Centralizing Patient Access in a System Environment

Presented by MedStar Health

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The Central Business Office

Presented by: Cathy Foster, Assistant Vice President

CPAM, CHAM

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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,

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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

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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!!