Awakening the Sleeping Giant
How Technology will Elevate the
Effectiveness and Visibility of Patient Access
Paul Shorrosh, MSW, MBA, CHAM
Founder & CEO, AccuReg Patient Access Solutions
NAHAM Board Member and Southeast Regional Delegate
Ever feel like this
in Patient Access?
Time to Wake Up!
…to our potential
Change Drivers
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Increased patient responsibility
48 million uninsured
More Medicaid-eligible population than ever
2-4% avg US hospital operating margin
30% of hospitals with <0% operating margins
ACO’s and VPB (Value Based Purchasing)
Complexity of registration and billing
= more required of Patient Access?
What More Might We Do?
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Order/Referral Mgmt
Demographic Verification
Insurance Verification
Medical Necessity
Service Authorizations
Quality Assurance
• Price Transparency
• Payment Estimation
• Collect current & past
due balances
• Financial Clearance
– Credit & Payment
History
– Charity or Medicaid
– Discounts & Pmt Plans
…At POS and Pre-Arrival
Multi-Step Process
AV ID
IV
MN
Auth
POS
Fin Clr
QA
Specialization
Demographics
Identity
Address
Orders
Insurance
Verify
COB
MN
Auth
Clearance
Qualify
Estimate
Collect
Arrange
Quality
Review
Correct
Train
Centralized/System Approach
Identity
Verification
Payment
Estimation
& Collection
Address
Verification
Insurance
Verification
Financial
Assistance
Qualification
Medical
Necessity
Quality
Exception
Queue
Service
Auth/Cert
Evolution of Quality Assurance
QA CENTRAL HUB
Automated
QA
1% in 2005
Manual QA 19% in 2008
Difficult
Ineffective
Costly
35% in 2011
Auto QA &
Management
Tools
Auto QA,
Insurance Verification
Management Address/ID Verification
& Education
Payment Estimation &
Tools
Training
Productivity
Testing
Accuracy
Scoring
Performance
Immediate
Coaching &
Guidance
Volume Staffing
Wait/Reg Times
Collection
Service Authorization
Medical Necessity
Financial Assistance
Qualification & Clearance
Price Transparency
Comprehensive Reporting
SaaS & Mobile Devices
Person-Centered QA Environment
Payment
Estimation &
Collection
Identity
Verification
Financial
Assistance
Qualification
Address
Verification
dddddddddd
s
Medical
Necessity
Insurance
Verification
Service
Auth/Cert
Exhibit A: Insurance Verification
Shift from Analysis to Resolution
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Initiate Request
• Initiate Request
Open Response
• Open Response
Coverage
Benefits
Read Response
• Read Response
Find Relevant Info Copay/Ded • Find Relevant Info
Interpret Relevant Info
• Interpret Relevant Info
Identify Variances
• Identify Variances
Correct Variances
• Correct Variances
Variances Requiring
Resolution• Resolution Rate KPI
Verification Rate KPI
Exhibit B: Pre-Registration
Shift from Activation to Completion
Past Pre-Reg Process:
Future Pre-Reg Process:
• Account activation
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• Pre-reg to scheduled rate KPI?
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Account activation
ID & Address Verification
Insurance Verification
Authorizations
Medical Necessity
Payment Estimate/Collect
Pre-qual for Fin Assist
Payment plan setup
Quality Assurance
Pre-Reg Completion Rate KPI?
How will we make this shift?
Source: Multitasking Makes us Stupid, CPU Blog March 22, 2006
http://headrush.typepad.com/creating_passionate_users/2006/03/multitasking_ma.html
Multi-tasking Tools?
Well, sure! But… the real change we must drive
is not to do more work, but to do different work
Working Different Requires
Patient Access Technology that will:
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Keep pace with growing complexity & duties
Multitask, audit and distill for user action
Automate, centralize, standardize & interact
Serve, educate and empower the person
Enforce behavioral change (issues resolved)
Demonstrate value:
– Increased duties
– Improved quality
– Revenue cycle results
NAHAM Initiatives
Registration Components and Time
Estimates
FTE Calculator
• Develop Key Performance Indicators
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For Patient Access Processes
Result-focused vs activity-focused
Comparison to peers
Correlate to back-end metrics to prove value
• Identify and Publish Best Practices
We can do this.
Patient Access Leaders
It is not the strongest of the species that
survives, nor the most intelligent, but the
one most responsive to change.
Charles Darwin
Survivors adapt to change… Leaders drive change!
Paul Shorrosh
paul@accuregsoftware.com
251-338-3443