ED Financial Triage

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  • ED Financial Triage

    1. 1. emergency department financial triage
    2. 2. especially now
    3. 3. “ The new legislation will impact emergency physicians greatly as newly insured patients find it difficult to find primary care doctors who accept their insurance. I recently saw a Medicaid patient who received a medical card with the name of a doctor who was to be her primary care physician only to find out that he was not accepting any new patients. This lack of good primary care for Medicaid patients is a tragedy made more acute by the 16 million plus patients who will join the Medicaid ranks in the years ahead. Dr. Michael Nauss is an emergency room doctor in Ohio
    4. 4. “ My concern is how quickly (the legislation) was put together and really how it will actually work. For example, Massachusetts has passed similar reform and emergency department visits are increasing and certain hospitals are cutting back on services and patients are often waiting longer for care. Just passing the bill is not enough. Congress needs to start working now on the details of the health care reform plan. Dr. Paul Kivela — an emergency physician at Queen of the Valley Medical Center and co-managing partner of Napa Valley Emergency Medical Group
    5. 5. copay self pay charity medi-cal third party
    6. 6. triage noun 1 the action of sorting according to quality. 2 (in medical use) the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties. verb [ trans. ] assign degrees of urgency to (wounded or ill patients). New Oxford American Dictionary
    7. 7. copay medi-cal self pay
    8. 8. medi-cal copay self pay
    9. 9. rethink retool remodel
    10. 10. Expected Gains more money, quicker copay collections deposits payment arrangements prepped accounts insurance verification completed forms information pass-through decrease time to disposition eligibility categorization TOS information gathering dispersion via matrices
    11. 11. rethink
    12. 12. “ Rethink Staggering under a load of bad debt, many hospitals have started asking patients to pay at least part of their out-of-pocket responsibility before they receive healthcare services. Although the rewards can be great, initiating the program is not easy because registrars may be uncomfortable with the responsibility of asking patients for money. • Prioritize Collection Events • Define the Scope and Scale of Collection Efforts • Incentives May Increase Collections Boosting Point-of-Service Collections HFMA Patient Friendly Billing, Jan. 2010
    13. 13. Rethink staff training your staff other departments patient education available information counseling /education business rules general goals predictive assessment workflow initiatives documented rules audit routines
    14. 14. retool
    15. 15. “ Retool / Technology IRS Form 990 Schedule H requires hospitals to estimate the amount of charity care in their reported bad debt. Are you ready to document this information—and prove it? At a Glance • IRS Form 990 Schedule H requires hospitals to estimate the amount of bad debt expense attributable to patients eligible for charity under the hospital’s charity care policy. • Responses to Schedule H, Part III.A.3 open up the entire patient collection process to examination by the IRS, state officials, and the public. • Using predictive analytics can help hospitals efficiently identify charity-eligible patients when answering Part III.A.3.  A Form 990 Schedule H Conundrum: How Much of Your Bad Debt Might Be Charity? HFM Journal, April 2010
    16. 16. Retool / Technology what examples of technology are in use?
    17. 17. Retool / Technology registration system registration codes financial classes payor selection customized field utilization pros / cons
    18. 18. Retool / Technology homebrewed system tracking system {charity, medical assistance, discounts, cash collections} status reporting link back pros / cons
    19. 19. Retool / Technology bolt-on system actionable sophisticated functions real time categorization edi with patient acct. system pros / cons
    20. 20. remodel
    21. 21. “ Remodel / Workflow To improve patient flow in the ED, hospitals should: • Establish a measure of patient demand by hour, and design a system to handle it • Appropriately capacitate triage processes and systems • Use a system for patient segmentation and establish distinct processes for different patient segments • Consider using team triage, and examine current triage protocols • Devise a method of tracking patients and results Field a willing staff with a burning platform Improving patient flow in the emergency department. HFM Journal, November 2008
    22. 22. Remodel / Workflow physical patient flow one-way traffic funneling to financial triage incentives
    23. 23. Remodel / Workflow “ Success of technology applications depends on quality of utilization.
    24. 24. Remodel / Workflow process flow connect technology to staff trace account flow to end predict disposition and prioritize use hierarchy for work flow know the crossover manage exceptions
    25. 25. Example In a scenario of a busy emergency room, one person has 5 patients waiting to be financially triaged, with only 30 minutes to see them all. All five patients are covered, and each has a $100 E.D. co-payment, and one of the five presented as a result of a car accident.
    26. 26. Example progressive department insurance verified policy matrices special factor recognition
    27. 27. skipping ahead
    28. 28. Example All five accounts are paid by insurance. For easy math, let’s say each account’s balance was $2500, and insurance paid 30% less the E.D. co- payment, so insurance paid $720 for each account. Let us also congratulate our E.D. personnel and collections staff, because three patients paid upfront, and a fourth paid through the mail. Total collections for these five accounts was $4000 on $12,500. Not bad at all.
    29. 29. Example optimal result? good screening excellent collections no loss from insurance what about the car accident?
    30. 30. Example Staff in the E.D. during the screening process was able to determine the auto carrier, and policy number; they even loaded it as the primary insurance in the billing system. Unfortunately, the auto carrier did not pay, as “policy limits have been met.” The claim, thus, was billed to the group health plan and paid. {We’ll overlook that the claim was denied by the group plan, because of a missing accident questionnaire.}
    31. 31. what grade would this effort earn at your facility?
    32. 32. looking back
    33. 33. Example what we know all 5 patients are covered $500 max from copays potential tpl, 100% of charges we still have PFS back-stop
    34. 34. work the car wreck first
    35. 35. Example it takes time accident information patient interview various authorizations adjuster contact info
    36. 36. Example When we’re done, we only have ten minutes, so we work with one patient and collect one co-payment. One out of five is not a good percentage, but now let’s jump forward in time, and count the money again.
    37. 37. Example The four non-accident accounts were paid by insurance to the tune of $2880, add in the $100 co-payment we collected upfront, and another $100 paid through the mail, and we’re at $3080. The one patient still did not pay their co-payment, and a second patient did not pay either, based on our missed opportunity to screen them. That leaves us with the auto insurance account. Hard work paid off, and by taking the steps required to actually collect from the auto-carrier, the hospital received payment of $2500 from the MedPay policy. In the end, our work in the E.D. resulted in total collections of $5580, which is $1580 more. Not bad for a half hour’s work. Also, keep in mind we saved the patient $100, a definite plus for patient service.
    38. 38. gardner group corey shank cshank@gardnerteam.com www.gardnerteam.com (800) 401-4060
    39. 39. VENDOR PERFORMANCE FORUM Come be a part of an online forum for providers and vendors that focuses on vendor management and performance based solution acquisition. vpf.tumblr.com

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