbound Volume Outbound Volume Passed to Messaging Abandoned Rate Individual Call Statistics

Pre-Registration The Ontario Dialer allows management to visually monitor all representatives’ real time activity, as well as track their weekly statistics.

Pre-Registration Collection Process Calculate Deposit Scripting for Collections Payment Secured If Patient is unable to pay deposit 50% 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.

Pre-Registration

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.

Pre-Registration Calculating Deposit

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 Elements Scripting Collections Customer Service

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.

Pre-Registration Survey – Tracking Patient Satisfaction

Pre-Registration

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 / Conclusion Surgery Collections Voicemail Survey

Pre-Registration Call Flow

Accountability Recognition Balancing Accountability and Recognition will create Excellent Performance

Accountability Department Standards Productivity – 100 % weekly = 175 accounts for PreRegistration 255 for Elective IV Accounts 400 for Specialty IV Accounts 275 for Urgent IV Accounts Quality Review- 2.7 or higher on a 3.0 scale Collections- $45 per Patient

Accountability Accountabilty Steps Step 1: Documented Verbal Coaching Step 3: Written Counseling/ Corrective Action Discretionary Action Plan may be devised Step 4: Written Counseling/ Corrective Action Step 5: Termination

Team/Individual Recognition Monthly Team Contests – centered around KPI goals Balloon Friday- Increasing Collections/Productivity Shout Outs – quick email recognition with whole department Accomplishment Jar- Staff selects/shares Pass the Dino/Monkey – Peer to Peer Reward

The House the PAIC Built Each team member received a brick to write their committment to each other and the PAIC, which helped to build morale and unifiy our team.

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