Leveraging Best Practices

1. Leveraging Best Practices Patient Access Management

2. Discussion Points • Best Practices within the Patient Access Process • Core Fundamentals • Are these part of your strategy? • Best Practices • Definition of the best practice • How a healthcare organization can support these best practices • How a vendor should support each of Best Practices • Looking ahead into 2014 and beyond • Where our focus may be in a few years

3. Patient Access Best Practices • Assumptions: • Your organization is committed to providing a high level of customer satisfaction • Your organization is committed to and supportive of a financial clearance approach • We recognize the following statements to be true • ‘If you’ve seen one hospital, you’ve seen one hospital’ • ‘If you’ve seen one successful process, you’ve seen one successful process’

4. Core Fundamentals • These are ‘must haves’ to be successful with Patient Access Best Practices • Defined Patient Access Process • Clearly documented and current • Belief • Hiring the right individuals and appropriate wages • Training • Investment in a solid training process/unit • Adherence to new hire training • Regimented training(retraining) calendar for existing employees • Consistency!! • Investment in technology • Organizational ‘buy in’ to a financial clearance process • Physician office relationships and scoring (accountability)

5. Patient Access and its role in Financial Clearance • By leveraging sound best practices, Patient Access contributes to the accuracy and completeness of the patients account. • Scheduling • Pre-Registration/Pre-Visit Verification • Authorizations/Certifications • Point of Service • Next day audit • Discharge Patient Accounting • Pre Claim Submission • Remittance Advice

6. Patient Access and its role in Financial Clearance • Critical data element validation points throughout the Patient Access process. • Benefit Information • Insurance company • Insured • Patient share of cost • CoPays • Deductibles • Estimated Patient Responsibility • Address Information • Current Address • Static Address • Employer Information • Credit Score • Fraud detection • Payment sources • Authorization Requirements

7. Patient Access Best Practice WorkflowScheduling • The first interaction with the patient sets the tone for the rest of their experience. • Demographic Information Accuracy • Patient name • Date of birth • Social security number • Address • Telephone number • Insurance Information Accuracy • Insurance carrier identification • Policy Number / Member ID / Subscriber Number • Subscriber name • Subscriber Relationship • Pre-certification / Authorization Phone number • Service accuracy • Servicing Physician (or Nurse Practitioner) • Location • Referring Physician information

8. Patient Access Best Practice WorkflowPre-Registration/Pre-Verification • The Pre-Registration process gives the organization the best opportunity to capture and validate. • Insurance verification • Determine coverage • Service level Co-Pays and Deductibles • Establish who is insured • In Network and Out of Network benefits • Address verification • If not previously performed in last 90 days • Patient Bill Estimation • Payment capture of patient cost of share

9. Patient Access Best Practice WorkflowPre-Registration/Pre-Verification • The Pre-Registration process gives the organization the best opportunity to capture and validate. • Credit scoring • Establishing patients likelihood to pay • Fraud alerting • Sources for payment • Employer verification • Establish Authorization Requirements • Patient requirements • Provider requirements • Pursue funding options for uninsured or under-insured • Charity • Medicaid • Local funding sources • Identify Payer Readmission risks

10. Patient Access Best Practice WorkflowPoint of Service • By establishing a Best Practice Pre-Registration process, the patients experience is that of CARE versus FINANCIAL. • Re-verification of benefits: • If greater than 24 hours since last verification • First day of the month • Form execution • If ED patient or Urgent Admission: • Insurance verification • Address Verification • Patient Bill Estimation • Credit scoring • Authorization requirements • Uninsured funding • Readmission Risk

11. Patient Access Best Practice WorkflowNext Day Audit/Discharge • The best processes and technologies do not ensure end user compliancy. • Identification of existing discrepancies • Insurance benefit • Name • DOB • SS# • Member ID • Address • Diagnosis codes

12. Technologies that Support Best Practice Workflow • A single solution is the key to preventing leakage and end user compliance/acceptance to the best practice workflow. • End user familiarity and similar workflow • Minimizes integration points with HIS and HER • Central repository for data • Centralized patient view • Single source for data integrity • Owned solutions versus multiple partnerships • Data content leader • Content is king!

13. Beyond 2013…… • The direction the industry is going……… • More automation……less people • Voice enabled technology • The patient will play a larger role in the registration process • Kiosks/Smart screens • Patient portals • Increase in services to support ACA requirements

14. Questions?