2. SIGNATURE Presentation SIGNATURE Presentation

3. Debbie Harkins Patient Accounts IT Coordinator, Central Business Office Baycare Health System, Oldsmar, Florida Annette Yanna Senior System Analyst Baycare Health System, Clearwater, Florida Dale Sahlberg Senior System Analyst Baycare Health System, Clearwater, Florida Debbie Harkins Patient Accounts IT Coordinator, Central Business Office Baycare Health System, Oldsmar, Florida Annette Yanna Senior System Analyst Baycare Health System, Clearwater, Florida Dale Sahlberg Senior System Analyst Baycare Health System, Clearwater, Florida

4. What is SIGNATURE ? SIGNATURE is an integrated outpatient management & outpatient accounting application. Front-office functions include registration, scheduling and report writing tools. Business office functions manage accounts receivables with collection tools to maximize reimbursements.

5. Has advanced collection tools (target files) to maximize allowable reimbursements based on payers and collectors Generates 1505 medical billing claim forms (combined charge for services and physician - example: chest X-ray) Produces UB04s - same as an inpatient hospital bill with surgery billing for nurse, facility and supplies ( surgeons do their own billing ) Has a combined Patient Management and Patient Accounting database (integrated application) that allows charges to be entered and bills produced that same day (day-end) Utilizes SCHEMES that allow multiple insurance plans to meet the different ambulatory care needs

6. A patient was registered at the Imaging site for a annual diagnostic mammogram and ultrasound with Medicare and Medicaid plan providing coverage. Scheme 1 - established with insurance plans Z01 Medicare with a priority of 1 and Z25 Medicaid Fl with a priority of 2

7. The patient was in an auto accident later that day and returned to the Imaging site to have a MRI of the cervical spine. Scheme 2 - established with I16 Auto Allstate Insurance with a priority of 1

8. The patient was scheduled for a knee arthroscopy due to a work related injury that occurred the previous week. Scheme 3 - established with 0041 Commercial Risk Work Comp with a priority of 1

9. The Siemens enhanced SIGNATURE version employs browser technology called OAS GOLD. The original SIGNATURE application was based on a 3270 terminal design.

10. 3270 version

11. Original model design for GOLD

12. The Siemens GOLD model was sent to the Baycare body shop to be reprogrammed, redesigned, repainted and enhanced

13. Baycare SIGNATURE GOLD

14. GOLD has new graphical features such as: check boxes, radio buttons, labels, selectable lines with banners, combo boxes, a calendar, text boxes, images, scroll bars, data evaluators & controllers check boxes, radio buttons, labels, selectable lines with banners, combo boxes, a calendar, text boxes, images, scroll bars, data evaluators & controllers

15. Edits on name and address fields to remove bad characters !@#$%/&*)+? that cause interface errors. Example of a bad character # GOLD will automatically remove: Edits on name and address fields to remove bad characters !@#$%/&*)+? that cause interface errors. Example of a bad character # GOLD will automatically remove:

16. Warning notices to prevent the selection of expired insurance plan codes Warning notices to prevent the selection of expired insurance plan codes

17. Educational messages to guide the user through a process: Educational messages to guide the user through a process:

18. One shared main menu with variable options based on job role

19. Users have an access tcl that determines what functions are available

20. When the Accounts Receivable staff signon they see:

21. When the Patient Management staff signon they view:

22. HIPAA compliant notices HIPAA compliant notices

23. Billing warning messages Billing warning messages Previous accounts had bad information. Previous accounts were bad debt. Previous accounts were charity. Previous accounts had billing problems.

24. Tooltip help has full sentences & detailed information for a field Tooltip help has full sentences & detailed information for a field Inquiry screens are enhanced for faster searches, such as doctor name inquiries with quick picks Inquiry screens are enhanced for faster searches, such as doctor name inquiries with quick picks

25. "Minor as the Guarantor" reasons that are easy to select (rather than type in) "Minor as the Guarantor" reasons that are easy to select (rather than type in) Radio button selection will appear as a comment

26. VIP VIP BOARD MEMBER FRANCISCAN ORDER CLERGY FOUNDATION FRIEND COMMUNITY LEADER GOVERNMENT OFFICIAL FINANCIAL DONOR STAFF PRIVILEGED PHYSICIAN CELEBRITY

27. Checkmark lights up green if an HDX inquiry is possible for this plan. Eliminates wasted HDX inquiries for unsupported insurance plans. Checkmark lights up green if an HDX inquiry is possible for this plan. Eliminates wasted HDX inquiries for unsupported insurance plans.

28. Immediate messages if the data entered is not correct, such as the Insurance Company name. Immediate messages if the data entered is not correct, such as the Insurance Company name.

29. Customized documents and patient face sheets with full insurance company mailing addresses Customized documents and patient face sheets with full insurance company mailing addresses

31. Custom Features

32. Mail statistics: 23.6% of all mail in the U.S. is incorrectly addressed. 2.7% of the total mail volume is undeliverable as addressed. 1 out of every 32 pieces of first-class mail is undeliverable. Causes: Incorrect spelling of street or city Misread the address from a document Transposed numbers in street or zip code Misunderstood the person verbally providing the data

33. Address validation confirms that a given address is a deliverable address within the United States as defined by the United States Postal Service. Address verification for bills and statements will also improve the ability to collect fees for services rendered. The USPS standardizes the address in accordance with USPS guidelines – example: Road will be abbreviated as Rd Additional Benefits of Address Verification are: Improve collections by eliminating returned bills & statements. Reduce staff time & costs formerly spent processing returned mail. Achieve data integrity through correctness & standardization. Address Verification Benefits

34. Former 3270 screen was unable to verify a patients address with the US Post Office

35. The customized GOLD screen can verify online a patients address with the US Post Office

36. There is an online address verification for both the patient and guarantor addresses There is an online address verification for both the patient and guarantor addresses The verified USPS address is automatically returned to the screen The verified USPS address is automatically returned to the screen Corrects the address: 13618 N FLORIDA STREET Corrects the address: 13618 N FLORIDA STREET that should be 13618 N FLORIDA AVE that should be 13618 N FLORIDA AVE Corrects the zip code: 33631 Corrects the zip code: 33631 that should be 33613 that should be 33613 The US Post Office returns a message if more information is needed ( apartment or lot number ) The US Post Office returns a message if more information is needed ( apartment or lot number ) Address Verification

38. If the address was not found, then the US Post Office returns the following message: Option: GOLD also can inform the user verbally of an error message.

40. IMPLEMENTATION PROCESS IMPLEMENTATION PROCESS

41. THREE SIGNATURE REGIONS St Joseph's Diagnostic Center … 4 Imaging Centers Morton Plant Health Services … 3 Imaging Sites 1 OP Surgery / Endo site 1 OP Surgery / Endo site Baycare Ambulatory Care … 3 Imaging Sites 2 St Anthony 2 St Anthony 1 Med Specialist 1 Med Specialist 1 OP Surgery Site 1 OP Surgery Site 5 Mental Health Sites 5 Mental Health Sites

42. Analysis Phase Examined the model SIGNATURE GOLD application at Siemens headquarters Made site visits to other hospitals Reviewed the Baycare Invision GOLD application which has a similar design Made phone calls to other SIGNATURE users Checked the SNUG users web board for information about current issues Sent Emails to other SIGNATURE users Held many meetings and had extensive collaboration between the Central Business Office, Registration areas and Information Services

43. Then a list of the current 3270 issues was compiled. These issues became the reasons SIGNATURE was converted to the GOLD version …

44. CHALLENGES – Experienced significant HDX model issues that were unique to the GOLD combined insurance pathway – Standardized insurance plan codes for all outpatient sites (example: where A01 means AETNA for all sites) – Made revisions prior to the GOLD live to an estimated 1000 pre- registrations that were using the old insurance plans – The 3270 Patient Face Sheet had been customized to include full insurance company mailing addresses - which was converted to print GOLD combined insurance fields – Needed popup panels to notify users when insurance plans were terminated (should not be selected for a new registration) – GOLD now requires address information be entered for all miscellaneous insurance plans … that used to be an optional PF9 secondary screen in 3270

45. Build Phase Examined the current 3270 SIGNATURE pathways Examined the current 3270 SIGNATURE pathways Reviewed the Siemens model SIGNATURE design Reviewed the Siemens model SIGNATURE design Created a composite GOLD version of the above two applications Created a composite GOLD version of the above two applications

46. Testing Phase Used predefined scripts for the Patient Management and Accounts Receivable pathwaysUsed predefined scripts for the Patient Management and Accounts Receivable pathways Verified interface transmissions to other systems ( such as IDX )Verified interface transmissions to other systems ( such as IDX ) Validated facesheets & bills were generatedValidated facesheets & bills were generated Emulated real patient scenarios for the types of insurances used ( managed care, workman's compensation, Medicare, Medicaid, etc … )Emulated real patient scenarios for the types of insurances used ( managed care, workman's compensation, Medicare, Medicaid, etc … )

47. Integrated Systems Tests EAD ( Enterprise Access Directory ) US Post Office address verification HDX ( insurance eligibility ) ImageCast ( Radiology ) EDM ( Electronic Data Management ) Lawson - General Ledger & refunds Target Files TSI ( Managed Care )

48. Training Phase PM – Patient Management PM – Patient Management AR – Accounts Receivable AR – Accounts Receivable Two training sessions:

49. Training Manual PATIENT MANAGEMENT

50. Training Manual ACCOUNTS RECEIVABLE

51. LIVE Implementation Morton Plant Hospital went live first Morton Plant Hospital went live first Other two regions are going live in the following months Other two regions are going live in the following months ACBO (Ambulatory Care Business ACBO (Ambulatory Care Business Office) is the final live event Office) is the final live event

52. ONLINE DEMO ONLINE DEMO

53. OUTPATIENTCAREREGISTRATIONPATHWAY

54. Staff can select a printer from this first menu.

55. Patient Management

56. EAD inquiry options

57. After demographic data is filled out, the system will automatically automatically

58. Original address data US Post Office abbreviated the AVE and corrected the zip 33613 Further information is needed

59. More information is required - such is required - such as an OFC, LOT as an OFC, LOT or APT number or APT number The USPS supplies a list of known a list of known addresses to addresses to select from select from

60. The US Post Office verified address is then transferred through this screen and parsed into the street, city, state through this screen and parsed into the street, city, state and zip code fields. and zip code fields.

61. The corrected address is automatically copied to the demographic screen. The user then adds LOT 71 to demographic screen. The user then adds LOT 71 to complete a full mailing address. complete a full mailing address.

62. GUARANTOR information – will automatically copy all patient data and gray out the screen to protect data all patient data and gray out the screen to protect data

63. Bottom part of the GUARANTOR information screen is shown … with COMMENT and EMPLOYMENT options shown … with COMMENT and EMPLOYMENT options

64. INSURANCE Click on PLAN to access a quick pick help screen

65. Insurance Company help screen with quick pick options

66. Select an insurance plan Select an insurance plan ZZZ identifies a terminated plan

67. The managed care plan automatically had a 1 appended to the plan code 102 and an MC filled in for the CONTRACT. the plan code 102 and an MC filled in for the CONTRACT.

68. The HDX button lit up indicating an HDX inquiry is available.

69. The INSURANCE flow returns to the The INSURANCE flow returns to the GUARANTOR screen where the button is activated so the user can continue on to the CASE screen

70. CASE

71. Once all required data is completed Once all required data is completed the system will show the button.

72. ACCOUNTSRECEIVABLEPATHWAY

73. Accounts Receivable Main Menu Main Menu

74. A R Follow-Up

75. A R Inquiry Vital functions automatically selected (radio buttons)

76. A R Summary Collector Name and Comment automatically valued from codes

77. Detail Summary CALCULATOR and EMAIL options added to the Navigator

78. Additional Details REASON codes custom feature added

79. Internal email information is automatically filled in with AR detail … saving time and preventing transposition errors

80. Are there any questions ?