Patient Access Intake Center: Five Years in the Making

1. Patient Access Intake Center: Five Years in the Making Lynn Arrington & Alyssa Corallo Managers of Patient Access Intake Center

2. Patient Access Intake CenterFive 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

3. Texas HealthResources…Mission, Vision and Values

4. ‘’It all startswith Patient Access and wetruly do pave the road to success for our patients and our facilites ’’  Patti Consolver, Administrative Director -Patient Access Services

5. PAIC: Five Years in the Making… • In 2006 Texas Health Resources analyzed industry and competitor trends, assessed strengths and weaknesses and develop ambitious strategies that would position Texas Health to transform itself faster than the rate of change in the environment, thereby transforming health care delivery in North Texas. • In 2007 PAIC, the centralized function for verification and pre-registration, was created. The PAIC Pre-registration department takes care of all the preliminary steps in the patient’s registration via phone or online putting the case in motion prior to the patient arrival at the facility. While the insurance verification department will secure authorization requirements and benefits for both future and past patient cases. • Texas Health Resources serves 16 counties in the Dallas-Fort Worth area of North Central Texas, home to more than 6.2 million people. • The system includes more than 20,500 employees working in 24 acute-care and short-stay hospitals that are owned, operated, joint-ventured or affiliated with Texas Health Resources.

6. WhyCentralize? • Areas of Concern: • THR was only Pre-Admitting 72% of Scheduled Admissions while the Benchmark was set at 90%. • Not all facilities had the luxury of having a dedicated pre-admission department or staffed appropriately. • Several entities pre-registered in between patients or not at all. • For entities with designated pre-admission staff, the process was inconsistent and the focus was varied throughout the organization. • Collections were not completed on all accounts consistently. • Opportunity to avoid denials by communicating appointments lacking precertification prior to the date of service. • Ability to review patient’s specific benefits for accurate coverage details helping to improve up front collections. • Enables a more relaxed environment to discuss benefits and deposit prior to the patient’s visit and enables transfer to a Financial Counselor for financial follow up . • 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. • Goals in creating the PAIC: • Develop a streamlined Pre-Admission process to exceed the 90% benchmark. • Develop a streamlined pre-certification and verification process to ensure timely notification and pre-certification. • Develop an express check in concept for pre-registered patients at the entity. In 2006 the Strategic Revenue Cycle needed higher standards set for Texas Health Resources. At that time THR needed to compare industry standards and conducted a study to see where improvements were needed.

7. Benefits of a Centralized PAIC

8. 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.

9. 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

10. THR Operations: A detailed look at the THR Pre-Registration and InsuranceVerification • The PAIC’s greatest impact is due to the centralized design and separation of the Pre-Registration process and Insurance Verification process • The initial contact withour patients for information, updates, quoting and collections isperformed by Pre-Registration • The initial contact and follow up with the insurancecompany , physcian and facilityisperfomed by InsuranceVerification Department

11. InsuranceVerification Worklist & Workflow • Stockamp Ontracworklist tool • EachworlklistcontainsNoVA (Notification Verification and Authorization) accounts • The OntracWorklistis split up in Urgent, Elective, Next Day, and Specialty.

12. InsuranceVerification • DenialReduction : 2008-2011 • 2008 average Denial for Precert was $ $450,785.00 • 2011 averageDenial for Precertwas$203,691.00

13. InsuranceVerification TrackingRevenue Cycle Communication & Trace • Trace Voice • (PC Call) • Trace Pixcert • Trace Faxcert • Trace Voicert

14. InsuranceVerification ELAP and Limited Benefit Plans

15. 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

16. 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

17. Pre-Registration The Ontario Dialer allows management to visually monitor all representatives’ real time activity, as well as track their weekly statistics.

18. Pre-Registration Collection Process • CalculateDeposit • Scripting for Collections • PaymentSecured If Patient isunable to paydeposit • 50% upfrontdepositisoffered to patient. • Patients thatcan not pay the minimum of 50% of the deposit amountwillbetransferred to the Entity Financial Counselor to discuss further payment options.

19. Pre-Registration

20. Pre-Registration Calculating Deposits • Eachpatient’sbenefits are verified and thenenteredintoourCarePricer system, whichpopulates the depositamount on a form the patient signsupon Admission. • During Pre-Registration each patient isscreened for an outstanding balance, whichisadded onto the CarePricerestimate.

21. Pre-Registration Calculating Deposit

22. Pre-Registration Quality Assurance All calls and computer activity are recorded on ourCentricity system, which management uses to performmonthlyqualityreviews. Centricityis able to capture the entire Pre-Registration process. • Registration Data Elements • Scripting • Collections • Customer Service

23. Pre-Registration Patient Satisfaction Each patient isasked to take a surveyat the end of the pre-registration phone call to rate the representative’scustomer service. The results of thesesurveys are monitored on a weekly basis and reportedmonthly as part of the department KPI standards.

24. Pre-Registration Survey – Tracking Patient Satisfaction

25. Pre-Registration

26. 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

27. Pre-Registration Call Flow

28. Accountability Recognition Balancing Accountability and Recognition will create Excellent Performance

29. 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

30. Accountability AccountabiltySteps • Step 1: Documented Verbal Coaching • Step 2: Documented Verbal Coaching • Step 3: WrittenCounseling/ Corrective Action • DiscretionaryAction Plan maybedevised • Step 4: WrittenCounseling/ Corrective Action • Step 5: Termination

31. Recognition • Team/Individual Recognition • Monthly Team Contests – centeredaround KPI goals • Balloon Friday- Increasing Collections/Productivity • Shout Outs – quick email recognition withwholedepartment • Accomplishment Jar- Staff selects/shares • Pass the Dino/Monkey – Peer to Peer Reward

33. 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.

35. 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 havingIndividuals Caring for Individuals, Together