penn state hershey medical center. penn state hershey medical center outpatient pre arrival services...
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Penn State Hershey Medical CenterOutpatient Pre Arrival ServicesPenn State Hershey Medical CenterOutpatient Pre Arrival Services
Presenters Mary Stephens, Manager, Inpatient
Access – Previously a Coordinator inOutpatient Pre Arrival Services (6 yrs)
Linda Cranston, Manager, of Out Patient Pre Arrival Service
LeAnn Stringer, Manager, Eclipsys Application
Penn State Hershey Medical CenterPenn State Hershey Medical Center
500 bed Tertiary Care Academic Medical Center
Adult and Children’s Hospital
Level 1 Trauma Accreditation (adult/pediatric)
Penn State Cancer Institute
588 Faculty Physicians
Annual Clinical Activity Annual Clinical Activity
Inpatient admissions – 27, 615
OR Cases Inpatient – 10,125 Outpatient – 6,564
Emergency Room visits – 47,163
Outpatient Visits Booked - 1,412,255 Actual - 779,520
HMC Systems HMC Systems
Eclipsys AM/PFM Eclipsys Registration data interfaces to
20 systems
Other Systems used at HMC
Cadence (Scheduling) Cerner Clinicals GE Centricity (Radiology) Mysis (Laboratory) Pyxis Seimens (Signature-Professional Billing)
Redesign of Front End ProcessesRedesign of Front End Processes
Multi-Disciplinary Team Approach Patient Financial Services (PFS) Nursing Physicians Inpatient Access Health Information Services Information Technology Representatives from various outpatient
clinics
HMC Identified Financial OpportunitiesHMC Identified Financial Opportunities
Reduce Accounts Receivable Hospital & Physician AR
Reduce write offs (revenue deductions)
Decrease check in time for outpatients
Team RecommendationTeam Recommendation
Form the Outpatient Pre Arrival Services (OPAS) Department (2001)
OPAS Goal Obtain accurate patient and insurance
information prior to the outpatient visit to ensure full reimbursement of services
Facilitate gathering and verification of sensitive information to ensure HIPAA compliance and increase patient satisfaction
OPAS Department GoalsOPAS Department Goals
Decrease facility accounts receivable days from 86 to 45-55
Decrease professional account receivable days from 81 to 51-57
Decrease facility write offs from 3.2% to 1.3-1.7%
Decrease professional write offs from 2.8% to 1.3-1.6%
Decrease average check in time from approximately 6 minutes to less than 1minute
OPAS StaffingOPAS Staffing
Initial Pilot (3 month period in 2001) 4 new FTEs 2 clinics (Dermatology and OB/GYN)
Currently 70 FTE’s (existing and new staff) 43 clinics
Pre-Arrival ProcessesPre-Arrival ProcessesProcessProcess Improvement GoalImprovement Goal Decision Decision
Pre-Registration/Registration
How often should patient demographic information be updated/validated
Suggested 60-90 days
Pre-Clinic % of scheduled patients pre-registered prior to date of service
100%
Insurance Verification
How often should insurance be verified (this will vary by payer and all services)
Each encounter/visit (100%)
Pre-Arrival ProcessesPre-Arrival Processes
ProcessProcess Improvement GoalImprovement Goal Decision Decision
Referrals % of referrals obtained prior to service
100%
Authorization/Certification
% of scheduled patients authorized prior to service
95%
Authorization/CertificationWalk Ins
pre-registered patients that have authorization/pre-certification verified within 24 hrs of arrival
100%
System EnhancementsSystem Enhancements
Scheduled appointments 28 days out (Cadence Report) Eclipsys pre-clinic visit creation Eclipsys Worklists by service and location Identify & refer S/pay accounts to Financial Counselor
Self Pay ProcessSelf Pay Process
Price estimate of service is obtained Review patient’s account for payment
history Credit report Patient is contacted
Provide estimated cost of service 75% of estimate is requested MA process is discussed Financial Risk process
Physician makes the decision (based on medical necessity) whether appointment is canceled or postponed
Improved Outcomes in ClinicsImproved Outcomes in Clinics
Decreased denials due to 100% verification of insurance and ability to obtain referrals and authorizations prior to the clinic visit
Reduced check in/check out time for patients
Increased point of service cash collection approximately $750,000 monthly
Financial Improvement OutcomesFinancial Improvement Outcomes
Facility accounts receivable days reduced from 86 to 45
Professional accounts receivable days reduced from 81 to 45.2
Facility write offs reduced from 3.2 % to less than 0.5 % of revenue
Professional write offs reduced from 2.8% to less than 0.5 % of revenue