Sample Health Care Process Map

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Forensic-level process map for health care organization.

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Sample Health Care Process Map

  1. 1. Process Map Legend Each STEP of a PROCESS is detailed as illustrated below. This page provides a legend for the process maps presented on the folliwing pages. This is the client’s process map before optimization. STEP 2a PATIENT INTAKE 1. Enter Patient Demographic Data (AllScripts) (m) Payer Codes ICD-9 Diagnostic Codes 2. Check Benefits (m) 3. Check Eligibility (m) 4. Get Initial authorization (Insurer Web or Voice) (m) 5. Verify & Enter Insurance Coverage Number (m) INTAKE NURSE 6. Create New Insured Patient (Allscripts) (o) Patient Intake 7. Vailidate Doctor’s License Status(State Web Site) (m) 8. Review Availability of Internal Resources (o) 9. Research Unusual Diagnosis (o) 10. Enter Doctor Orders (Allscripts) (m) 11. Review For Medicare Guideline Compliance (m) 12. Print Chart (Basic Referal Info.) (m) 13. Review History & Physical (m) 14. Send Chart to Appropriate Line of Service (m) 15 .Enter Medication Therapies (AllScripts) (o) Copyright 2009 FlowLogic FlowLogic This process map is shared with permission from the Michael R. Neece, EVP Global Services client organization o. 508-435-2647 m. 508-735-4656 mneece@flowlogic.com10/27/2009 1 of 23
  2. 2. Start HHHC Patient Intake STEP 1 PATIENT HOSPICE EVALUATION 1. Complete Hospice Eval Form (m) 2. Complete Discharge Form (o) LIASON 3. Gather Medical Records (m) Patient Hospice Medications, History & Physical Evaluation Last Clinical Notes 4. Send Referral to Intake (AllScripts) (m) 5. Arrange Transportation (o) 6. Arrange Medical Hockups (o) STEP 2a PATIENT INTAKE Referal 1. Enter Patient Demographic Data (AllScripts) (m) Payer Codes ICD-9 Diagnostic Codes 2. Check Benefits (m) 3. Check Eligibility (m) STEP 2b CASE INTAKE 4. Get Initial authorization (Insurer Web or Voice) (m) 1. Check Primary Payer (AllScripts) (m) 5. Verify & Enter Insurance Coverage Number (m) 2. Check Benefit Limits (AllScripts) (m) CASE INTAKE NURSE 6. Create New Insured Patient (Allscripts) (o) 3. Check Pre Authorization Levels & End Dates MANAGEMENT Patient Intake 7. Vailidate Doctor’s License Status(State Web Site) (m) (AllScripts) (m) Case Intake 8. Review Availability of Internal Resources (o) 4. Get Insurance Authorization (Web or Phone) (m) 9. Research Unusual Diagnosis (o) 5. Review Patient Clinical Needs (AllScripts) (m) 10. Enter Doctor Orders (Allscripts) (m) 11. Review For Medicare Guideline Compliance (m) 12. Print Chart (Basic Referal Info.) (m) PAYER 13. Review History & Physical (m) Referal Authorization 14. Send Chart to Appropriate Line of Service (m) 15 .Enter Medication Therapies (AllScripts) (o) Home Hospice Home Palliative Private Health House Hospice Care Duty Care In-Patient Care Skilled Nursing Hospice Home Care Home Health Aid Nursing Physical Therapy Hospice Nursing Home Making Home Health Aid Home Care Companion Occupational Therapy Hospice General In- Foot Clinic Speech Therapy Patient (GIP) Medical Social Worker Grief Counseling Home Health Aid Volunteers10/27/2009 2 of 23
  3. 3. From INTAKE A Home Referal Health HHHC Home Health Care 1 of 4 Care STEP 2a ASSIGN REFERAL 1. Enter On Referal Assignment Board (m) 2. Enter Existing Patient Doctor’s Orders (o) 3. Triage Patients (o) 4. Clinical Calls (o) 5. Balance Case Load (Allscripts) (m) CASE 6. Schedule Services MANAGER TEAM LEADER 7. Fax Referal To Non-Computer Clinicians (o) Medicare Assign Referal 8. Place Referal Order In Clinician’s Mailbox Discharge 9. Send Medicare Patient Discharge Info To Case Manager (o) 10. Hold Occupational Therapy Until Admitted (o) 11. Schedule Pre-Habilitation (o) 12. Notify Hospital of Resumption/Re-Intake (for pre habilitation) (o) 13. Review Medicare Compliance (m) 14. Send Referal To TeleHealth Nurse (o) Referal TEAM LEADER STEP 2b CASE LOAD REVIEW & AUTHORIZATION Assigment Case Load 1. Review Clinician Case Load (Allscripts) (m) Board Review & 2. Check Initial Authorization (Allscripts) (m) Authorization STEP 3a SCHEDULE SERVICES 1. Enter Assignment Board (Allscripts) (m) 2. Notify Patient (m) SCHEDULER 3. Notify Clinicians (voice mail) (m) PATIENT Schedule 4. Schedule Services From Clinicians (m) Services 5. Schedule Home Health Aids (o) 6. Notify Hospital For Re-Intake After Hospitalization (o) 7. Review & Enter Telephone Data (Allscripts) Validate Codes STEP 4a PRE-ADMISSION 1. Synchronize Laptop (Allscripts) (m) 2. Check Schedule (Allscripts) (m) 3. Review Doctor’s Orders (Allscripts) (m) CLINICIAN 4. Review Insurance Coverage (Allscripts) (m) Pre-Admission 5. Review Discharge Paperwork (Allscripts) (m) 6. Assess Medicare Status (m) 7. Enter I.V. Status (for IV Patients) (Allscripts) (o) 8. Schedule Initial Visit with Patient (m) Continued Home10/27/2009 Health Care 2 3 of 23
  4. 4. From Home Health Care 1 HHHC Home Health Care 2 of 4 STEP 5a.1 PATIENT ADMISSION 1. Confirm Identity (Allscripts) (m) 2. Verify Insurance Data (Allscripts) (m) 3. Interview Patient (Allscripts) (m) 4. Conduct Full Assessment (Allscripts) (m) 5. Create Plan of Care (Allscripts) (m) STEP 5a.2 CASE INTAKE 6. Create Orders (Allscripts) (m) 1. Check Frequency & Duration of Visit (AllScripts) (m) 7. Review Admit Book With Patient (m) 2. Get Pre-Authorization for Care (AllScripts) (m) 8. Complete Signed Admission Contract (Allscripts) (m) 9. Complete Consent to Treat (Allscripts) (m) 10. Review & Sign Medicare Supply Coverage-Medicare Patients (o/m) 11. Review Emergency Prepare Plan With Patient (m) CASE CLINICIAN 12. Enter Patient Priority (n/a, 1, 2, 3) (Allscripts) (m) MANAGER Patient 13. Complete I.V. Consent for Medicare Patients (o/m) Case Intake Admission 14. Educate Patient: Review Plan for Discharge (m) 15. Complete Problem Chart (m) 16 Complete Appropriate Tasks (Allscripts) (o) 17. Signed Paperwork to Admin Assistant (m) 18. Review Admin. Visit with Primary Clinician (m) PAYER 19. Notify Doctor of Plan-of-Care (Allscripts) (m) Authorization 20. Order Supplies (o) 21. Give Patient Copies of Paperwork (m) -Contract (m), -Consent to Treat (m) -Admissions Book (m) -Medicare Discharge Notice (m) -Medication Planner (o) -Schedule (m) -Medical Supplies (o) Orders for Copies of Orders for Signed Contract Paperwork Care Paperwork Supplies MEDICAL ADMIN. SCHEDULER STEP 6a.1 Schedule Care SUPPLY ASSISTANT BILLING PRIMARY MD PATIENT OR CLINICIAN 1. Schedule Ongoing Care (Allscripts) (m) VENDOR Audit Admission Schedule Care 2. Schedule Home Health Aid (o) Order Continued Home Health Continued Care 3 Accounting110/27/2009 4 of 23
  5. 5. From Home HHHC Home Health Care 3 of 4 Health Care 2 STEP 6a.2 AUDIT PAPERWORK 1. Verify Contract Signed (m) 2. Verify Consent to Treat (m) STEP 6a.4 ONGOING CARE 3. Audit Entire Patient Record (Allscripts) (m) 1. Record Change in Care 4. Resolve Discrepencies (Allscripts) (o) 2. Record Doctor Changes (Allscripts) (o) 5. Print & Send Orders to M.D. (m) 3. Deliver Plan of Care 6. Set Follow-up Tasks (Allscripts) (m) 4. Notify Doctor of Changes ADMIN. 7. Review M.D. Orders to Treat (m) 5. Notify Clinician Team of Changes CLINICIAN ASSISTANT 8. Get Signed M.D. Orders (30-days) (m) 6. Chart Visit (Allscripts) (m) Deliver Care Audit Paperwork 9. Verify SS# & Medicare # (Medicare Sys) (o) - Assessment - Clinical Notes 10. Verify New M.D. (o) - Problem Charting 11. Send Referral (o) - Transactions (times in/out/travel) 12. Enter NPI# for M.D. (Allscripts) (o) 7. Discuss Plan for Discharge with Patient (m) 13. Complete Open Tasks (m) 8. Enter tasks as Needed (Allscripts) (o) 14. OASIS Complete (Medicare/caid) (m) 9. Give Appropiate Forms/Notice to Patient (o) 15. Review Emergency Prep. Plan (m) 16. Notify Clinicians of Recertification Due (o) Orders STEP 6a.5 CASE REVIEW CASE 1. Review Pre-Authorization Cycle MANAGER (AllScripts) (m) Ongoing Care Case Review 2. Get Pre-Authorization for Care (AllScripts) (o) PAYER Authorization PRIMARY MD Audit Paperwork SCHEDULER STEP 7a Schedule Care OR CLINICIAN 1. Schedule Ongoing Care (Allscripts) (m) Schedule Care 2. Schedule Home Health Aid (o) Discharge Discharge Continued Home Paperwork Health Care 410/27/2009 5 of 23
  6. 6. From Home Discharge Health Care 3 Notification HHHC Home Health Care 4 of 4 (Allscripts) Discharge STEP 8a.2 DISCHARGE CLINICIAN or PRIMARY MD 1. Delete Future Tasks & Visits (Allscripts) (o) SCHEDULER 2. Notify Case Mgr. of Discharge (m) Notification Discharge Paperwork CASE MANAGER STEP 8b.2 PAYER NOTIFICATION Payer 1. Notify Payer of Patient Discharge (m) Notification STEP 8a.1 DISCHARGE 1. Audit Contract for Completeness 2. Audit Consent to Treat PAYER 3. Audit Admit Orders from Intake Discharge Notification 4. Check Assessments & OASIS Assements Notification 5. Verify Admissions Data (Allscripts) (m) 6. Resolve Discrepencies (Allscripts) (o) ADMIN. - Clinicians - Billing - Doctor ASSISTANT 7. Audit Regulatory Paperwork (Allscripts) (m) Discharge 8. Print & Send Orders to Doctor for Signature (Allscripts) (m) 9. Perform Assigned Tasks (Allscripts) (o) 10. Run Reoports (Allscripts) (m) 11. Contact Clinician for Patient Recertification 12. Contact Doctor to Resolve Open Orders 13. Audit & Resolve OASIS Inaccuracies (Allscripts) (m) 14. Send Survey to Patient (m) Orders Orders MEDICAL PRIMARY MD END RECORDS10/27/2009 6 of 23
  7. 7. A From INTAKE Hospice HHHC Hospice House In-Patient 1 of 2 Referal House In- Patient STEP 3b.1 PRE-ADMIT: CLINICAL REVIEW CASE CLINICAL 1. Assess Hospice Level of Care (m) STEP 3b.2 INITIAL AUTHORIZATION MANAGER MANAGER 2. Assess Safety (m) Update 1. Obtain Initial Authorization From Payer (m) Initial Pre-Admission 3. Order Hook-ups & Equipment (m) Authorization Clinical Review 4. Order Medications (Allscripts) (m) 5. Collect Signed Orders (m) Notification STEP 2b ASSIGN REFERAL Orders for ADMIN. PAYER 1. Request Standing Orders From Primary Care MD (m) PRIMARY MD Care ASSISTANT Aurthorization 2. Enter Hospice Certification (Allscripts) (m) Assign Referal 6. Create Patient Chart (m) Notification STEP 4b.1 PATIENT ADMISSION 1. Conduct Full Assessment (Allscripts) (m) 2. Review Medication (Allscripts) (m) CASE 3. Order Medication (o) CLINICIAN STEP 4b.2 UPDATE AUTHORIZATION MANAGER 4. Order Hockups, Special Equipment (to Vendor) (o) Update Patient 1. Update auth and LOC with payer (m) Update 5. Execute Consents & Contracts (paper) (m) Admission Authorization 6. Create Medication Administration Record (MAR) (paper) (m) 7. Create Plan of Care (Allscripts) (m) 8. Signed Paperwork to Admin Assistant (m) 9. Create KARDEX (m) DME PHARMACY VENDOR Prescription Equipment & Hoockups STEP 5b AUDIT ADMISSION ADMIN. 1. Send Plan of Care to Primary Care Doctor (m) Plan of Care 2. Collect Signed Plan of Care from Doctor (Allscripts) (m) PRIMARY MD ASSISTANT Audit Admission 3. Create Daily Census Report (m) 4. Send Daily Census Report to Billing/Merrimack/Nashua (m) Continued Hospice Houce10/27/2009 7 of 23 In-Patient 2
  8. 8. From Hospice HHHC Hospice House In-Patient 2 of 2 Houce In-Patient 1 STEP 6b.1 ONGOING CARE 1. Review Medication Administration Record (MAR) (paper) (m) 2. Review KARDEX Daily Task List (paper) (m) 3. Deliver Plan of Care (m) CASE 4. Review Patient Record (Allscripts) (o) STEP 6b.2 UPDATE AUTHORIZATION MANAGER 5. Record Care Delivered (Allscripts) (m) 1. Update auth and LOC with payer (m) Update Update CLINICIAN 6. Update KARDEX Daily Task List (o) Authorization Deliver Care 7. Voice Record Clinical Info (for next shift) (m) 8. Review Hospice Level of Care (daily) (Allscripts) (m) Notification 9. Create Discharge Plan (Allscripts) (paper) (o) 10. Create Discharge Summary (upon patient death)(Allscripts) (o) Ongoing Care 11. Complete Death Certificate (Allscripts)(paper) (o) 12. Notify Berevement Coordiator (upon patient death) (o) Every 2 weeks 13. Create Discharge / Transfer Notice (Allscripts)(paper) (o) Inter-disciplinary STEP 7b Patient Care Review PAYER Notification Team 1. Review Plan of Care (m) Aurthorization Patient Care 2. Document Meeting Notes (Allscripts)(paper) (m) Review Meeting 3. Sign Attendance Sheet (paper) (m) Inter-disciplinary Team MD Nurse Nurse Manager Social Worker Therapy LNA Counselor (Spiritual, Bereavement, Volunteer) Discharge / CASE Death STEP 8b UPDATE AUTHORIZATION Transfer MANAGER Certificate 1. Update authorization and LOC with payer (m) Notice Update Authorization Home External Bereavement Funeral Hospice Nursing Coordination Home Care Home10/27/2009 8 of 23
  9. 9. A From INTAKE Referal Home HHHC Home Hospice 1 of 3 Hospice ADMIN. ASSISTANT STEP 1 PATIENT ADMISSION Patient 1. Create Patient Case File (m) Admission DME DME Request VENDORS STEP 2 LEVEL OF CARE REVIEW CLINICAL 1. Review Level of Care (m) MANAGER 2. Schedule Admission Visit (Allscripts) (m) Level of Care 3. Coordinate DME (Durable Med. Equip.) w/Vendors (m) Review 4. Get Admission Approval from Physician (m) Admission Approval STEP 3 PATIENT ADMISSION 1. Pick up Case File (m) 2. Conduct Full Assessment (Allscripts) (m) 2. Review Medication (Allscripts) (m) CLINICIAN 3. Order Medication (o) PRIMARY MD Patient 4. Execute Consents & Contracts (paper) (m) Admission 5. Create Plan of Care (Allscripts) (m) 6. Determine Level of Care (Allscripts) (m) 7. Print Care Plan (for Hospital or Nursing Home) (o) 8. Educate Facility Staff (o) Plan of Care 9. Deliver Case file to Admin Assistant (m) & Hospice STEP 4 ADMISSION FORM REVIEW Certification ADMIN 1. Review Admission Forms (m) ASSISTANT 2. Send Plan of Care to Primary MD (m) Patient 3. Get Signed Hospice Certification from Primary Doctor (m) Admission 4. Get Signed Hospice Certification from Hospice MD (m) HOSPICE Hospice MEDICAL Certification DIRECTOR Continued Home Hospice 210/27/2009 9 of 23
  10. 10. PATIENT Contract From Home HHHC Home Hospice 2 of 3 FAMILY Hospice 1 STEP 5 DELIVER CARE 1. Self Schedule Visits (Allscripts) (m) FACILITY 2. Deliver Plan of Care STAFF Plan of 3. Update Patient Record (Allscripts) (m) Review Care 4. Obtain Orders From Doctor (Allscripts) (m) Plan of 5. Order Medications (o) Care 6. Order DME (Allscripts) (o) 7. Print Care Plan Updates for Facilities (o) 8. Review Care Plan Updates with Facilities Staff (Allscripts) (m) PHARMACY Medication 9. Schedule Other Clinicians (Allscripts) (o) CLINICIAN Medication Request 10. Prepare Referral Transfer Forms Deliver Care Process 11. Notify Case Manager of Changes in Care or Setting (o) 12. Obtain Signed Contracts from Family (o) 13. Discuss Plan for Transfer with Patient (o) 14. Enter tasks as Needed (Allscripts) (o) 15. Give Appropiate Forms/Notice to Patient (o) DME 16. Notify Doctor of Changes VENDOR DME 17. Notify Clinician Team of Changes Request 18. Chart Visit (Allscripts) (m) Equipment Request - Assessment - Clinical Notes - Problem Charting - Transactions (times in/out/travel) PRIMARY MD Orders Sign Orders BILLING Contract ASSOCIATE Continued Accounting1 Continued Home Hospice 310/27/2009 10 of 23
  11. 11. From Home HHHC Home Hospice 3 of 3 Hospice 2 STEP 6b AUDIT CONTRACT 1. Audit Contract (m) ADMIN CASE STEP 6a CASE REVIEW 2. Enter Level of Care Changes (AllScripts) (m) ASSISTANT MANAGER 1. Review Pre-Authorization Cycle (AllScripts) (m) 3. Create Daily Census Report (AllScripts) (m) Audit Contract Case Review 2. Get Pre-Authorization for Care (AllScripts) (o) 4. Distribute Census Reports (m) 5. Send Updated Orders to Primary MD (AllScripts) (o) Ongoing PAYER Care Aurthorization Updated PRIMARY MD Orders Updated Orders STEP 6c ONGOING CARE 1. Self Schedule Visits (Allscripts) (m) 2. Deliver Plan of Care 3. Update Patient Record (Allscripts) (m) 4. Order Medications (o) Death FUNERAL 5. Order DME (Allscripts) (o) Certificate HOME 6. Print Care Plan Updates for Facilities (o) 7. Review Care Plan Updates with Facilities Staff (Allscripts) (m) 8. Schedule Other Clinicians (Allscripts) (o) CLINICIAN 9. Prepare Referral Transfer Forms Ongoing Care 10. Notify Case Manager of Changes in Care or Setting (o) 11. Enter Tasks as Needed (Allscripts) (o) 12. Notify Doctor of Changes (o) 13. Notify Clinician Team of Changes (o) BEREAVEMENT 14. Chart Visit (Allscripts) (m) 15. Prepare & Submit Referral Transfer (o) 16. Prepare & Submit Discharge Notice (o) 17. Prepare & Submit Death Certificate (o) 18. Notify Bereavement Coordinator (o) Referral Every 2 weeks Transfer or Discharge Inter-disciplinary STEP 7 Patient Care Review HOSPICE Team 1. Review Plan of Care (m) PALLATIV PRIVATE HOUSE IN- Patient Care 2. Document Meeting Notes (Allscripts)(paper) (m) E CARE DUTY PATIENT Review Meeting 3. Sign Attendance Sheet (paper) (m)10/27/2009 11 of 23
  12. 12. Accounting 1 of 3 Home Health & Commercial Hospice From Patient BILLING Admit. Contract STEP 1 REVIEW PAYER & PATIENT SETUP 1. Check Payer Status & Date (Allscripts) (m) Medicare / PPS / MHB BILLING 2. Check Patient Eligibility (phone, web) (m) VA / Title 20 / Government ASSOCIATE 3. Review Contract (m) Anthem / Cigna Revew Payer & 4. Enter Negotiated Rate (Allscripts) (o) Medicade / Private / Self Pay Patient Setup 5. Review Letter of Agreement (o) 6. Enter Room & Board Fees (Allscripts) (o) STEP 2 BILLING 1. Run & Review Pre-Billing Audit Report (Allscripts) (m) (Eligibility Report for Each Payer) 2. Process Billing Cycle (Allscripts) (m) 3. Print Billing Register (Allscripts) (m) 4. Compare Reports (Allscripts) (m) 5. Recalculate Payer (Allscripts) (m) 6. Verify & Correct Accuity Levels (Allscripts) (m) 7. Check Authorization (Comm. Payers) (Allscripts) (o) 8. Check Daily Census (Hospice House) (Allscripts) (o) 9. Enter Clinician Visits @ Hospice House (Allscripts) (o) 10. Get Notice of Benefit Election (Hospice House) (document) (o) 11. Get Certificaton of Terminal Illness (Hospice House) (document) (o) BILLING 12. Review Patient Contract (o) ASSOCIATE 13. Review Letter of Agreement (Comm. Payer/Hospice House) (o) Billing Cycle 14. Send 81A To Medicare (Allscripts) (o) 15. Force Date & Process Corrections (Allscripts) (m) 16. Print Claims (Allscripts) (m) 17. Verify Claims vs. Home Care Visits (Allscripts) (m) 18. Verify Revenue Codes/HCPSC Codes & Rates (Allscripts) (o) Claim 19. Print & Check Assessments & Dr. Orders (o) 20. Check Dr. Visits (Hospice, Medicare) (Allscripts) (o) 21. Submit Claims to Payer (Allscripts, electronic, paper) (m) 22. Verify Authorizations Match on Claim (Allscripts) (m) 23. Check Projected Visits for Medicare/PPS (o) 24. Check OASIS is Complete (o) Medicare, Harvard Freedom, Medicare Private To Accounting2 25. Reconcile Accounts Receivables10/27/2009 12 of 23
  13. 13. From Accounting 2 of 3 Accounting1 Commercial Payers Claim PRIVATE VA, TITLE MEDICADE MEDICARE PATIENT PAYERS 20, GOV. Claim Claim Claim Claim Claim Processing Processing Processing Processing Processing Payments STEP 3 POST & RECONCILE DEPOSITS 1. Post Deposits (Allscripts) (m) 2. Reconcile Deposits (Allscripts) (m) BILLING 3. Post Medicare (ERA) (Allscripts) (m) MANAGER 4. Post Manual Payments (Allscripts) (m) Post & 5. Post Payment Denials (Allscripts) (m) Reconcile 6. Post Manual Adjustments & Write-Offs (Allscripts) (m) Deposits 7. Review Accounts Receivables (m) 8. Generate Reports & Graphs (m) 9. Bill Med Cap (m) 10. Bill Patients (o) End STEP 1 TELEPHONY 1. Enter Clinician Visits (Telephone) (Allscripts) (m) BILLING 2. Reconcile Visit Data (Allscripts) (m) ASSOCIATE 3. Enter Manual Green Day Sheets (Allscripts) (m) Telephony 4. Enter Contract Services (Allscripts) (m) 5. Generate Reports (Allscripts) (m) PAYROLL10/27/2009 13 of 23
  14. 14. Accounting 3 of 3 Commercial Payers MEDICAL SUPPLY VENDOR Invoice (document) BILLING STEP 1 MEDICAL SUPPLY BILLING HOSPICE ASSOCIATE 1. Send For Approvals (m) HOUSE Approvals Medical 2. Enter Medical Supply Bills (Allscripts) (m) Supplies 3. Send Supply Bills to A/P (Allscripts) (o) Invoice ACCOUNTS PAYABLE End10/27/2009 14 of 23
  15. 15. OVERVIEW 1 of 8 HHHC Patient Intake NURSING HOSPITAL DR. OFFICE FAMILY HOME Patient Hospice Patient Hospice Patient Hospice Patient Hospice Referal Referal Referal Referal Referal Referal Start LIASON Patient Hospice Evaluation CASE PAYER INTAKE NURSE MANAGER Authorization Patient Intake Case Intake Home Hospice Home Palliative Private Health House Hospice Care Duty Care In-Patient Care10/27/2009 15 of 23
  16. 16. OVERVIEW 2 of 8 Home HHHC Home Health Care 1 of 4 A Health Care From INTAKE TEAM LEADER Assign Referal SCHEDULER Schedule Services CLINICIAN Pre-Admission CASE CLINICIAN PAYER MANAGER Patient HHHC Home Health Care 2 of 4 Authorization Case Intake Admission DME VENDOR ADMIN. SCHEDULER PRIMARY MD PATIENT Medical Supply ASSISTANT OR CLINICIAN Delivery Audit Admission Schedule Care Continued Home Health10/27/2009 Care 3 16 of 23
  17. 17. OVERVIEW 3 of 8 From Home HHHC Home Health Care 3 of 4 Health Care 2 ADMIN. CLINICIAN ASSISTANT Deliver Care Audit Paperwork CASE Ongoing Care MANAGER Case Audit Scheduler or Clinician Schedule Care PAYER HHHC Home Health Care 4 of 4 Aurthorization Discharge Notification (Allscripts) Discharge ADMIN. PRIMARY MD CLINICIAN OR ASSISTANT SCHEDULER Discharge Notification Orders CASE MANAGER MEDICAL PRIMARY MD Payer Orders RECORDS Notification Notification PAYER Discharge END Notification10/27/2009 17 of 23
  18. 18. OVERVIEW 4 of 8 HHHC Hospice House In-Patient 1 of 2 A From INTAKE Hospice Referal House In- Patient ADMIN. Orders PRIMARY MD ASSISTANT Assign Referal CASE CLINICAL MANAGER MANAGER Update Initial Pre-Admission Authorization Clinical Review Notification PAYER Aurthorization Notification CASE CLINICIAN MANAGER Update Patient Update Admission Authorization ADMIN. Continued ASSISTANT Hospice Houce Audit Admission In-Patient 210/27/2009 18 of 23
  19. 19. OVERVIEW 5 of 8 HHHC Hospice House In-Patient 2 of 2 From Hospice Houce In-Patient 1 CASE Inter-disciplinary MANAGER CLINICIAN Team Update Update Deliver Care Every 2 weeks Patient Care Authorization Review Meeting Ongoing Care Discharge / Death Certificate Transfer Notice Notification Update FUNERAL HOME CASE Home External PAYER Notification MANAGER Hospice Nursing Bereavement Aurthorization Update Care Home Authorization10/27/2009 19 of 23
  20. 20. OVERVIEW 6 of 8 From INTAKE HHHC Home Hospice 1 of 3 A Referal Home Hospice ADMIN ASSISTANT Patient DME Admission VENDORS DME Request CLINICAL Admission MANAGER Approval Level of Care Review PRIMARY CARE PHYSICIAN CLINICIAN Patient Admission Plan of Care & Hospice Certification Continued Home Hospice 2 ADMIN ASSISTANT Patient Admission HOSPICE Hospice MEDICAL Certification DIRECTOR10/27/2009 20 of 23
  21. 21. OVERVIEW 7 of 8 HHHC Home Hospice 2 of 3 From Home PATIENT Contract Hospice 1 FAMILY FACILITY STAFF Plan of Review Care Plan of Care PHARMACY Medication Medication Request Process CLINICIAN Continued Home DME VENDOR DME Deliver Care Hospice 3 Request Equipment Request PRIMARY MD Orders Sign Orders Continued BILLING Contract Accounting1 ASSOCIATE10/27/2009 21 of 23
  22. 22. OVERVIEW 8 of 8 HHHC Home Hospice 3 of 3 From Home Hospice 2 Updated ADMIN CASE PRIMARY MD Ongoing PAYER Orders ASSISTANT MANAGER Updated Orders Care Aurthorization Audit Contract Case Review Death Funeral Certificate Home CLINICIAN Referral Transfer Ongoing Care Or Discharge Bereavement Inter-disciplinary Hospice Team Every 2 weeks Palliative Private House Patient Care Care Duty In-Patient Review Meeting10/27/2009 22 of 23
  23. 23. ACCOUNTING OVERVIEW From Patient Accounting Admit. Home Health & Commercial Hospice Contract BILLING ASSOCIATE Revew Payer & Patient Setup Claim BILLING ASSOCIATE Billing Cycle PRIVATE VA, TITLE MEDICADE MEDICARE PATIENT PAYERS 20, GOV. Claim Claim Claim Claim Claim Processing Processing Processing Processing Processing BILLING MANAGER Post & Reconcile Payments Deposits End BILLING MEDICAL ASSOCIATE SUPPLY Invoice Telephony VENDOR (document) BILLING ASSOCIATE Approvals HOSPICE Medical HOUSE Supplies PAYROLL Invoice ACCOUNTS End PAYABLE End10/27/2009 23 of 23

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