Leveraging Best Practices
Patient Access Management
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Discussion Points
Best Practices within the Patient Access Process
•Core Fundamentals
•
Are these part of your strategy?
•Best Practices
Definition of the best practice
• How a healthcare organization can support these best practices
• How a vendor should support each of Best Practices
•
•Looking ahead into 2014 and beyond
•
Where our focus may be in a few years
Emdeon Proprietary & Confidential
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Patient Access Best Practices
Assumptions:
• Your organization is committed to providing a high level of customer
satisfaction
• Your organization is committed to and supportive of a financial clearance
approach
•
We recognize the following statements to be true
 ‘If
you’ve seen one hospital, you’ve
seen one hospital’
 ‘If you’ve seen one successful
process, you’ve seen one successful
process’
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Core Fundamentals
These are ‘must haves’ to be successful with Patient Access Best Practices
•Defined Patient Access Process
Clearly documented and current
• Belief
•
•Hiring the right individuals and appropriate wages
•Training
Investment in a solid training process/unit
• Adherence to new hire training
• Regimented training(retraining) calendar for existing employees
•
Consistency!!
•
•Investment in technology
•Organizational ‘buy in’ to a financial clearance process
•Physician office relationships and scoring (accountability)
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Patient Access and its role in Financial Clearance
By leveraging sound best practices, Patient Access contributes to the accuracy
and completeness of the patients account.
• Scheduling
• Pre-Registration/Pre-Visit Verification
• Authorizations/Certifications
• Point of Service
• Next day audit
• Discharge
Patient Accounting
• Pre Claim Submission
• Remittance Advice
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Patient Access and its role in Financial Clearance
Critical data element validation points throughout the Patient Access process.
• Benefit Information
Insurance company
 Insured
 Patient share of cost
o CoPays
o Deductibles
o Estimated Patient Responsibility

• Address Information
Current Address
 Static Address

• Employer Information
• Credit Score
Fraud detection
 Payment sources

• Authorization Requirements
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Patient Access Best Practice Workflow
Scheduling
The first interaction with the patient sets the tone for the rest of their
experience.
• Demographic Information Accuracy
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Patient name
Date of birth
Social security number
Address
Telephone number
• Insurance Information Accuracy
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Insurance carrier identification
Policy Number / Member ID / Subscriber Number
Subscriber name
Subscriber Relationship
Pre-certification / Authorization Phone number
• Service accuracy
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Servicing Physician (or Nurse Practitioner)
Location
Referring Physician information
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Patient Access Best Practice Workflow
Pre-Registration/Pre-Verification
The Pre-Registration process gives the organization the best opportunity to
capture and validate.
• Insurance verification
Determine coverage
 Service level Co-Pays and Deductibles
 Establish who is insured
 In Network and Out of Network benefits

• Address verification

If not previously performed in last 90 days
• Patient Bill Estimation
• Payment capture of patient cost of share
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Patient Access Best Practice Workflow
Pre-Registration/Pre-Verification
The Pre-Registration process gives the organization the best opportunity to
capture and validate.
• Credit scoring
Establishing patients likelihood to pay
 Fraud alerting
 Sources for payment
 Employer verification

• Establish Authorization Requirements
Patient requirements
 Provider requirements

• Pursue funding options for uninsured or under-insured
Charity
 Medicaid
 Local funding sources

• Identify Payer Readmission risks
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Patient Access Best Practice Workflow
Point of Service
By establishing a Best Practice Pre-Registration process, the patients experience
is that of CARE versus FINANCIAL.
• Re-verification of benefits:
If greater than 24 hours since last verification
 First day of the month
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• Form execution
• If ED patient or Urgent Admission:
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Insurance verification
Address Verification
Patient Bill Estimation
Credit scoring
Authorization requirements
Uninsured funding
Readmission Risk
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Patient Access Best Practice Workflow
Next Day Audit/Discharge
The best processes and technologies do not ensure end user compliancy.
• Identification of existing discrepancies
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Insurance benefit
Name
DOB
SS#
Member ID
Address
Diagnosis codes
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Technologies that Support Best Practice Workflow
A single solution is the key to preventing leakage and end user
compliance/acceptance to the best practice workflow.
• End user familiarity and similar workflow
• Minimizes integration points with HIS and HER
• Central repository for data
• Centralized patient view
• Single source for data integrity
• Owned solutions versus multiple partnerships
• Data content leader

Content is king!
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Beyond 2013……
The direction the industry is going………
• More automation……less people
• Voice enabled technology
• The patient will play a larger role in the registration process
• Kiosks/Smart screens
• Patient portals
• Increase in services to support ACA requirements
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Questions?
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