Essential Aspects of a

Successful Access Department

Christine F. CollinsExecutive Director, Patient Access Services

Brigham and Women’s and Faulkner HospitalsMAHAM Fall EventSeptember 16, 2011

BWH Overview FY10

• 768 Operating Beds• 793 Licensed Beds• 45,995 Admissions• 2,996 ATO’s (inpt bed)

LOS 25.5 hours• 31,526 Surgical Procedures• 19,195 Inpatient Surgeries• 11,013 Day Surgeries• 1,318 Foxboro Surgeries• 256,373 Patient Days

• 91% Occupancy• 5.6 ALOS• 783,544 Ambulatory

Visits• 9,252 Weiner Pre-op• 7,894 Births• 24,717 CDIC• 58,466 ED Visits• 5,370 EDOBS

LOS 10.0 hours

Philosophy

The overall philosophy within

Patient Access Services

is to maintain

timely, accurate processing

of every patient,

focusing on the “up front” activities

that will guarantee

“back end” success.

and…

There is No Magic Bullet

One Size Doesn’t Fit All

just remember that…

Flexibility is the Key

Be Receptive to Change

What is Access?

• A means of approaching, entering, exiting, communicating with, or making use of

• Permission, liberty, or ability to enter, approach or pass to and from a place or to approach or communicate with a person or thing

• Freedom or ability to obtain or make use of something

• The state or quality of being approachable

What Should Access Encompass?

• Almost anything that you want

• One size doesn’t fit all

• Your department should be tailored to fit the needs of your institution

• Accept the challenges of the present health care environment and look at the changes as opportunities

• Embrace and willingly accept responsibility for non-traditional aspects of access

Customer Access Vision

Customers should be able to gain access to services through an

integrated system, which meets their needs and expectations, minimizes the number of transactions, and maximizes

the use of resources and space allocated to these processes.

Keys to Success

• Develop and maintain outstanding relationships – use your personality to your advantage

• Stay current with government and industry changes• Proactively respond to changes and current issues• Accurate and timely identification of patients• Contract participation• Apply high standards for data collection and integrity• Insurance verification/precertification• Rapid follow-up on emergency admits• Concurrent review• Timely Billing• Denial Management

Access Data

Text

Bed Managemen

t ADT

TextText

Patient Financial

and BusinessServices

MD Connect

Reservation Center

Hospitality and Family

Liaison

ED Registration

International Department

Ruth & Carl J. Shapiro Pavilion

Denial Managemen

t

Access Data

Reservation Center

• Schedule surgical procedure and/or medical admission

• Schedule associated visit• Obtain visit specific and demographic data• Schedule Preadmission Test Center

appointment• ESP (on-line booking from MD’s office)• Determine eligibility for admission

Patient Financial/Business Services

• Responsible for screening over 70,000 patients per year from time booked until bill cut

• Verify insurance benefits and data collected• Notify payor of pending visit, submit case for

precertification, if required• Notify patient of any co-pay, deposit requirements,

financial liability• Verify approvals on-line• Follow-up with payor requirements at time of

admission• Determine order to be billed for multiple plans• Maintain accurate and complete documentation

Forwarding Account to Billing

• Patient Financial/Business Services completes all necessary requirements by payor

• Current financial class information and billing order is maintained on-line

• Issues are addressed and resolved• Completed cases are forwarded to Billing.

MD Connect

• Process transfer requests from outside physicians

• Provide link between outside physician and appropriate BWH clinical consultant

• Collect/verify patient data and insurance• Arrange for transfer of patient• Establish priority level to facilitate patient flow• Maintain correspondence with PCP’s and

Referring MD’s to ensure closure of communication loop

Bed Management/ADT

• Maximize utilization of resources• Facilitate flow of patients• Collect/verify patient data and insurance• Establish placement priorities• Assign housestaff – load balance• Maintain dynamic bed system• Maintain accurate census• Administrative responsibility for medico-legal

cases

Hospitality - Family Liaison

• Track patients undergoing surgery/invasive procedures

• Serve as liaison between patients, their families and the medical staff

• Identify & register person to be notified and manner in which he/she can be reached

• Escort patients to Operating Room Suite• Keep family up-to-date on patient’s progress• Monitor patients’ personal belongings• Assign and monitor beepers for families• Inform family of room assignment, estimated

time of arrival on unit and telephone number

ED Registration

• Greet and accurately identify patients in accordance with policy; initiate online visit

• Collect/verify patient demographics, including insurance details (bedside reg)

• Collect co-pay• Refer uninsured and underinsured to appropriate staff• Initiate notification as mandated by payor• Obtain necessary signatures• Distribute HIPAA notice and obtain signed

acknowledgement of receipt from patients• Ensure that patients have received notification of their

rights to allow hospital to be in compliance with all city, state and federal regulations and mandates

• Keep family up-to-date on patient’s progress

International Department

• Coordinate all aspects for international patients• Arrange for BWH Physician Consultant• Collect/verify patient data and insurance details• Responsible for financial arrangements from

initial contact through collection – revenue producing

• Schedule all appointments• Coordinate travel arrangements• Provide concierge services from the time of 1st

appointment until discharge• Provide interpreter services for all appointments,

and on an as needed basis while patient is in the hospital

Denial Management

• Follow-up on denied claims, until resolved• Formulate and submit appeals, meeting all

applicable deadlines• Work collaboratively with all hospital

departments to minimize loss of revenue due to denials

• Initiate write-off policy• Cultivate, maintain and enhance relationships

with third party payors• Watch for trends/new types of denials• Follow-up with fixes whenever possible

The Ruth and Carl J. Shapiro Pavilion Liaison

• Administrative responsibility for Business Operations of Pavilion

• Fully responsible for cash collection management• Obtain credit card details at the time of reservation to

guarantee reimbursement of charges• Post all charges within 24-48 of discharge• Send patient Pavilion Statement• Maintain strict controls and documentation• Excellent interpersonal skills required to address issues

and patients’ needs• Point person for non-clinical issues• Liaison with Development regarding key donors and

potential donors

You can’t build a reputation on what you’re going to do. Henry Ford

Identify Improvement Opportunities

• Maintain and cultivate excellent working relationships

• Streamline your process, eliminate duplication• Small changes can often produce big results• Documentation is imperative for all aspects of

compliance and reimbursement• Preadmission screening is key in reducing denials• Follow-up on all unresolved cases with third party

payors, before they become denials• Be creative

Technology to the Rescue

• Use technology to make improvements whenever possible

• Maintain all documentation online – scanners are our friends

• Use system prompts/drop down menus

• Improve data collection and integrity

• Integrate systems to provide maximum availability of necessary data

• Streamline process

Experience is not what happens to you; it’s what you do with what happens to you. Aldous Huxley

Thank you for your interest in this presentation.

Christine F. Collins Executive Director, Patient Access Services

Brigham and Women’s and Faulkner HospitalsPartners HealthCare System

75 Francis Street, Boston, MA 02115Telephone: (617) 732-7453 Fax: (617) 264-6335

E-mail: cfcollins@partners.orgBWH Web Site:

www.brighamandwomens.org