A 360° Look at Patient Access Presented by: Rodney R. Adams Director of Pre Service and Patient Access Maury Regional Medical Center

Who is Maury Regional?  Maury Regional Medical Center is the largest hospital between Nashville and Huntsville  Serves a region consisting of more than a quarter-million people in southern Middle Tennessee.

Who is Maury Regional?  Our 275-bed facility has a medical staff of more than 185 physicians and 2,000 employees  Top Recognitions in the last 3 years include:  Two Time Recipient of Thomson Reuters Top 10 Health System, Top 100 Hospital, Top 50 Health System  2009 TNCPE Excellence Award  2009 and 2010 Enterprise Best Practice Customer Award winner by MedAssets  Premier Quality Award

REWIND (about 5 years): Where were we in the Revenue Cycle?  We weren’t:  Doing full pre-registrations  Doing estimates and were doing little on Point-of- Service collections  Doing QA on registrations  Answering scheduling calls timely  The list could go on and on…  We were relying heavily on Patient Accounts to collect all the cash

We looked like:

Realizing the Impact of Patient Access  Garbage in, garbage out  100% of patient demographics and insurance billing information is obtained from registration  Registration errors are the #1 complaint of billers  Most denials come from pre-cert and registration  The Registration department typically suffers from a high turnover rate  Registration accounts for over 65% of the fields on a UB04

“You’re Killing Me Here!”

Where did we want to be?  We wanted Patient Access to have an active role in cash collection and the Revenue Cycle  We wanted to do as much work as possible on the front-end  Resolve issues at the source, stop creating work-arounds  A leader in the Revenue Cycle

We wanted to look more like:

How do we get there?

What’s the real answer?  Change in mindset  Increased Accountability  Enhanced Focus  Have a plan/work the plan  Move focus from back-end to front-end  Revenue Cycle Redesign  Redeployed staff  Created a new department (Pre Service)  Examined our processes and made changes where needed  A LOT OF WORK!

The New Department  Pre Service would have responsibility for:  Scheduling  Prior Authorizations/Pre-certs  Pre Registration  Which would ultimately include Patient Estimates  Financial Counseling

Keys to Success Multi Departmental  Not just a Patient Access effort  Must engage all departments that will be affected by the changes  Must engage and gain the support of your Management Team and Senior Leadership Team (C-Suite)  Changing the culture of an organization and community takes everyone  Consistency

Keys to Success Processes, Processes, Processes  It is truly all about your processes  Evaluate processes, change processes, refine processes  No system will compensate for inadequate/antiquated processes  Phased approaches  Train the trainer  Look for “bugs” in systems and processes

Improvements made by Patient Access/Pre Service  Improve Scheduling Process  Improve Order Management Process  Develop Pre Registration Process  Install New Insurance Verification System  Improve Pre Cert Process  Develop POS Collection Process/Install Estimate System

Improvements (cont.)  Improve Customer Service in Access Areas  Improve Medical Necessity Processes  Implement Bank Loan Program  Implement Uninsured Assistance and Disability Assistance Programs  Develop QA Processes and Install QA System

Improve Scheduling Process  Determine scope (who are you scheduling for?)  Determine hours of operation  Determine staffing level  Standardize data elements to be collected during scheduling  Cross-training is key

Scheduling Results

Improve Order Management Process  Ask and ye shall receive (orders)  Process to identify incorrect/incomplete orders  Take action now  Process to identify missing orders  Take action now  Scan orders into EMR prior to patient arrival

Develop Pre Registration Process  Determine the scope-i.e. for which departments will pre-reg be completed?  Prioritize based on $’s at risk  Define Pre Registration  Determine goal  Determine staffing level  Formulate actual rules for pre registration

Pre Registration Results

Install Insurance Verification System  Stop manually rekeying patient info  This is rework and creates room for errors  Chose a system that could be fully integrated into our HIS system  Historical transaction storage (you’re going to need it!)  Look for payer availability (80/20 Rule)  Should be able to electronically verify 80%+ of patients with this system

Improve Pre Cert Processes  Stop “Gate Keeping” and be Proactive  Reduces rework by improving accuracy  Creates partnership with referring MD’s and their office staff  Be Ready for Road Blocks  Payer requirements  Payer updates/changes

Develop POS Collection Processes Why Collect at the Point-of-Service?  Lower cost to collect  Some studies show that if the patient leaves the facility without paying, the chances of collecting drop by as much as 60%  Improve patient satisfaction?  Started by setting up processes to collect co-pays and remaining deductibles  In the ED, OP, IP, Pre Reg areas  Expanded into other access points (phased approach)

The Results of Changing Processes:

Now that our processes were in place:  We began the decision making process of how to provide patient estimates  We believed this would help us bridge the gap between deductibles and out-of-pocket max  Two Basic Options  Homegrown system  Partner with a vendor

We Chose a Partner

Giving Patient Estimates  Implemented in Pre Service and Patient Access first  Expanded into other areas  Helped staff with suggested ways to present the estimates  Created a cross-walk of exams and CPT codes for easier estimate creation  Getting the “bugs” out

Easily determines and communicates the Patient’s estimated bill and payable portion using the insurance plan for calculating the estimated contractual allowance along with the patient co-pay, co- insurance and remaining deductible. Financial arrangements can also be included on the patient estimate form. Patient Estimate

The Results of Implementing an Estimator System:

Does an Estimator System Really Help Improve Patient Satisfaction?  I’ve heard that statement before, but mostly from Estimate System Vendors  Truth or a myth?  Do you believe it?

OP Customer Service Improvement

Why does an Estimator System Improve Patient Satisfaction?  Able to plan and budget for medical expenses  They feel like they are more involved in their care  Increases patient awareness  Gives us, as a provider, a time to actually explain to them how their insurance will pay  Improves pricing transparency

Improve Medical Necessity Processes Automate System, create processes, review issues daily and solve the root of the problem

Implement Bank Loan Program (we are a hospital, not a bank)

Implement Uninsured Assistance Programs  IV Therapy/Cath Lab  Many pharmaceutical companies and supply companies have programs to provide free medication for patients who are indigent and/or uninsured

Implement Disability Assistance Program  The uninsured patient  NOTE: Current estimates of the uninsured in the US are at 16.7% (according to latest US Census Bureau Survey)  A successful way to identify patients eligibility  SSI/SSDI/Other  Results  80+% of patients accepted in program are later approved  Improved community relationships  $1.13M+ annually in added cash  Reduction in uncompensated care  Our newest “out of the box” concept-partnering with a local disability representation firm, saving $ and achieving results!

Implement Registration QA Processes and System  Implement Quality Assurance Process  Per FTE Quality Checks  Time and Labor Intensive  Not 100% Accurate or Effective  Implement Registration QA Software  Number of Edits  We have just over 150 now  Be prepared- you’re not as good as you think you are!

Results of QA Processes and Software

What Now?  Lean Healthcare  Automations  Planetree (Patient Centered Care)  Patient Portal  Online Scheduling  Online Pre Registration  Electronic Signatures  Online Access to Medical Information  Online MD Visits?

The Possibilities are Endless

Time to be “The Helm of the Revenue Cycle” Reform is here, or at least it’s coming, or some strange combination of both. So are we going to put our heads in the sand, pretend the changing landscape of healthcare won’t affect us, and suffer tremendously…or are we going to implement better processes, challenge ourselves to always do better, never settle, and thrive in a changing market? Remember-it all starts with Patient Access, are we creating cash or rework? The time is NOW!

 Thank you for attending “A 360° Look at Patient Access!”  Questions? Rodney R. Adams Director of Pre Service and Patient Access Maury Regional Medical Center (931)