that could be improved with simple process changes. First, to improve the pre-certifi cation process, employees began faxing scheduling forms to central scheduling with clinical details included on the forms. Next, the issue of same-day requests was tackled by eliminating calls to ancillary areas and instead employing an automated process that would add the requests to the schedule and send an electronic notifi cation to the appropriate contact. Finally, the length of telephone calls in the pre-encounter process was addressed. By adopting the use of standardized procedural questionnaires, OhioHealth was able to mini- mize the amount of demographic information collected at the time of each call. As a result of the questionnaires, all facilities began gathering more consistent data across the system and the number of questions was reduced. In another effort to provide easier access for patients, OhioHealth implemented alternatives to the traditional telephone method of scheduling. Patients could use a fax option, or physicians could schedule procedures over the Internet. Other online requests also were accepted. “Overall, we were pleased with these improvements,” says Carlisle. “For the fi rst half of the fi scal year, our pre- registration rates either remained stable or increased, and the average length of calls into the central scheduling center gradually began to decrease.”
OhioHealth’s next steps in the pre-encounter phase will be to develop deferral policies. In the future, for those patients who have not been pre-certifi ed, their procedures will be rescheduled. In addition, self-pay patients will be required to qualify for charity care or pay a deposit prior to scheduling.
In the second key segment – the encounter – the fol- lowing actions were addressed: • Concierge services, • Transport coordination, • Way fi nding, • Information, • Family liaison services, • Order entry, • Consent education, • ADT system entry, • Charge capture, • Billing, • Customer service, • Collections, • Financial counseling, • Benefi t verifi cation, • Scheduling, and • Patient identifi cation.
As expected when evaluating the large number of activi- ties related to each patient encounter, OhioHealth offi cials found several vulnerabilities that could be translated into areas for improvement. Missing or incorrect insurance information was at the top of the list, followed by the
need for more timely distribution of paperwork to the patient care fl oors. To improve the quality of insurance information gathered from patients, OhioHealth updated its hospital information system (HIS) to include mandatory fi elds that would ensure the proper data was collected initially. Patient identifi cation information was scanned into the system for verifi cation purposes. Self-pay patients were required to sign a waiver so their information could be referred to an outside vendor for screening.
In addition, a daily review of all error reports was implemented to identify pre-billing edits that could easily be made. New reports were developed, and employees received additional education and training. “We really felt as if we were redefi ning the customer experience,” says Carlisle. “We wanted to provide optimal patient experiences, reduce wait times and eliminate re- dundancies in the often tedious paperwork process.” The fi rst six months of fi scal year 2009 saw dramatic improvements in customer service scores, along with im- provements in both cash levels and clean claim rates. The next steps for OhioHealth regarding the encounter phase will involve developing more effi cient procedures for col- lecting past balances and notifying patients when services will not be covered by their insurance. Identity theft also will be an important area of focus.
In the third key segment, the post-encounter area, OhioHealth offi cials reviewed the following: • Patient billing statements, • Insurance follow up, • Payment variance, • Cash posting, • Medicare regulations and recovery audit contractors (RACs), and • Collections. Perhaps the most critical concern within this area was determining how to handle RAC audits. The RAC program was established to identify improper payments made on healthcare claims for services provided to Medicare ben- efi ciaries. According to the American Hospital Association, RACs corrected more than $1.03 billion in improper Medi- care payments from March 2005 to March 2008 in just fi ve states during a demonstration period. Of that number, approximately 96 percent were overpayments collected from providers – and more than 40 percent were linked to patient access issues. OhioHealth formed a RAC steering committee to ad- dress concerns related to RAC requests, as well as conduct front-end training and education on managing the coordi- nation of benefi ts. Looking to the future, OhioHealth plans to expand its successful improvements and implement even more technological advances to enhance the patient access process.
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