How One Surgery Center Improved Staff Efficiency, Collections and Patient Satisfaction Utilizing Technology

Transcription

1 How One Surgery Center Improved Staff Efficiency, Collections and Patient Satisfaction Utilizing Technology Teresa Copeland OrthoTennessee Knoxville Orthopaedic Surgery Center

2 Knoxville Orthopaedic Surgery Center» Physician-owned musculoskeletal Ambulatory Surgery Center» Opened in January 2010 with 4 ORs one Procedure Room. Completed ORs 5 & 6 in Spring 2013» All physicians are subspecialized» On target for 9000 procedures in % Ortho 44% Interventional Pain Management

3 Important to Note» Physician-owned Developed the center to have control over the facility/processes to manage quality and efficiency» All sub-specialized High acuity cases Use of specific, high quality products» High volume

4 Managing The Middle Our challenge is to maintain a high quality, patient-centered facility, managing individual physician preferences during this time of decreasing reimbursement and increasing patient responsibility.

5 To be successful we must collect as much as possible, as soon as possible. Verification of benefits Estimation of patient responsibility Collection at time of service Timely filing of clean claim Billing and collection Denial Management

6 Staff and space are costly regardless of the organization s size Demands on staff have increased significantly in recent years Electronic Health Records Increased payer requirements Reporting requirements Our goal is to continually review our processes and work with our partners to equip current staff to work more efficiently.

7 This is particularly true in today s Alternative Payment Environment» Accountable Care Organization (ACO)» Comprehensive Primary Care Initiative (CPC)» Bundled Payment for Care Improvement (BPCI)» Comprehensive Care for Joint Replacement (CJR)» State Innovation Models Initiative (SIM)» Commercial Payer Bundled Payment Arrangements» Employer/Municipality Bundled Arrangements

8 HHS has set a goal of tying 30 percent of Medicare fee-for-service payments to quality or value through alternative payment models by 2016 and 50 percent by HHS also set a goal of tying 85 percent of all Medicare fee-forservice to quality or value by 2016 and 90 percent by 2018.

9 This means that someone will be at risk for the majority, if not all, of the entire episode of care

10 Eligibility Verification» Then Utilized multiple payer websites to verify patient benefits Cumbersome and time consuming for staff» Now Utilize software for verification One site for most payers Much more time efficient for staff

11 Patient Estimation More than 90 million adults in the United States have low health literacy. --NIH» This includes cost of care and expected patient responsibility. When consumers were asked about prices. They were 5% off on a Honda Accord..and 50% off on a routine doctor s visit 2006 Consumer Attitudes Survey, GreatWest Healthcare» Overall patient experience is highly influenced by the financial aspect of care.

12 Patient Estimation» Then Created the White Book with average reimbursement by CPT/MD/Payer---this was a better than nothing tool but was static and time consuming to update Notified patient day before procedure Generic document given to patient» Now In process Estimation based on most recent claims by Payer/MD/CPT Difficulty is to capture all procedure CPT codes and implant cost in estimate Working with vendor to identify TOTAL claim allowable based on primary code instead of at the line item level

13 Patient Estimation for Professional Claims» Create and verify the patient s eligibility status using demographic, insurance, encounter, and procedure information» Review the benefit details, including the charge amount, allowed amount, co-pay, co-insurance, patient responsibility, and insurance responsibility» Complete the estimate» Collect your money!

14 Professional, easy to understand document given to patient reflecting information received from THEIR insurance 14

15 Collecting at Time of Service» Then» Now Attempted to contact patient by phone prior to day of procedure Attempted to collect on day of procedure Had patient sign Promissory Note for balance of estimate Billed patient after insurance payment(s) often behind other providers (anesthesia, pathology) Contact patient at least 2 days prior to procedure Discuss estimated patient responsibility by phone, request payment and set up payment plan Day of procedure follow up on payments and payment plans as needed, give patient documentation

16 Patients Demand Multiple Methods Of Payment

17 Acceptable Forms of Payment In the office» Credit/debit cards Over the phone In the mail» FSA & HSA cards (all except billing services) Online» Personal checks using ACH check conversion Point-of-care checks must be scanned Check-by-phone, check-by-web, payments plans Checks unacceptable for conversion can be processed through the cash functionality» Cash, money orders, and other paper mediums based on the provider s rules anything that must be deposited directly into the bank account Through the bank

18 Payment Entry Screen Payment at time of service or anytime by phone Payment Options

19 Create a Payment Plan» Offering patients an option to pay over time can increase revenue, reduce bad debt, and improve patient satisfaction» Can be setup in-person or over the phone» Payments can be weekly, twice a month, every two weeks, or monthly» Payments are automatically taken out based on the tender setup no manual intervention needed!» Notifications for payment reminders, receipts, and declined payments» See all pre-arranged payments in the Reports tab

20 Payment Receipt

21 Payment Plan Statement Payment Plan Posted

22 Statements and Follow up» Then Printed, stuffed, mailed paper statements once a month---approx. 800 statements/month *Limited patient payment options: Mail a check, send credit card info via mail, or call the center to make payment Not patient friendly» Now Electronic statements uploaded Patients can elect e delivery Address for all statements are run against the National Change of Address data base to avoid issues Activated logic to send collection letters *Patients can pay on line via electronic statement link or our website

23 Patients Are Consumers- Pay Bills Online» 73% of households paid a bill online last month

24 Without Online Options, You May Lose Payments

25 Make a Payment

26 e-commerce Transaction Examples Patient Payments Transaction Detail Report Account: Knoxville Orthopaedic Surgery Center (46887) Transaction Date(s): 11/01/ :00 AM to 11/30/ :59 PM Report Generated: 12/22/ :36 PM Point of Entry: e-commerce Method of Payment Transaction Date Transaction Time Point of Entry Card Type Patient Name Transaction Amount Credit Card 11/6/ :59:14 PM e-commerce Visa XXXXXXXX $ Credit Card 11/6/ :21:00 PM e-commerce Visa XXXXXXXX $85.96 Credit Card 11/6/ :08:13 AM e-commerce Visa XXXXXXXX $15.00 Credit Card 11/6/ :23:33 AM e-commerce Visa XXXXXXXX $ Credit Card 11/6/2015 9:18:49 AM e-commerce Visa XXXXXXXX $10.00 Credit Card 11/6/2015 7:44:17 AM e-commerce Visa XXXXXXXX $

27 The easier it is for patients to pay the sooner you will be paid!

28 Claim Filing and Remits» Then Now Most commercial claims through clearinghouse Workers Comp filed paper with attachments Other paper claims printed and mailed Only a portion of commercial remits through clearinghouse Additional remits through separate sites or via mail All claims going through clearinghouse Workers Comp with documents attached Claims dropped to paper by clearinghouse as needed Receiving most remits via clearinghouse add on as needed Balance resolved to patient responsibility much faster

29 Denial Management -- Then Payment poster identified problem at time of posting.claim denial, line item denial, variance from expected Poster responsible for follow up on some denials.such as: no authorization, need medical records, etc. Poster made copy of EOB and passed along to Collector for follow up on variance from expected Laborious notes to document status

30 Denial Management -- Now» Staff Denials grouped by reason Established workgroup to bucket work by employee or group no guessing who is responsible Ability to sort as desired reason, payer, amount improves productivity Avoid Timely write offs---nothing falls through the cracks» Management Dashboard for status at a glance Improved ability to track and report progress Transparency improves accountability

31 Denial Management Dashboard

32 Win-Win» Our staff loves the process: Less moving around in multiple sites Professional documentation buys patient confidence Payment posting more efficient Division of denials into workgroups improves workflow and ability to track and report outcomes Our patients love it: More timely and accurate estimation of patient responsibility Professional documentation Ease of payment through multiple options Faster resolution of claims

33 Thank You! Teresa Copeland Knoxville Orthopaedic Surgery Center