1. HMO Badge Buddy
By: Kelsey Fox

2. Definitions
O Capitated Contract
 A healthcare plan that allows payment of a flat
fee for each patient it covers. Under a
capitation, an HMO or managed care
organization pays a fixed amount of money for
its members to the health care provider.
O Non-Capitated Contract
O HMO (Health Maintenance Organization

3. HMOs of Ohio
O Caresource
O Molina
O Paramount Advantage
O United Health Care
O Buckeye Community Health Plan

4. Why a badge buddy?

5. Benefits
O Easily & Readily accessible
O You won’t forget your badge for work, so
you won’t forget this
O Saves time
O Saves Space
O Saves Money!! $$$$

6. May, 2014
• Began my
internship (big
portion was to start
a project that would
help the hospital)
• Idea for badge
buddy began,
creating the layout
of the product
June, 2014
• Sent ideas to print
shop to have 30
copies made (card
stock and lamination)
• Dispersed my
buddies out to
registration staff on
my floor of
Ambulatory as well
as select other
locations
July, 2014
• Contacted IMPACT
and submitted my
idea via ANCHOR
• informed Amber
Tripplett (IS) of my
idea, and she loved
it! Requested that
she receive a supply
of my product to
pass out to new
hires.
• Got together with AJ
as my IMPACT
Specialist, and
discussed the
product
August, 2014
• Created a survey &
sent it out hospital
wide to all
registration staff,
MA, and Patient
Access/ Accounts
employees.
Received amazing
feedback!
• Completed
internship, but
project with Badge
buddy still
continuing
September,
2014
• Met with Daryl
Barker (Marketing)
to discuss creating
the project on
harder material
and ordering
multiples. Also
discussed pricing.
October, 2014
• Received
feedback for
pricing and
decided to order
1,000 of my
finished product.
November, 2014
• Discussed with
Tracy Burris
(Director –
Patient Access)
to see about
budget and
ordering options.
Decided 1,000
was a good
number.
December, 2014
• Received original
design from print
shop to have
harder copies
made. Updated
Insurance
pictures were put
into place.
January, 2015
• Hopefully final
printed products
will be here! &
IMPACT
presentation!!
Timeline of my project

10. Cap Counties in Ohio
Athens Logan
Belmont Madison
Coshocton Marion
Crawford Meigs
Delaware Monroe
Fairfield Morgan
Fayette Morrow
Franklin Muskingum
Gallia Noble
Guernsey Perry
Harrison Pickaway
Hocking Pike
Jackson Ross
Jefferson Scioto
Knox Union
Lawrence Vinton
Licking Washington
ALL PATIENTS AGE 19 AND OVER
ARE ALWAYS NON-CAP!!
5 Ohio HMOs
Front Back

11. Importance?
O If insurance information is wrong on the patient’s
hospital account, the claim will not be sent to
insurance.
O If a hospital claim is not billed in the time frame, it
may not be paid at all by the insurance company.
O If payment of a bill is not received within 30 days,
the hospital automatically loses out on money.
O Hospitals will still bill patients for services whether
insurance has kicked in or not, but this can result
in lack of payments.
O Past 90 days from the billing date, it’s virtually
impossible to see any form of payment. (Bad Debt)

12. Did you know?
O EOB (Explanation of Benefits) from your
health insurance could possibly say
something to the extent of: "claim was
submitted after the timely filing limit, therefore
no payment was made. The patient is not
liable for the remaining balance.“
O This creates more Bad Debt for the hospital,
which is a loss in revenue and only a slight
hope to write off some of that debt at tax time.

13. Medical Billing Mistakes
O It is estimated that doctors in the U.S.
leave approximately $125 billion on the
table each year due to poor billing
practices.
O This is a stark reminder for physicians that
providing optimal patient care is only one
of the big factors in becoming successful
in the industry.

14. Billing Errors
O It is estimated that up to 80% of medical bills
contain errors. Insurance companies are very strict
on correct medical billing and coding practices,
and even the smallest mistake can cause an
insurance company to reject a medical billing
claim.
O This starts a long process requiring the doctor to
fix the error, submit the claim a second time, and
then wait (and hope) for the new claim to be
accepted and processed.
O Medical billing errors can cause a doctor to have to
wait several months or more before receiving
payment for their services.

15. My hope for this project
O I intend for NCH staff, on-site and off-campus, that will be
entering, deleting, correcting, or verifying patient insurance
information to possess one of these badge buddies.
O Roles include, but are not limited to:
 Registration
 Medical Assistants
 Patient Access
 IS (Training Purposes)
 Patient Accounts
 Medical Records
 Clinic Leads and Program Management
O Also, I intend for all new hires in these important roles to
receive their badge buddy during training.

16. Thank you so much for
your time!!