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Technology allowed the patient access department at Charlotte, NC-based Carolinas HealthCare System to take on new coverage areas with no additional staff and repurpose five FTEs.
"This has completely changed the way we think about, distribute, and complete our pre-service work," says Jonathan Johnson, director of corporate patient services.
The health system’s pre-service unit handles pre-registration, insurance verification, and authorization for approximately 26,000 scheduled accounts per month covering eight facilities. "Our old process was probably similar to what a lot of organizations are still doing today," says Johnson.
Staff members registered the accounts, saw what the patient was having done based on the schedule, and then went to a payer website to check eligibility and benefits. "Hopefully, if the physician’s office did their part, we found the authorization online ready to go," says Johnson.
Next, staff members had to input the benefit data into the price estimator. "We took that data and put it into the notes or other field where the onsite registrar could see it," says Johnson.
Finally, registrars called the patients ahead of time to discuss their estimated responsibility. "We had a great team who made that process work, but it was cumbersome and inefficient," he says.
Accounts are now scheduled and then pre-registered, with all the necessary information flowing from the scheduling system and ADT [admission/discharge/transfer] system into an automated tool.
"Accounts automatically go through the eligibility, benefit, estimation, and authorization processes," says Johnson. "Let me be clear: We no longer need any human interaction after registration for the majority of our accounts."
Not every account makes it completely through the automated process without errors. "We believe about 12% of accounts that should automate end up stopping for various reasons," says Johnson.
If a certain piece of the benefits information is not available online, the insurance is ineligible, or the authorization is required but not found, the account will stop.
"It will hit a work list that our pre-service team then corrects. Once corrected, automation resumes," says Johnson.
The payment estimate flows to a work list, and patient access staff members call the patients. "If we don’t have time or can’t reach the patient prior to the date of service, the estimate and the authorization information flows back into our ADT system via a file and populates certain fields," says Johnson. Registrars can easily view the information so they can review it with the patient on the day of service. The department has seen these benefits:
"We have seen about a 5% rise in collections," says Johnson. "We have had a robust cash collection process since 2002, so facilities newer to that process could probably expect a greater increase."
Five FTEs were repurposed.
Two of the FTEs assumed the responsibility for the department’s Price Estimation Line, and the other three FTEs handle other patient access needs.
"The ability to repurpose staff into other roles has allowed us to take on many new challenges in a resources-limited environment," says Johnson.
Patient access expanded its role with no additional staff.
"We absorbed the workload from a freestanding surgery center and the pre-service work for another facility," reports Johnson.
Every patient access process is being reshaped by technology, says Linda Kloss, principal of Kloss Strategic Advisors, a Chicago-based consulting firm specializing in health information management.
"But it is not the technology that should be the focus; it is the information that is the product of the technology," she underscores.
Kloss says these are important questions to answer before any tool is implemented in patient access areas:
Does it enable accurate and efficient capture of information?
Does it prompt for missing or conflicting information?
Is the technology optimized to support the best work flow? Or does work flow take a back seat to the technology?
Kloss says, "Patient access processes trigger a number of interlocking workflow processes," as follows:
Patient access originates the episode of care and the accurate record of that episode.
"Critical master data management functions begin with access, including identifying the correct patient," says Kloss.
Patient access initiates the processes for payment of services.
Accurate information can trigger timely approval and verification processes that then expedite billing and payment. "This benefits the provider, but it also benefits patients," says Kloss.
Patient access processes set the stage for customer service excellence.
"The values of the organization are on display from the outset," says Kloss. "Poor impressions created at access points can color the experience of the care episode."
Jonathan Johnson, Director, Corporate Patient Services, Carolinas HealthCare System, Charlotte, NC. Phone: (980) 487-4808. Fax: (704) 446-2268. Email: Jonathan.email@example.com.
Linda Kloss, Kloss Strategic Advisors, Chicago. Phone: (312) 624-9750. Email: firstname.lastname@example.org.