Patient Access AAHAM Carolina Chapter - PowerPoint Presentation

Slide1

Patient Access

AAHAM Carolina Chapter

Charlynne Lynch, Patient Access Director, Cone Health System

John Cook, Chief Client Office, PRC, Inc. Slide2

Topics of Focus

Patient Experience

Patient Access Metrics and Definitions

Care Management Roles

Point of Service CollectionsSlide3

Why is Patient Experience Important

We are in a highly competitive business. You cannot sit down to watch the TV without seeing Healthcare related commercials which market for customers in your community.

It is well known that a positive patient experience is vital to help ensure that the patient will return for future healthcare visits.

Patients are verbal also, positive experiences are the expectation, so when a patient has a bad experience, those stories are shared with many people.

So, how do we know how we are doing?

We take surveys which show how we compare to other organizations.

The worst thing that can be said to a patient or family member.

Since patients are paying more out of pocket they will demand exception service

Measuring Patient Experience Slide4

HCHAPSHospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) is a metric that represents the patient’s perception of quality care.

According to CMS, the survey was shaped by three overreaching goals:

1. To produce comparable data on patients’ perspectives of care so that consumers can make objective and meaningful comparisons among hospitals.

2. To create incentives for hospitals to improve their quality of care.

3. To enhance public accountability in healthcare by increasing the transparency of the quality of hospital care.Slide5

Financial Incentives (HCHAPS)

These are some of the financial incentives for healthcare organizations to survey highly:

1. Value-Based purchasing (VBP) focuses on HCAHPS and core measure results. VBP transitions providers from HCAHPS pay for-reporting to pay-for-performance.

2. CMS imposes financial penalties on what it deems “excess admissions” compared to expected levels for 30 day readmissions of patients with specific diagnosis.

HCAHAPS provides consumers with information that is helpful in choosing a hospital and standardizes questions for public comparisons.Slide6

Functions of Patient Access

What are the roles of Patient Access ? Slide7

Function of Patient Access

Scheduling Services

Providing Instruction for the date of service

Gathering Patient Demographic and Insurance information

Verifying Insurance Eligibility

Obtaining or ensuring Authorization, Pre-certification, and Notice of Admission are in place

Creating patient estimates

Collecting Pre-Service/Point of Service on Patient Liability

Financial Counseling

Medicaid Screening and Eligibility

Financial Assistance – Charity Care

Regulatory Signature

Regulatory Signage Slide8

Patient Access Functions

How does the Patient Access Function impact Patient Accounting/Billing Slide9

How important is Patient Access to the Clean Claims Process -- UB 04

Patient’s Full Name

Discharge Hour

Medical Record Number

Patient’s Complete Mailing Address

Patient’s Birthdate

Patient’s Sex

Admission Date

Admission Hour

Admission Type

Admission Source

Discharge Status

Guarantor/Responsibility

Primary Payer Name

Secondary Payer

Tertiary Payer

Health Plan ID

Consent to Release Information

Assignment of Benefits

Insured’s Name

Treatment Authorization Codes

Insured's Unique ID

Insurance Group Name

Insurance Group Number

Admitting Diagnosis Code

Patient's Relationship to the Insured

Employer Name Slide10

Care Management Critical Functions

Reduce unnecessary admission

Manage the patients approved days – length of stay

Care Management works with the physicians and insurance to obtain any approvals for clinical necessity and re-certification

Aid patient’s in understanding Medicare Important Message from Medicare regarding the patient’s rights as it pertains to their discharge – and now the MOON (Medicare Outpatient Observation Notice)

They assist with appeals and denials Slide11

Metrics: how do you know you are doing Good, Better, or Best

What do you we measure – Critical Process?

Collections

Productivity

Accuracy Slide12

Collections

What are the 5 Control Point for Patient Liability Collections?

Pre-Service

Point of Service

In-house

Discharge

After Services rendered

How are you measuring up?

Point of Service, POS, Collection to Revenue

POS Collection/Net Patient Service Revenue

Good 1% Better 1.5% Best 2.0%Slide13

Where are the best control points to collect at Point of Service? Slide14

Best control points to collect

Pre- Service

Point of Service/Arrival

After services rendered Slide15

Why are point of service collections so important?

Statistics show that collections suffer by more than 50% when patients leave the service area – increase cash collections and overall accounts receivable

We have leverage for collections in the service area – therefore, a decrease of patient liability due at or after discharge

Our payer contracts support point of service collection

We can begin the discussion with patients by offering payment options and possible financial assistance

Collecting at Point of Service decrease financial risk and bad debt for your facility Slide16

Compliance for Point of Service Collections

Be aware of your organizations Collections Policy

Are you compliant with 501R?

Written financial assistance policy and patient access has knowledge and how to refer a patient

Written emergency medical care policy

This can be integrated in overall FAP or combined with the Emergency Medical Treatment Active Labor Act, EMTALA, policy Slide17

Productivity

How do you measure up?

Productivity is measured by

Average registration per person per day

Total registration/FTE’s registering

Benchmarks:

Good Better Best

40% 60% 80%

Other productivity areas to measure

Good Better Best

Insurance Verification 80% 90% 98%

Schedule Patient Rate 40% 60% 80%

Pre-Registration Rate 80% 90% 95%Slide18

Accuracy

How do you measure up?

Accuracy is measured by

Initial accuracy rate

Error free registration at Point of Service / Total Registration

Benchmarks:

Good Better Best

80% 85% 90%

Final accuracy rate

Error free registration at Billing/Total Registration

Good Better Best

90% 95% 98% Slide19

Other Metrics of Importance

Denials

Denial Write-Off

No Authorization

No Notice of Admission

Timely Filing

No ABN – Advance Beneficiary Notification

Denials Technical

Patient not eligible

Coordination of Benefits

ETC……. Slide20

Patient Access, Important Formulas

Average Length of Stay

Total # of patient days/# of discharges

Midnight Census

Previous Midnight Census – discharges + admissions+/-status changes

Average Daily Census

Total # of Patient days/# of days

Percentage of Occupancy

Census/#of licensed bed available Slide21

Questions