badge buddy powerpoint
TRANSCRIPT
HMO Badge BuddyBy: Kelsey Fox
DefinitionsO 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
HMOs of OhioO CaresourceO MolinaO Paramount AdvantageO United Health CareO Buckeye Community Health Plan
Why a badge buddy?
BenefitsO Easily & Readily accessibleO You won’t forget your badge for
work, so you won’t forget thisO Saves timeO Saves SpaceO Saves Money!! $$$$
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
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
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)
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.
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.
Billing ErrorsO 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.
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.
Thank you so much for your time!!