SIGNATURESIGNATURE

PresentationPresentation

Debbie  Harkins  Debbie  Harkins  Patient Accounts IT Coordinator, Patient Accounts IT Coordinator, Central Business OfficeCentral Business OfficeBaycare Health System, Oldsmar, FloridaBaycare Health System, Oldsmar, Florida

Annette  Yanna  Annette  Yanna  Senior System AnalystSenior System AnalystBaycare Health System, Clearwater, FloridaBaycare Health System, Clearwater, Florida

Dale  Sahlberg  Dale  Sahlberg  Senior System AnalystSenior System AnalystBaycare Health System, Clearwater, FloridaBaycare Health System, Clearwater, Florida

What is SIGNATURE ?What is SIGNATURE ?

SIGNATURE is an integrated outpatient SIGNATURE is an integrated outpatient management & outpatient accounting application.management & outpatient accounting application.

Front-office functions include registration, Front-office functions include registration, scheduling and report writing tools.scheduling and report writing tools.

Business office functions manage accounts Business office functions manage accounts receivables with collection tools to maximize receivables with collection tools to maximize reimbursements.reimbursements.

Has advanced collection tools (target files) to maximize allowable Has advanced collection tools (target files) to maximize allowable reimbursements based on payers and collectorsreimbursements based on payers and collectors

Generates 1505 medical billing claim forms (combined charge for Generates 1505 medical billing claim forms (combined charge for services and physician - example: chest X-ray)services and physician - example: chest X-ray)

Produces UB04s - same as an inpatient hospital bill with surgery Produces UB04s - same as an inpatient hospital bill with surgery billing for nurse, facility and supplies ( surgeons do their own billing )billing for nurse, facility and supplies ( surgeons do their own billing )

Has a combined Patient Management and Patient Accounting Has a combined Patient Management and Patient Accounting database (integrated application) that allows charges to be entered database (integrated application) that allows charges to be entered and bills produced that same day (day-end)and bills produced that same day (day-end)

Utilizes SCHEMES that allow multiple insurance plans to meet the Utilizes SCHEMES that allow multiple insurance plans to meet the different ambulatory care needsdifferent ambulatory care needs

A patient was registered at the Imaging site for a annual diagnostic A patient was registered at the Imaging site for a annual diagnostic mammogram and ultrasound with Medicare and Medicaid plan mammogram and ultrasound with Medicare and Medicaid plan providing coverage.providing coverage.

Scheme 1Scheme 1 - established with insurance plans - established with insurance plans Z01 MedicareZ01 Medicare with a with a priority of priority of 11 and and Z25 Medicaid FlZ25 Medicaid Fl with a priority of with a priority of 22

The patient was in an auto accident later that day and returned to The patient was in an auto accident later that day and returned to the Imaging site to have a MRI of the cervical spine. the Imaging site to have a MRI of the cervical spine.

Scheme 2Scheme 2 - established with - established with I16 Auto Allstate InsuranceI16 Auto Allstate Insurance with a with a priority of priority of 11

The patient was scheduled for a knee arthroscopy due to a work The patient was scheduled for a knee arthroscopy due to a work related injury that occurred the previous week.related injury that occurred the previous week.

Scheme 3Scheme 3 - established with - established with 0041 Commercial Risk Work Comp0041 Commercial Risk Work Comp with with a priority of a priority of 1 1

The Siemens enhanced The Siemens enhanced

SIGNATURESIGNATURE version version employs browser technology employs browser technology called called OAS GOLD.OAS GOLD.

The original The original SIGNATURE SIGNATURE application was based on a application was based on a 3270 terminal design.3270 terminal design.

32703270 version version

Original model design for Original model design for GOLDGOLD

The Siemens The Siemens GOLDGOLD model was model was sent to the Baycare body shopsent to the Baycare body shop

to beto be reprogrammed, redesigned, reprogrammed, redesigned,

repaintedrepainted and and

enhancedenhanced

Baycare Baycare SIGNATURESIGNATURE GOLDGOLD

GOLDGOLD has new graphical features such as:has new graphical features such as:

check boxes, radio buttons, labels, selectable lines with check boxes, radio buttons, labels, selectable lines with banners, combo boxes, a calendar, text boxes, images, banners, combo boxes, a calendar, text boxes, images, scroll bars, data evaluators & controllersscroll bars, data evaluators & controllers

• Edits on name and address fields to remove Edits on name and address fields to remove bad characters bad characters !@#$%/&*)+? !@#$%/&*)+? that cause that cause interface errors. interface errors. Example of a bad character Example of a bad character ## GOLDGOLD

will automatically remove:will automatically remove:

• Warning notices to prevent the selection of expired insurance plan codesWarning notices to prevent the selection of expired insurance plan codes

• Educational messages to guide the user Educational messages to guide the user through a process:through a process:

One shared main menu with variable options One shared main menu with variable options based on job role based on job role

Users have an access tcl that determines Users have an access tcl that determines what functions are availablewhat functions are available

When the Accounts Receivable staff signon they see:When the Accounts Receivable staff signon they see:

When the Patient Management staff signon they view:When the Patient Management staff signon they view:

• HIPAA compliant noticesHIPAA compliant notices

• Billing warning messagesBilling warning messages

Previous accounts had bad information. Previous accounts were bad debt. Previous accounts had bad information. Previous accounts were bad debt. Previous accounts were charity. Previous accounts had billing problems.Previous accounts were charity. Previous accounts had billing problems.

Tooltip help has full sentences & detailed information Tooltip help has full sentences & detailed information for a fieldfor a field

Inquiry screens are enhanced for faster searches, such as Inquiry screens are enhanced for faster searches, such as doctor name inquiries with “quick picks”doctor name inquiries with “quick picks”

• "Minor as the Guarantor" reasons that are easy to select "Minor as the Guarantor" reasons that are easy to select ((rather than type inrather than type in))

Radio button selection will appear as a commentRadio button selection will appear as a comment

• VIPVIP

BOARD MEMBER FRANCISCAN ORDER CLERGY BOARD MEMBER FRANCISCAN ORDER CLERGY FOUNDATION FRIEND COMMUNITY LEADER FOUNDATION FRIEND COMMUNITY LEADER GOVERNMENT OFFICIAL FINANCIAL DONOR GOVERNMENT OFFICIAL FINANCIAL DONOR STAFF PRIVILEGED PHYSICIAN CELEBRITYSTAFF PRIVILEGED PHYSICIAN CELEBRITY

Checkmark lights up Checkmark lights up greengreen if an HDX inquiry is possible for if an HDX inquiry is possible for this plan. Eliminates wasted HDX inquiries for unsupported this plan. Eliminates wasted HDX inquiries for unsupported insurance plans.insurance plans.

Immediate messages if the data entered is not Immediate messages if the data entered is not correct, such as the Insurance Company name.correct, such as the Insurance Company name.

Customized documents and patient face sheets with full insurance Customized documents and patient face sheets with full insurance company mailing addressescompany mailing addresses

Custom FeaturesCustom Features

Mail statistics:• 23.6% of all mail in the U.S. is incorrectly addressed. • 2.7% of the total mail volume is undeliverable as addressed. • 1 out of every 32 pieces of first-class mail is undeliverable.

Causes:• Incorrect spelling of street or city • Misread the address from a document • Transposed numbers in street or zip code• Misunderstood the person verbally providing the data

Address validation confirms that a given address is a deliverable address within the United States as defined by the United States Postal Service.

Address verification for bills and statements will also improve the ability to collect fees for services rendered.

The USPS standardizes the address in accordance with USPS guidelines – example: Road will be abbreviated as Rd

Additional Benefits of Address Verification are:• Improve collections by eliminating returned bills & statements. • Reduce staff time & costs formerly spent processing returned mail. • Achieve data integrity through correctness & standardization.

Address Verification Benefits

Former 3270 screen was unable to verify a patient’s address with the US Post Office

The customized GOLD screen can verify online a patient’s address with the US Post Office

There is an online address verification for both There is an online address verification for both the patient and guarantor addressesthe patient and guarantor addresses

The verified USPS address is automatically The verified USPS address is automatically returned to the screenreturned to the screen

Corrects the address: Corrects the address: 13618 N FLORIDA STREET13618 N FLORIDA STREET

that should be that should be 13618 N FLORIDA AVE13618 N FLORIDA AVE Corrects the zip code: Corrects the zip code: 3363133631

that should bethat should be 3361333613 The US Post Office returns a message if more The US Post Office returns a message if more

information is needed (information is needed (apartment or lot numberapartment or lot number) )

Address VerificationAddress Verification

If the address was not found, then the US Post Office returns the following message:

Option: GOLD also can inform the user verbally of an error message.

IMPLEMENTATIOIMPLEMENTATIONN

PROCESSPROCESS

THREE SIGNATURE REGIONSTHREE SIGNATURE REGIONS

St Joseph's Diagnostic Center St Joseph's Diagnostic Center … … 4 Imaging Centers4 Imaging Centers

Morton Plant Health Services Morton Plant Health Services … … 3 Imaging Sites3 Imaging Sites 1 OP Surgery / Endo site1 OP Surgery / Endo site

Baycare Ambulatory CareBaycare Ambulatory Care … … 3 Imaging Sites 3 Imaging Sites 2 St Anthony 2 St Anthony 1 Med Specialist1 Med Specialist 1 OP Surgery Site1 OP Surgery Site 5 Mental Health Sites5 Mental Health Sites

Analysis PhaseAnalysis Phase

Examined the model SIGNATURE Examined the model SIGNATURE GOLDGOLD application at Siemens application at Siemens headquartersheadquarters

Made site visits to other hospitalsMade site visits to other hospitals

Reviewed the Baycare Invision Reviewed the Baycare Invision GOLDGOLD application which has a application which has a similar design similar design

Made phone calls to other SIGNATURE usersMade phone calls to other SIGNATURE users

Checked the SNUG users web board for information about Checked the SNUG users web board for information about current issuescurrent issues

Sent Emails to other SIGNATURE usersSent Emails to other SIGNATURE users

Held many meetings and had extensive collaboration between Held many meetings and had extensive collaboration between the Central Business Office, Registration areas and Information the Central Business Office, Registration areas and Information ServicesServices

Then a list of the current Then a list of the current 32703270 issues was compiled. issues was compiled.

These issues became the reasons These issues became the reasons SIGNATURESIGNATURE was converted to the was converted to the GOLDGOLD version … version …

CHALLENGESCHALLENGES

– Experienced significant HDX model issues that were unique to the Experienced significant HDX model issues that were unique to the GOLDGOLD combined insurance pathway combined insurance pathway

– Standardized insurance plan codes for all outpatient sites Standardized insurance plan codes for all outpatient sites ((example: where A01 means AETNA for all sitesexample: where A01 means AETNA for all sites))

– Made revisions prior to the Made revisions prior to the GOLDGOLD live to an estimated 1000 pre- live to an estimated 1000 pre-registrations that were using the old insurance plans registrations that were using the old insurance plans

– The The 32703270 Patient Face Sheet had been customized to include full Patient Face Sheet had been customized to include full insurance company mailing addresses - which was converted to print insurance company mailing addresses - which was converted to print GOLDGOLD combined insurance fields combined insurance fields

– Needed popup panels to notify users when insurance plans were Needed popup panels to notify users when insurance plans were terminated (terminated (should not be selected for a new registrationshould not be selected for a new registration))

– GOLDGOLD now requires address information be entered for all now requires address information be entered for all miscellaneous insurance plans … that used to be an optional PF9 miscellaneous insurance plans … that used to be an optional PF9 secondary screen in secondary screen in 32703270

Build PhaseBuild Phase

Examined the current Examined the current 32703270 SIGNATURE SIGNATURE pathwayspathways

Reviewed the Siemens model Reviewed the Siemens model SIGNATURE designSIGNATURE design

Created a composite Created a composite GOLDGOLD version of the version of the above two applicationsabove two applications

Testing PhaseTesting Phase

• Used predefined scripts for the Patient Used predefined scripts for the Patient Management and Accounts Receivable Management and Accounts Receivable pathwayspathways

• Verified interface transmissions to other Verified interface transmissions to other systems (systems (such as IDXsuch as IDX))

• Validated facesheets & bills were generatedValidated facesheets & bills were generated

• Emulated real patient scenarios for the types Emulated real patient scenarios for the types of insurances used (of insurances used (managed care, workman's managed care, workman's compensation, Medicare, Medicaid, etc …compensation, Medicare, Medicaid, etc …))

Integrated Systems TestsIntegrated Systems Tests

EAD (Enterprise Access Directory) US Post Office address verification HDX (insurance eligibility) ImageCast (Radiology) EDM (Electronic Data Management) Lawson - General Ledger & refunds Target Files TSI (Managed Care)

Training Training PhasePhase

• PM – Patient ManagementPM – Patient Management

• AR – Accounts ReceivableAR – Accounts Receivable

Two training sessions:Two training sessions:

Training Training ManualManual

PATIENT MANAGEMENTPATIENT MANAGEMENT

Training Training ManualManual

ACCOUNTS RECEIVABLEACCOUNTS RECEIVABLE

LIVE ImplementationLIVE Implementation

Morton Plant Hospital went live first Morton Plant Hospital went live first Other two regions are going live in Other two regions are going live in

the following monthsthe following months ACBO (Ambulatory Care BusinessACBO (Ambulatory Care Business

Office) is the final live eventOffice) is the final live event

ONLINE ONLINE DEMODEMO

OUTPATIENTOUTPATIENTCARECARE

REGISTRATIONREGISTRATIONPATHWAYPATHWAY

Staff can select a printer from this first menu.Staff can select a printer from this first menu.

Patient ManagementPatient Management

EAD inquiry optionsEAD inquiry options

After demographic data is filled out, the system willAfter demographic data is filled out, the system will automatically automatically

Original address dataOriginal address data US Post Office abbreviated theUS Post Office abbreviated theAVEAVE and corrected the zip and corrected the zip 3361333613

Further information is needed Further information is needed

More informationMore information is required - suchis required - such as an OFC, LOTas an OFC, LOT or APT numberor APT number

The USPS suppliesThe USPS supplies a list of known a list of known addresses toaddresses to select fromselect from

The US Post Office verified address is then transferredThe US Post Office verified address is then transferred through this screen and parsed into the through this screen and parsed into the streetstreet, , citycity, , statestate and and zip codezip code fields. fields.

The corrected address is automatically copied to the The corrected address is automatically copied to the demographic screen. The user then adds demographic screen. The user then adds LOT 71LOT 71 to to complete a full mailing address.complete a full mailing address.

GUARANTOR information – will automatically copyGUARANTOR information – will automatically copy all patient data and “gray out” the screen to protect dataall patient data and “gray out” the screen to protect data

Bottom part of the GUARANTOR information screen isBottom part of the GUARANTOR information screen is shown … with shown … with COMMENTCOMMENT and and EMPLOYMENTEMPLOYMENT options options

INSURANCEINSURANCE

Click on Click on PLANPLAN to access a “quick pick” help screen to access a “quick pick” help screen

Insurance Company help screen with “quick pick” options Insurance Company help screen with “quick pick” options

Select an insurance plan Select an insurance plan

ZZZ identifies a terminated plan ZZZ identifies a terminated plan

The managed care plan automatically had a The managed care plan automatically had a 11 appended to appended to the plan code the plan code 102102 and an and an MCMC filled in for the filled in for the CONTRACTCONTRACT..

The HDX button The HDX button lit uplit up indicating an HDX inquiry is available. indicating an HDX inquiry is available.

The The INSURANCEINSURANCE flow returns to the flow returns to the GUARANTORGUARANTOR screen where the button is activated screen where the button is activated

so the user can continue on to the so the user can continue on to the CASECASE screen screen

CASE CASE

Once all required data is completedOnce all required data is completedthe system will show the button. the system will show the button.

ACCOUNTSACCOUNTSRECEIVABLERECEIVABLE

PATHWAYPATHWAY

Accounts ReceivableAccounts Receivable Main MenuMain Menu

A R Follow-UpA R Follow-Up

A R InquiryA R Inquiry

Vital functions automatically selected (radio buttons)Vital functions automatically selected (radio buttons)

A R SummaryA R Summary

Collector NameCollector Name and and CommentComment automatically valued from codes automatically valued from codes

Detail SummaryDetail Summary

CALCULATORCALCULATOR and and EMAILEMAIL options added to the Navigator options added to the Navigator

Additional DetailsAdditional Details

REASONREASON codes custom feature added codes custom feature added

Internal email information is automatically filled in with AR Internal email information is automatically filled in with AR detail … saving time and preventing transposition errorsdetail … saving time and preventing transposition errors

Are there any questions ?Are there any questions ?