Patient Access Services Quality Assurance

1. Patient Access ServicesQuality Assurance Bon Secours Virginia

2. MEDICAL MANAGEMENT MEDICAL RECORD & CODING CHARGE CAPTURE & ENTRY CLAIMS SUBMISSION REGISTRATION & POS CASH COLLECTIONS THIRD PARTY FOLLOW-UP FINANCIAL COUNSELING PAYMENT POSTING INSURANCE VERIFICATION REJECTION PROCESSING DENIAL & APPEAL MANAGEMENT PRE-REG & PRE-CERT CONTRACT MANAGEMENT SCHEDULING The Revenue Cycle CDM Metrics & KPIs FOCUS AREA EDI-capability Regulatory compliance

3. Revenue cycle • Front End (Access Services) • Scheduling • Gathering PreReg/PreCert • Insurance Verification • Financial Counseling • Registration/Point of Service Collections • Patient Access Quality Assurance Audit • Sits between Data Capture/Data Entry and Insurance Claim generation • Provides timely, “accurate” billing • Reduces rework

4. Case Study - Bon Secours VirginiaAccess Services – QA Process • Overview • Policy • Procedure • Daily • Monthly • As Needed • Questions

5. Policy • Policy of Patient Access Department to provide quality control audits on a daily/monthly basis, using the reports and material provided so that all patients are registered accurately and consistently across the local system.

6. QA Procedure • Daily • Access Metaviewer and pull up the following reports for each facility: • 00000 Doctor Report • Patient/Guarantor Address Report • Employer Information Audit Report • Medicare Audit Report • Auditing Code Check Report • Backdated Admission Report • Insurance Auditing Report • Key errors into an Excel spreadsheet for each hospital. • Correct the errors into SMS for each hospital.

7. QA Process cont’d • Monthly • Send the error spreadsheets out to each manager/supervisor before the 10th of each month to include in staff evaluations • As Needed • Assist in training of new employees • Notify Manager/Supervisor if you notice an employee is consistently making the same error • Re-train Employees in areas needed • Keep New Employee training material updated

8. Questions?

9. Contact Info Jillian B. Surace Jill_Surace@bshsi.org 757-889-4385