Patient Access Intake Center Five Years in the

Patient Access Intake Center: Five Years in the Making Lynn Arrington & Alyssa Corallo Managers of Patient Access Intake Center

Patient Access Intake Center Five Years in the Making • • Consolidation • Why consolidation was necessary • How the Centralized Patient Access System came to be • Benefits and results over last five years Insurance Verification • Work list & Workflow • Denials Reduction • Revenue Cycle Communication and Trace Tracking • Insurance Benefits Pre- Registration • Securing Days Out • Dialer • Pre-Service Collections • Quality assurance • PT Satisfaction Survey • Scripting Balancing Staff Accountability and Recognition • Department Standards • Accountability Steps • Raise Morale through Team and Individual Recognition

Texas Health Resources… Mission, Vision and Values

‘’It all starts with Patient Access and we truly do pave the road to success for our patients and our facilites ’’ Patti Consolver, Administrative Director -Patient Access Services

PAIC: Five Years in the Making… • In 2006 Texas Health Resources analyzed industry and • In 2007 PAIC, the centralized function for verification and pre. Texas Health Resources serves 16 counties in the Dallas-Fort Worth competitor trends, assessed strengths and weaknesses and registration, was created. The PAIC Pre-registration department area of North Central Texas, home to more than 6. 2 million people. develop ambitious strategies that would position Texas Health to takes care of all the preliminary steps in the patient’s registration transform itself faster than the rate of change in the environment, via phone or online putting the case in motion prior to the patient The system includes more than 20, 500 employees working in 24 acutethereby transforming health care delivery in North Texas. arrival at the facility. While the insurance verification department care and short-stay hospitals that are owned, operated, joint-ventured will secure authorization requirements and benefits for both future or affiliated with Texas Health Resources. and past patient cases.

Why Centralize? Areas of Concern: • Opportunity to avoid denials by communicating appointments • THR was only Pre-Admitting 72% of Scheduled Admissions while the lacking precertification prior to the date of service. • Benchmark was set at 90%. Ability to review patient’s Goals in creating the PAIC: specific benefits for accurate coverage details helping to improve up front collections. • • Not all facilities had the luxury of having a dedicated pre-admission department Develop a streamlined Pre-Admission process to exceed the 90% benchmark. In 2006 the Strategic Revenue Cycle needed higher standards set for Texas Health • or staffed appropriately. environment to discuss benefits and deposit Enables a more relaxed • Resources. At that time THR needed to compare industry standards and conducted Develop a streamlined pre-certification and verification process to ensure timely prior to the patient’s visit and enables transfer to a Financial • Several entities pre-registered in between patients or not at all. notification and pre-certification. . Counselor financial follow up a study to see where improvements were needed. • • • For entities with designated pre-admission staff, the process was inconsistent Develop an express check in concept for pre-registered patients at the entity. Gives the advantage of setting service standards. To be able to and the focus was varied throughout the organization. Resources’ deliver a consistent experience at all the Texas Health locations delivering the same compassionate, individualized • Collections were not completed on all accounts consistently. care every day, every time.

Benefits of a Centralized PAIC

Benefits of a Centralized PAIC • • Opportunity to avoid denials by communicating appointments lacking pre-certification prior to the date of service. Ability to review patient’s specific benefits for accurate coverage details helping to improve up front collections. For improved efficiency the PAIC enables the possibility of implementation of an automated kiosk on sight at each entity in the registration area benefiting both the healthcare system and the patient. Gives the advantage of setting service standards. To be able to deliver a consistent experience at all the Texas Health Resources’ locations delivering the same compassionate, individualized care every day, every time.

Five Years of Growth The PAIC has grown in the last five years with management leading the staff to fulfill and exceed expectations set by our Central Business Office. We have made improvements to our : • Communication scripting and verbiage • Pre-Service collections • Denial Reduction • Work flow via the Ontrac System • Identification process of limited benefits plans and ELAP plans • Overall ability to secure future dates of service appointments out to 5 -15 days prior to the patient’s arrival

THR Operations: A detailed look at the THR Pre-Registration and Insurance Verification • The initial contact with our patients for information, updates, quoting and collections is performed by Pre-Registration • The PAIC’s greatest impact is due to the centralized design and separation of the Pre-Registration process • The initial contact and follow up with the and Insurance Verification process insurance company , physcian and facility is perfomed by Insurance Verification Department

Insurance Verification Worklist & Workflow • • • Stockamp Ontrac worklist tool Each worlklist contains No. VA (Notification Verification and Authorization) accounts The Ontrac Worklist is split up in Urgent, Elective, Next Day, and Specialty.

Insurance Verification Denial Reduction : 2008 -2011 • • 2008 average Denial for Precert was $ $450, 785. 00 2011 average Denial for Precert was $203, 691. 00 $2, 500, 000. 00 $2, 000. 00 $1, 500, 000. 00 No Denial/Precert (1219) Total THR $1, 000. 00 $450, 785. 00 $203, 691. 00 $500, 000. 00 $0. 00 2008 2011

Insurance Verification Tracking Revenue Cycle Communication & Trace • Trace Voice (PC Call) • Trace Pixcert • Trace Faxcert • Trace Voicert

Insurance Verification ELAP and Limited Benefit Plans

Pre-Registration Securing Days Out- Work Flow • 2011 & 2012 Pre-Registration 93% Completed Rate • 100% attempted for 5 days out and 75% attempted on 6 -15 days out for all service types • • Teams Focus System Urgent Team- DOS within next 1 -5 days Surgery Team- 5 to 30 days out Diagnostic Team- 6 to 60 days out

Pre-Registration Ontario Dialer With over 1800 inbound calls weekly, we utilize Ontario Dialer technology to route and manage all calls. This helps us track the following user statistics and call volume: • • • Wait Time Inbound Volume Outbound Volume Passed to Messaging Abandoned Rate Individual Call Statistics

Pre-Registration The Ontario Dialer allows management to visually monitor all representatives’ real time activity, as well as track their weekly statistics.

Pre-Registration Collection Process • Calculate Deposit • Scripting for Collections • Payment Secured If Patient is unable to pay deposit • 50% upfront deposit is offered to patient. • Patients that can not pay the minimum of 50% of the deposit amount will be transferred to the Entity Financial Counselor to discuss further payment options.

Pre-Registration

Pre-Registration Calculating Deposits • Each patient’s benefits are verified and then entered into our Care. Pricer system, which populates the deposit amount on a form the patient signs upon Admission. • During Pre-Registration each patient is screened for an outstanding balance, which is added onto the Care. Pricer estimate.

Pre-Registration Calculating Deposit

Pre-Registration Quality Assurance All calls and computer activity are recorded on our Centricity system, which management uses to perform monthly quality reviews. Centricity is able to capture the entire Pre. Registration process. • Registration Data Elements • Scripting • Collections • Customer Service

Pre-Registration Patient Satisfaction Each patient is asked to take a survey at the end of the pre-registration phone call to rate the representative’s customer service. The results of these surveys are monitored on a weekly basis and reported monthly as part of the department KPI standards.

Pre-Registration Survey – Tracking Patient Satisfaction

Pre-Registration

Pre-Registration Scripting Uniformity is key. We provide scripting to all of our representatives to ensure that all patients are given a professional and courteous experience from beginning to end. Types of Scrpting: • • • Introduction / Conclusion Surgery Collections Voicemail Survey

Pre-Registration Call Flow

Accountability Recognition Balancing Accountability and Recognition will create Excellent Performance

Accountability Department Standards • Productivity – 100 % weekly = • 175 accounts for Pre. Registration • 255 for Elective IV Accounts • 400 for Specialty IV Accounts • 275 for Urgent IV Accounts • Quality Review- 2. 7 or higher on a 3. 0 scale • Collections- $45 per Patient

Accountability Accountabilty Steps • Step 1: Documented Verbal Coaching • Step 2: Documented Verbal Coaching • Step 3: Written Counseling/ Corrective Action • Discretionary Action Plan may be devised • Step 4: Written Counseling/ Corrective Action • Step 5: Termination

Recognition Team/Individual Recognition • • • Monthly Team Contests – centered around KPI goals Balloon Friday- Increasing Collections/Productivity Shout Outs – quick email recognition with whole department Accomplishment Jar- Staff selects/shares Pass the Dino/Monkey – Peer to Peer Reward

The House the PAIC Built Each team member received a brick to write their committment to each other and the PAIC, which helped to build morale and unifiy our team.

Questions & Answers? AND TO THE PATIENTS WE SERVE…. • At Texas Health Resources, a faith-based health care system, we combine clinical expertise, advanced technology, and compassionate individualized care to deliver the best possible outcomes for the patients we serve. We are proud to be a team working together continually improving our system as we transform ourselves by having Individuals Caring for Individuals, Together