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-ofService 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
Jan-12
Nov-11
Sep-11
Jul-11
May-11
Mar-11
Jan-11
Nov-10
Sep-10
Jul-10
May-10
Mar-10
Jan-10
Nov-09
Sep-09
Jul-09
May-09
Mar-09
Jan-09
Nov-08
Sep-08
Jul-08
May-08
Mar-08
Jan-08
Nov-07
Sep-07
Jul-07
Scheduling Results
100.0%
90.0%
80.0%
70.0%
15 secs or less
1 min or less
60.0%
50.0%
40.0%
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
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
Feb-11
Mar-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
Apr-10
Feb-10
Mar-10
Jan-10
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Pre Registration Results
98.00%
96.00%
94.00%
92.00%
90.00%
Pre Reg Percentage
88.00%
86.00%
84.00%
82.00%
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:
POS Collections
$240,000
$220,000
$200,000
$180,000
$160,000
$140,000
$120,000
$100,000
$80,000
$60,000
$40,000
$20,000
$Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug08
08
08
08
08
09
09
09
09
09
09
09
09
POS Collections
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
Patient Estimate
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, coinsurance and
remaining deductible.
Financial arrangements
can also be included on
the patient estimate
form.
The Results of Implementing an
Estimator System:
POS Cash
$225,000.00
$200,000.00
$175,000.00
$150,000.00
$125,000.00
$100,000.00
$75,000.00
$50,000.00
$25,000.00
$-
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
Mar-11
Feb-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
Apr-10
Mar-10
Feb-10
Aug-08
Oct-08
Sep-08
Dec-08
Nov-08
Jan-09
Mar-09
Feb-09
May-09
Apr-09
Jul-09
Jun-09
Aug-09
Oct-09
Sep-09
Dec-09
Nov-09
Jan-10
POS Collections (MRMC)
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
Medical Necessity Issues
80
70
# of Issues
60
50
40
30
20
10
0
Week
Implement Bank Loan Program
(we are a hospital, not a bank)
Gross Bank Loan $'s
$700,000.00
$600,000.00
$500,000.00
$400,000.00
$300,000.00
$200,000.00
$100,000.00
$-
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
OPIV Indigent Drug Program Assistance
$250,000.00
$200,000.00
$150,000.00
$100,000.00
$50,000.00
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
Mar-11
Feb-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
Apr-10
Mar-10
Feb-10
Jan-10
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Apr-09
Mar-09
Feb-09
Jan-09
$-
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
100.0%
95.0%
90.0%
Accuracy Rate
85.0%
80.0%
75.0%
Clean Claim Rate
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) 490-7103
radams@mauryregional.com