The MASCOT Process Improvement Team

1. The MASCOT Process Improvement Team TERROS West Outpatient (Mercy Care Advantage Services Collection Team) September 2008 to May 2009

2. Team AIM • Improve Collections from Mercy Care Advantage at the West Outpatient Clinic • Secondary Aim: Train future leaders in Process Improvement • Baseline collections: 30% Page 2

3. PI ChangesChange #1 - #3 • Oct.-08: Front Office will Color Code charts to identify the MCA clients (allows communication at site so everyone knows this client chart needs to be handled differently) • Nov.-08: Re-route the authorization forms received from MCA from the billing dept to FO Manager (increases communications between departments and ensures front office staff are aware of TPL appointment) • Dec.-08: the ‘clean-up’ authorization project (brought all auths up-to-date and got all existing client’s new auths for the new year and tracked which provider auth was given for so appointment was scheduled with appropriate provider)

4. PI Changes #4 & #5 • Jan.-09: Front Office manages Authorization Maintenance (Developed tracking tool to manage re-authorizations. Allowed staff to get authorizations timely, schedule appointment with correct provider, and request appropriate authorizations needed for type of service and ongoing treatment) • April-09: Re-routing the chart (Chart is given to FO manager following medical appointment. Business Office Manager (BOM) checks for changes in diagnosis in order to request updated authorization when changes are made)

5. DataLessons Learned • Billing processes from past need updated to bill TPL • Current process in computer system do not allow a clean method to track collection of payments • Need to identify TPL accurately and in order of primary and secondary TPL responsibility • Unable to determine if changes through process improvement affected collections • TPL is a complicated process • Need persons identified at site who understand and will manage TPL issues

6. Additional Challenges that the Team Encountered • 1. The initial auth for services is problematic insofar as the client has not yet been seen by either the clinician or the med provider. At this point we are using the dx provided by Mercy Care (which is a medical dx, not a behavioral health dx). • 2. It has been nearly impossible to get accurate payment data to establish any collections improvement.

7. RecommendationsNew Client Process • Call Center • Call Center will identify insurance at scheduling • TPL information is entered into electronic referral system • Hard copy referrals scanned and processed • Email ClaimTrak referral to business office manager (BOM) • Outpatient Sites • BOM forwards referral to TPL CSR who maintains site’s TPL log & to the person preparing the intake folder • TPL CSR follows process for creating color coded folder • Therapist completes pre-authorization request for upcoming psych evaluation

8. Recommendation Existing Clients • TPL CSR • Prior to TPL appointment verify the following • Guarantor in ClaimTrak is correct • Ensure authorization is in place • Appointment scheduled with wrong provider? Attempt to change appointment to correct provider or submit new pre-authorization request. • Log information in TPL spreadsheet

9. Fast forward to January, 2010 • All existing clients were registered in the electronic billing system with their TPLs • And properly identified primary, secondary, tertiary insurances • Meetings are scheduled to determine that the ‘collection’ process links dollars to the correct TPL

10. Team Members * Bob Mason * Charlotte Crow * Donovan Lusk * * Gayle Stocking * Kathy Randazzo * Marianne Watts * Saffron Wanger * Trish Johnson * John Greenawalt – Team Coach Debbie Tinsley – Team Leader