Presented by MedStar Health 1. Presented by: Cathy Foster, Assistant Vice President CPAM, CHAM 2.
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Transcript of Presented by MedStar Health 1. Presented by: Cathy Foster, Assistant Vice President CPAM, CHAM 2.
Centralizing Patient Access in a System Environment
Presented by MedStar Health
1
The Central Business Office
Presented by: Cathy Foster, Assistant Vice President
CPAM, CHAM
2
MedStar HealthMedStar Health is a $4.4 billion not-for-profit, regional
healthcare system with a network of 10 hospitals and 20 other health-related businesses across Maryland and the Washington, D.C., region.
As the area's largest health system, it is one of the region's largest employers with almost 30,000 associates and 5,600 affiliated physicians, all of whom support MedStar Health's patient-first philosophy that combines care, compassion and clinical excellence with an emphasis on customer service.
Revenue Cycle
Service
Patient First
Integrity
Respect
Innovation
Patient makes appointment
Ins. Verification/ ID Pt. Deposit/Co-pay
Services rendered / revenue is recorded
Coding: DX and procedure
SMS- Account qualifies for billing (837)
837 (UB04) generates & is sent to the payor: Medicare Caremedic / 3rd Party – Caremedic All Payor System
Payor: pay, pend or deny claim
Paid Claim: (835) Payment is posted, discount applied and patient is billed for any residual portion
Pended Claim: Require s follow-up with the payor and or the submission of additional information
Denied Claim: Based on the denial: 1) write the balance off, 2) appeal with documentation
Follow-up on pended and denied claims
Patient is sent statement(s) for the deductible, co-pay, etc
Patient makes payment, or payment arrangements. Once account balance is zero the account is closed
The account balance is not paid and the account is sent to bad debt
Account is referred to the -designated vendor for collection
Teamwork
Who are we?MedStar Union Memorial Hospital – Baltimore, MDMedStar Good Samaritan Hospital – Baltimore, MDMedStar Franklin Square Medical Center – White
Marsh, MDMedStar Harbor Hospital – Baltimore, MDMedStar Washington Hospital Center – Washington,
DCMedStar Georgetown University Hospital –
Washington, DCMedStar National Rehabilitation Network – Washington,
DCMedStar Montgomery Medical Center – Olney, MDMedStar St. Mary’s Hospital – Leonardtown, MDMedStar Southern Maryland Hospital Center – Clinton,
MD5
What do we do?Central Financial Clearance for hospital ancillary and
surgery and inpatient accounts.Patient Access Training Billing and Cash PostingCollections and Customer ServiceMedStar ResearchCompliance and RegulatoryRenal BillingPatient Advocacy – Medicaid Eligibility and Financial
AssistanceSMS-Invision Front and Back End Revenue Cycle
Oversight6
Central Financial Clearance (CFC)Located in White Marsh, MD and Arlington,
VAInsurance verification Initiation of authorizationEstimating chargesPre-collection activitiesDemographic verificationCurrent state vs. future state Pre-registration
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Old ProcessNo interface existed between SMS Invision
and PICIS (OR Scheduling System).Facility Patient Access created SMS account
during pre-registration.*CFC could not control their workflow as they
were dependent upon the account creation.If account was not created timely, could
possibly impact reimbursement and ability to obtain authorization.
*Pre-registration is defined as speaking to the patient to validate demographics.
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New ProcessInterface created between SMS Invision and
Cerner SurgiNet Scheduling.Immediate account creation upon scheduling
allows for more efficient CFC workflow.Required additional registration training for
the facility scheduling staff.Validation of positive patient ID required at
time of scheduling to avoid creation of duplicate medical records.
CFC and Facility Access Management teams worked together to create the process.
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New Workflow After Scheduling
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Via HDX, web or phone
Central Financial Clearance
If no authorization obtainedCFC contacts the facility when authorizations
are still outstanding within 48 to 24 hours.Facility/physician decides whether to accept
patient without definite authorization.CFC DOES NOT CANCEL SERVICES.
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Quality AssuranceCFC staff are continuously monitored to
ensure compliance with registration procedures.
Accounts are audited and phone calls are screened.
Follow up customer satisfaction phone calls to pre-registered patients.
Positive and negative feedback provided consistently between CFC and facilities via emails and regular meetings.
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TeamworkPatient Access and CFC collaborate to
assure:The highest quality experience to all MedStar
patientsSuccessful reimbursement for the services
providedOpen communication for consistent
performance improvement
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MedStar Union Memorial Hospital
Presented by: Barbara Blum, Access Director
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Facts and FiguresLocated at: 201 East University Parkway, Baltimore,
MD 21218 Total licensed beds: 249Acute care beds: 231Rehab beds: 18 Annual inpatient admissions: 14,979 Annual outpatient visits: 105,662Annual Emergency Department visits: 58,837Associates: 2,416Affiliated physicians: 623 Total net operating revenue: $427.0 million
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Our Specialties Hand Center
Since 1975, people all over the world have placed their hands in ours - Curtis National Hand Center.
Today, the Curtis National Hand Center is recognized as the largest, most experienced hand center in the nation.
Heart Institute Last year alone, our doctors performed more than 880 open-
heart surgeries and 6,100 catheter-based procedures, including nearly 2,000 angioplasties.
No hospital in Maryland or nationally performs a higher percentage (94 percent) of beating-heart bypass surgeries.
Orthopaedics and Sports Medicine Nationally-recognized for excellence in orthopaedics and
sports medicine, we're home to one of the world's largest hand centers, a comprehensive sports medicine program, and specialists who are fellowship-trained in care of the hand, foot and ankle, joint replacement, spine and sports medicine.
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Awards and Recognitions Delmarva Foundation Excellence Award for Quality
Improvement The only hospital in Maryland to receive the award five years in a row.
America Best Hospitals Named one of the nation's top 50 hospitals for diabetes and
endocrinology, orthopaedics, heart care and surgery, and geriatric care by U.S. News & World Report.
Named among the top three hospitals in Baltimore in U.S. News & World Report's metro area rankings, 2012.
Thomson Reuters 100 Top Hospitals®: Cardiovascular Benchmarks for Success Named four times as one of the nation's top 100 heart hospitals by
Thomson, a leading source of information products for the healthcare industry.
Commission on Cancer Cancer program accreditation
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Surgery Patient Check-InPatients check in at the centralized
outpatient registration area.Patients are tracked through the pre-op
Tracking Board.Patient ID and insurance are validated for
accuracy.Armband is placed on patient. Final consents and forms signed and
explained.Registrar checks Time of Service screen and
collects any patient liabilities due. Assure all patients’ questions are answered.18
Goals of On-Site Patient AccessDecrease registration wait times to avoid
delays in patient care.Increase Time of Service collections.Assure a positive patient registration and
scheduling experience.Accountable for final “quality check” of
demographic and insurance data. Admissions representatives are “partners”
with CFC in the patient arrival and clearance process.
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CentralizingAmbulatory Scheduling & Registration to
Enhance the Revenue CycleMay 2013
Presented by Louanne Diano-ZayasDirector, CSVU, CFC and Cashier’s Office
MedStar Washington Hospital Center
About MWHCLicensed 926 beds41,127 Inpatients/year9,853 Cardiac Caths/year1624 Open Heart Surgeries/year68,677 Emergency Dept Visits/year409,517 Outpatient Visits/year2,587 MedSTAR Trauma Visits/yearAlliance with the Cleveland Clinic
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Why did we Implement GECB?To Centralize and Standardize scheduling in a single
System Inconsistent Policies and Procedures followed to gather
information for scheduling appointment (ex. demographics, insurance, etc.)
Inconsistent scheduling practices Depts using Appointment Books Depts using Multiple Scheduling Systems – Resource
Scheduling, EMR, ARIA
To enhance the Professional Billing process and enter charges into a single systemProfessional Charge Entry was done manually
To Collect real time Professional Time of Service PaymentsPhysician Time of Service was a manual transfer process22
Why did we Implement GECB?To Enhance Patient through-put
Unable to view patient appointments for other departments
To Integrate with our Electronic Medical Record
To Centralize scanning in one system
To Standardize with Corporate Scheduling & Registration systems23
How we Did it?Piloted 2 Departments – ENT and EYE CenterUsed a Phased approach based on Specialty
Average of 3 months implementation for DepartmentsTrained over 350 Associates (4 day training)Manual Appointment Conversion Team Approach to Conversion
Department Management and AssociatesTraining and Education DepartmentsConsultants GECB, INVISION and other IT Representatives
Created Standardized Policies and ProceduresComplete Implementation took approximately 1 1/2Year
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OutcomesCreated a ONE-STOP process for patients for
scheduling, arrival and professional charge entry and TOS collections
Centralized and Standardized scheduling in a single System
Enhanced the Professional Billing and Time of Service Collections process
Standardized policies and proceduresReduction in Scanning – Single Repository for
DataImproved Patient Satisfaction
25
The Training DepartmentPresented by:
Carrie Long, Training ManagerCHAM
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Training DepartmentFour team members.Trains Patient Access registration procedures
and processes.Six hospitals and two business offices located
throughout Baltimore and DC.
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New Hire TrainingThree full days, twice a month.Presentation, hands-on practice in Test
system, in-class activities, competency tests.Topics covered:
Registration system (Siemens Invision)Patient Search and Duplicate Medical RecordAll major payors; Medicare and MSP,
Medicaid, Blue Cross, Managed Care, etc.Integrated eligibility system (Siemens HDX)
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Refresher TrainingMonthly sessionsConducted In-Class and by WebinarAt the facilities and business officesTopics include:
MedicareMSPMedicaidManaged Care
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System ChangesObtain agreement from all Access Directors.Change goes into Test system.Training team and each Access Director will
test the new change.Once all agree that change is functioning
appropriately, it will be moved into Production.
Training Team sends out educational notice to all facilities.
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Training New SystemsTrained all surgery schedulers:
How to conduct a proper patient search How to create a new registration How to select the appropriate insurance plan
Training Team was on-site for the week of go-live.
Maintain constant communication and feedback with each scheduling office.
Administered competency test several weeks after go-live.
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Training Website
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Webinar CommentsI thought this was a super professional job. You
should all be proud of this work.The Webinar was very well organized and easy to
follow. Thank you.The presenter did a great job with the Webinar.
She made the information very comprehendible. I will definitely attend another Webinar in the future...Kudos to Amy Gair!!!
I have a better understanding of how Medicare coverage works, especially the ESRD which I was not very comfortable with. Thank you Ladies.
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Monthly Newsletter
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See you at the races!
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YUM!!