Centralizing Patient Access in a System Environment

1. Centralizing Patient Access in a System Environment Presented by MedStar Health

2. The Central Business Office Presented by: Cathy Foster, Assistant Vice President CPAM, CHAM

3. MedStar Health • MedStar Health is a $4.4 billion not-for-profit, regional healthcare system with a network of 10 hospitals and 20 other health-related businesses across Maryland and the Washington, D.C., region. • As the area's largest health system, it is one of the region's largest employers with almost 30,000 associates and 5,600 affiliated physicians, all of whom support MedStar Health's patient-first philosophy that combines care, compassion and clinical excellence with an emphasis on customer service.

4. Revenue Cycle Patient makes appointment Account is referred to the -designated vendor for collection Ins. Verification/ ID Pt. Deposit/Co-pay The account balance is not paid and the account is sent to bad debt Teamwork Services rendered / revenue is recorded Coding: DX and procedure Patient makes payment, or payment arrangements. Once account balance is zero the account is closed SMS- Account qualifies for billing (837) Patient is sent statement(s) for the deductible, co-pay, etc 837 (UB04) generates & is sent to the payor: Medicare Caremedic / 3rd Party – Caremedic All Payor System Follow-up on pended and denied claims Payor: pay, pend or deny claim Denied Claim: Based on the denial: 1) write the balance off, 2) appeal with documentation Paid Claim: (835) Payment is posted, discount applied and patient is billed for any residual portion Pended Claim: Require s follow-up with the payor and or the submission of additional information

5. Who are we? • MedStar Union Memorial Hospital – Baltimore, MD • MedStar Good Samaritan Hospital – Baltimore, MD • MedStar Franklin Square Medical Center – White Marsh, MD • MedStar Harbor Hospital – Baltimore, MD • MedStar Washington Hospital Center – Washington, DC • MedStar Georgetown University Hospital – Washington, DC • MedStar National Rehabilitation Network – Washington, DC • MedStar Montgomery Medical Center – Olney, MD • MedStar St. Mary’s Hospital – Leonardtown, MD • MedStar Southern Maryland Hospital Center – Clinton, MD

6. What do we do? • Central Financial Clearance for hospital ancillary and surgery and inpatient accounts. • Patient Access Training • Billing and Cash Posting • Collections and Customer Service • MedStar Research • Compliance and Regulatory • Renal Billing • Patient Advocacy – Medicaid Eligibility and Financial Assistance • SMS-Invision Front and Back End Revenue Cycle Oversight

7. Central Financial Clearance (CFC) • Located in White Marsh, MD and Arlington, VA • Insurance verification • Initiation of authorization • Estimating charges • Pre-collection activities • Demographic verification • Current state vs. future state Pre-registration

8. Old Process • No interface existed between SMS Invision and PICIS (OR Scheduling System). • Facility Patient Access created SMS account during pre-registration.* • CFC could not control their workflow as they were dependent upon the account creation. • If account was not created timely, could possibly impact reimbursement and ability to obtain authorization. *Pre-registration is defined as speaking to the patient to validate demographics.

9. New Process • Interface created between SMS Invision and Cerner SurgiNet Scheduling. • Immediate account creation upon scheduling allows for more efficient CFC workflow. • Required additional registration training for the facility scheduling staff. • Validation of positive patient ID required at time of scheduling to avoid creation of duplicate medical records. • CFC and Facility Access Management teams worked together to create the process.

10. New Workflow After Scheduling Central Financial Clearance Via HDX, web or phone

11. If no authorization obtained • CFC contacts the facility when authorizations are still outstanding within 48 to 24 hours. • Facility/physician decides whether to accept patient without definite authorization. • CFC DOES NOT CANCEL SERVICES.

12. Quality Assurance • CFC staff are continuously monitored to ensure compliance with registration procedures. • Accounts are audited and phone calls are screened. • Follow up customer satisfaction phone calls to pre-registered patients. • Positive and negative feedback provided consistently between CFC and facilities via emails and regular meetings.

13. Teamwork • Patient Access and CFC collaborate to assure: • The highest quality experience to all MedStar patients • Successful reimbursement for the services provided • Open communication for consistent performance improvement

14. MedStar Union Memorial Hospital Presented by: Barbara Blum, Access Director

15. Facts and Figures • Located at: 201 East University Parkway, Baltimore, MD 21218   • Total licensed beds: 249 • Acute care beds: 231 • Rehab beds: 18 • Annual inpatient admissions: 14,979 •  Annual outpatient visits: 105,662 • Annual Emergency Department visits: 58,837 • Associates: 2,416 • Affiliated physicians: 623 • Total net operating revenue: $427.0 million

16. Our Specialties • Hand Center • Since 1975, people all over the world have placed their hands in ours - Curtis National Hand Center. • Today, the Curtis National Hand Center is recognized as the largest, most experienced hand center in the nation. • Heart Institute • Last year alone, our doctors performed more than 880 open-heart surgeries and 6,100 catheter-based procedures, including nearly 2,000 angioplasties. • No hospital in Maryland or nationally performs a higher percentage (94 percent) of beating-heart bypass surgeries. • Orthopaedics and Sports Medicine • Nationally-recognized for excellence in orthopaedics and sports medicine, we're home to one of the world's largest hand centers, a comprehensive sports medicine program, and specialists who are fellowship-trained in care of the hand, foot and ankle, joint replacement, spine and sports medicine.

17. Awards and Recognitions • Delmarva Foundation Excellence Award for Quality Improvement • The only hospital in Maryland to receive the award five years in a row. • America Best Hospitals • Named one of the nation's top 50 hospitals for diabetes and endocrinology, orthopaedics, heart care and surgery, and geriatric care by U.S. News & World Report. • Named among the top three hospitals in Baltimore in U.S. News & World Report's metro area rankings, 2012. • Thomson Reuters 100 Top Hospitals®: Cardiovascular Benchmarks for Success • Named four times as one of the nation's top 100 heart hospitals by Thomson, a leading source of information products for the healthcare industry. • Commission on Cancer • Cancer program accreditation

18. Surgery Patient Check-In • Patients check in at the centralized outpatient registration area. • Patients are tracked through the pre-op Tracking Board. • Patient ID and insurance are validated for accuracy. • Armband is placed on patient. • Final consents and forms signed and explained. • Registrar checks Time of Service screen and collects any patient liabilities due. • Assure all patients’ questions are answered.

19. Goals of On-Site Patient Access • Decrease registration wait times to avoid delays in patient care. • Increase Time of Service collections. • Assure a positive patient registration and scheduling experience. • Accountable for final “quality check” of demographic and insurance data. • Admissions representatives are “partners” with CFC in the patient arrival and clearance process.

20. CentralizingAmbulatory Scheduling & Registration to Enhance the Revenue Cycle May 2013 Presented by Louanne Diano-Zayas Director, CSVU, CFC and Cashier’s Office MedStar Washington Hospital Center

21. About MWHC • Licensed 926 beds • 41,127 Inpatients/year • 9,853 Cardiac Caths/year • 1624 Open Heart Surgeries/year • 68,677 Emergency Dept Visits/year • 409,517 Outpatient Visits/year • 2,587 MedSTAR Trauma Visits/year • Alliance with the Cleveland Clinic

22. Why did we Implement GECB? • To Centralize and Standardize scheduling in a single System • Inconsistent Policies and Procedures followed to gather information for scheduling appointment (ex. demographics, insurance, etc.) • Inconsistent scheduling practices • Depts using Appointment Books • Depts using Multiple Scheduling Systems – Resource Scheduling, EMR, ARIA • To enhance the Professional Billing process and enter charges into a single system • Professional Charge Entry was done manually • To Collect real time Professional Time of Service Payments • Physician Time of Service was a manual transfer process

23. Why did we Implement GECB? • To Enhance Patient through-put • Unable to view patient appointments for other departments • To Integrate with our Electronic Medical Record • To Centralize scanning in one system • To Standardize with Corporate Scheduling & Registration systems

24. How we Did it? • Piloted 2 Departments – ENT and EYE Center • Used a Phased approach based on Specialty • Average of 3 months implementation for Departments • Trained over 350 Associates (4 day training) • Manual Appointment Conversion • Team Approach to Conversion • Department Management and Associates • Training and Education Departments • Consultants • GECB, INVISION and other IT Representatives • Created Standardized Policies and Procedures • Complete Implementation took approximately 1 1/2Year

25. Outcomes • Created a ONE-STOP process for patients for scheduling, arrival and professional charge entry and TOS collections • Centralized and Standardized scheduling in a single System • Enhanced the Professional Billing and Time of Service Collections process • Standardized policies and procedures • Reduction in Scanning – Single Repository for Data • Improved Patient Satisfaction

26. The Training Department Presented by: Carrie Long, Training Manager CHAM

27. Training Department • Four team members. • Trains Patient Access registration procedures and processes. • Six hospitals and two business offices located throughout Baltimore and DC.

28. New Hire Training • Three full days, twice a month. • Presentation, hands-on practice in Test system, in-class activities, competency tests. • Topics covered: • Registration system (Siemens Invision) • Patient Search and Duplicate Medical Record • All major payors; Medicare and MSP, Medicaid, Blue Cross, Managed Care, etc. • Integrated eligibility system (Siemens HDX)

29. Refresher Training • Monthly sessions • Conducted In-Class and by Webinar • At the facilities and business offices • Topics include: • Medicare • MSP • Medicaid • Managed Care

30. System Changes • Obtain agreement from all Access Directors. • Change goes into Test system. • Training team and each Access Director will test the new change. • Once all agree that change is functioning appropriately, it will be moved into Production. • Training Team sends out educational notice to all facilities.

31. Training New Systems • Trained all surgery schedulers: • How to conduct a proper patient search • How to create a new registration • How to select the appropriate insurance plan • Training Team was on-site for the week of go-live. • Maintain constant communication and feedback with each scheduling office. • Administered competency test several weeks after go-live.

32. Training Website

33. Webinar Comments • I thought this was a super professional job. You should all be proud of this work. • The Webinar was very well organized and easy to follow. Thank you. • The presenter did a great job with the Webinar. She made the information very comprehendible. I will definitely attend another Webinar in the future...Kudos to Amy Gair!!! •  I have a better understanding of how Medicare coverage works, especially the ESRD which I was not very comfortable with. Thank you Ladies.

34. Monthly Newsletter

35. See you at the races! YUM!!