Patient Access Intake Center: Five Years
in the Making
Lynn Arrington & Alyssa Corallo
Managers of Patient Access Intake Center
Patient Access Intake Center
Five Years in the Making
•
•
•
•
Consolidation
•
Why consolidation was necessary
•
How the Centralized Patient Access System came to be
•
Benefits and results over last five years
Insurance Verification
• Work list & Workflow
• Denials Reduction
• Revenue Cycle Communication and Trace Tracking
• Insurance Benefits
Pre- Registration
•
Securing Days Out
•
Dialer
•
Pre-Service Collections
•
Quality assurance
•
PT Satisfaction Survey
•
Scripting
Balancing Staff Accountability and Recognition
•
Department Standards
•
Accountability Steps
•
Raise Morale through Team and Individual Recognition
Texas Health Resources… Mission,
Vision and Values
‘’It all starts with Patient Access and we truly do pave the road to success for our patients and our
facilites ’’
Patti Consolver, Administrative Director -Patient Access Services
PAIC: Five Years in the Making…
• In 2006 Texas Health Resources analyzed industry and
•
In Health
2007 PAIC,
the centralized
function
forinverification
and preTexas
Resources
serves 16strengths
counties
Dallas-Fort
Worth
competitor
trends, assessed
andthe
weaknesses
and
registration,
was
created.
The
PAIC
Pre-registration
department
area develop
of North ambitious
Central Texas,
homethat
to more
6.2 million
strategies
wouldthan
position
Texaspeople.
Health to
takes care of all the preliminary steps in the patient’s registration
transform itself faster than the rate of change in the environment,
via
phone or online
putting
caseemployees
in motion prior
to the
The system
more
thanthe
20,500
working
in patient
24
therebyincludes
transforming
health
care delivery
in North
Texas.
arrival
at
the
facility.
While
the
insurance
verification
department
acute-care and short-stay hospitals that are owned, operated, jointwill secure
authorization
requirements
and benefits for both future
ventured
or affiliated
with Texas
Health Resources.
and past patient cases.
Why Centralize?
Areas of Concern:
• Opportunity to avoid denials by communicating appointments
• THR
was precertification
only Pre-Admitting
ofdate
Scheduled
Admissions while the
lacking
prior72%
to the
of service.
was the
set
at 90%.specific benefits for accurate coverage
• Benchmark
Ability
to review
patient’s
Goals
in creating
PAIC:
details
helpinghad
to improve
up front
collections.
•• Not
all facilities
the luxury
of having
a dedicated
pre-admission
department
Develop
a streamlined
Pre-Admission
process
to exceed
the 90% benchmark.
In
theappropriately.
Revenue
Cycle needed
higher
standards
set for Texas Health
• or2006
Enables
aStrategic
more relaxed
environment
to discuss
benefits
and deposit
staffed
• Resources.
Develop
athe
streamlined
pre-certification
and verification
process
to ensure
timely
At
that timevisit
THR
needed
to compare
industry
standards
and conducted
prior
to
patient’s
and
enables
transfer
to
a
Financial
• Several
entities pre-registered
in between patients or not at all.
notification
pre-certification.
Counselor
for
financial
follow up . were needed.
a study
to seeand
where
improvements
•• For
entities
designated
pre-admission
staff, the process
was inconsistent
anwith
express
check
in
concept
pre-registered
patients
at the entity.
• Develop
Gives the
advantage
of setting
servicefor
standards.
To be able
to
and
the focus
was varied
throughout
deliver
a consistent
experience
at allthe
theorganization.
Texas Health Resources’
• Collections
locations delivering
were not completed
the same compassionate,
on all accountsindividualized
consistently. care
every day, every time.
Benefits of a Centralized PAIC
Benefits of a Centralized PAIC
•
•
•
•
Opportunity to avoid denials by communicating
appointments lacking pre-certification prior to the
date of service.
Ability to review patient’s specific benefits for
accurate coverage details helping to improve up
front collections.
For improved efficiency the PAIC enables the
possibility of implementation of an automated
kiosk on sight at each entity in the registration
area benefiting both the healthcare system and
the patient.
Gives the advantage of setting service
standards. To be able to deliver a consistent
experience at all the Texas Health Resources’
locations delivering the same compassionate ,
individualized care every day, every time.
Five Years of Growth
The PAIC has grown in the last five
years with management leading the
staff to fulfill and exceed
expectations set by our Central
Business Office.
We have made improvements to our :
• Communication scripting and
verbiage
• Pre-Service collections
• Denial Reduction
• Work flow via the Ontrac System
• Identification process of limited
benefits plans and ELAP plans
• Overall ability to secure future
dates of service appointments out
to 5-15 days prior to the patient’s
arrival
THR Operations: A detailed look at the THR
Pre-Registration and Insurance Verification
•
• The initial contact with our patients for
information, updates, quoting and
collections
is performed
bytoPre-Registration
The PAIC’s
greatest
impact is due
the centralized
design
andinitial
separation
ofand
the Pre-Registration
process
• The
contact
follow up with the
and Insurance
insuranceVerification
company ,process
physcian and facility is
perfomed by Insurance Verification
Department
Insurance Verification
Worklist & Workflow
•
•
•
Stockamp Ontrac
worklist tool
Each worlklist
contains NoVA
(Notification
Verification and
Authorization)
accounts
The Ontrac Worklist
is split up in Urgent,
Elective, Next Day,
and Specialty.
Insurance Verification
Denial Reduction : 2008-2011
•
•
2008 average Denial for Precert was $ $450,785.00
2011 average Denial for Precert was $203,691.00
$2,500,000.00
$2,000,000.00
$1,500,000.00
No Denial/Precert (1219)
Total THR
$1,000,000.00
$450,785.00
$500,000.00
$203,691.00
$0.00
2008
2011
Insurance Verification
Tracking Revenue Cycle Communication &
Trace
• Trace Voice
(PC Call)
• Trace Pixcert
• Trace Faxcert
• Trace Voicert
Insurance Verification
ELAP and Limited Benefit Plans
Pre-Registration
Securing Days Out- Work Flow
•2011 & 2012 Pre-Registration
93% Completed Rate
•100% attempted for 5 days out
and 75% attempted on 6-15 days
out for all service types
•
•
•
•
Teams Focus System
Urgent Team- DOS
within next 1-5 days
Surgery Team- 5 to 30
days out
Diagnostic Team- 6 to
60 days out
Pre-Registration
Ontario Dialer
With over 1800 inbound calls weekly, we utilize
Ontario Dialer technology to route and manage
all calls. This helps us track the following user
statistics and call volume:
•
•
•
•
•
•
Wait Time
Inbound Volume
Outbound Volume
Passed to Messaging
Abandoned Rate
Individual Call Statistics
Pre-Registration
The Ontario Dialer allows management to visually
monitor all representatives’ real time activity, as well as
track their weekly statistics.
Pre-Registration
Collection Process
• Calculate Deposit
• Scripting for Collections
• Payment Secured
If Patient is unable to pay deposit
• 50% upfront deposit is offered to patient.
• Patients that can not pay the minimum of 50% of
the deposit amount will be transferred to the
Entity Financial Counselor to discuss further
payment options.
Pre-Registration
Pre-Registration
Calculating Deposits
•
Each patient’s benefits are verified and then entered into our
CarePricer system, which populates the deposit amount on a
form the patient signs upon Admission.
•
During Pre-Registration each patient is screened for an
outstanding balance, which is added onto the CarePricer
estimate.
Pre-Registration
Calculating Deposit
Pre-Registration
Quality Assurance
All calls and computer activity are recorded on
our Centricity system, which management
uses to perform monthly quality reviews.
Centricity is able to capture the entire PreRegistration process.
•
Registration Data Elements
•
Scripting
•
Collections
•
Customer Service
Pre-Registration
Patient Satisfaction
Each patient is asked to take a survey at the end
of the pre-registration phone call to rate the
representative’s customer service. The results
of these surveys are monitored on a weekly
basis and reported monthly as part of the
department KPI standards.
Pre-Registration
Survey – Tracking Patient Satisfaction
Pre-Registration
Pre-Registration
Scripting
Uniformity is key. We provide scripting to all of our
representatives to ensure that all patients are
given a professional and courteous experience
from beginning to end.
Types of Scrpting:
•
•
•
•
•
Introduction / Conclusion
Surgery
Collections
Voicemail
Survey
Pre-Registration
Call Flow
Accountability
Recognition
Balancing Accountability and Recognition will
create Excellent Performance
Accountability
Department Standards
• Productivity – 100 % weekly =
• 175 accounts for PreRegistration
• 255 for Elective IV Accounts
• 400 for Specialty IV Accounts
• 275 for Urgent IV Accounts
• Quality Review- 2.7 or higher on a 3.0 scale
• Collections- $45 per Patient
Accountability
Accountabilty Steps
• Step 1: Documented Verbal Coaching
• Step 2: Documented Verbal Coaching
• Step 3: Written Counseling/ Corrective Action
• Discretionary Action Plan may be devised
• Step 4: Written Counseling/ Corrective Action
• Step 5: Termination
Recognition
Team/Individual Recognition
•
•
•
•
•
Monthly Team Contests – centered around KPI goals
Balloon Friday- Increasing Collections/Productivity
Shout Outs – quick email recognition with whole department
Accomplishment Jar- Staff selects/shares
Pass the Dino/Monkey – Peer to Peer Reward
The House the PAIC Built
Each team member received a brick
to write their committment to each
other and the PAIC, which helped to
build morale and unifiy our team.
Questions
& Answers?
AND TO
THE PATIENTS
WE SERVE….
•
At Texas Health Resources, a faith-based health care system, we
combine clinical expertise, advanced technology, and
compassionate individualized care to deliver the best possible
outcomes for the patients we serve. We are proud to be a team
working together continually improving our system as we
transform ourselves by having Individuals Caring for Individuals,
Together