Proposal for Medical Registration Software. Entertaining Diversity, Inc. d/b/a Voicewize

Transcription

1 Proposal for Medical Registration Software Entertaining Diversity, Inc. d/b/a Voicewize

2 Who are we? Entertaining Diversity, Inc. was founded in 1992 for the purpose of teaching cultural and ethnic diversity awareness through entertainment. We incorporated in In 2004, the Voicewize division was added under my direction. Voicewize's mission is voice and speech training and speechlanguage pathology services. Voicewize accepts 3 insurance plans: Blue Cross Blue Shield, Harvard Pilgrim Healthcare and Tufts Health plan for our speech therapy services. Other services are rendered on a feefor-service basis.

3 The problem - Summary Management of information flow for the speech therapy patients who are using their health plans to pay for services is extremely complex. There are hundreds of variations to the plans offered by the companies we accept. In addition, the collection of this data is time-sensitive. We need to have all of the patient's information in our system and have any needed insurance referrals or authorizations in place before the patient arrives for their appointment. Usually this requires the patient to take action, but we need to be able to check the insurance authorizations or referrals prior to the patient's arrival. In general, people don't understand how their insurance plans work or what is and isn't covered.

4 How Insurance Works - Overview 1. You go to an MD, who says you should get speech therapy 2. Either the MD refers you to someone they know, or you find a speech therapy practice in your list of in-network providers from your insurance company. 3. You make your appointment for an evaluation. 4. Now one of several things need to happen: - No action. Your insurance company requires nothing. - You need to call your primary care physician to enter a "referral" for the service (this is separate from the MD "order/prescription" for the service provided by the MD who said you need speech therapy) - You need to get some kind of "pre-authorization" or "precertification based on their analysis of your diagnosis (too bad they're not actually MDs...) 5. In order to get paid, the provider needs the referral to be registered with the insurance company. This is why many providers will not see you if you do not have a referral on file, or they will make you sign a "waiver" requiring you to take responsibility if the referral does not go through. (FYI: It's a law that providers have to collect your co-pay...)

5 How we do it now 1. First patient contact: Either they call us or we receive information from an MD asking us to call the patient. 2. Scheduling may take a little bit of phone tag and/or back and forth via . Then at some point our part-time admin asst has to talk to them on the phone to collect their demographic and insurance information. 3. Either via or snail mail we send them written information regarding what they need to do for their insurance referral. 4. From there it kind of goes into no-man's land and we really aren't capturing the information prior to the patient's visit. Often this works out - sometimes it doesn't...

6 What we want to do 1. Eliminate the phone tag involved in collecting demographic and insurance information and provide a way for the patient to enter their information at any time of day. 2. Provide instructions to the patient that are clear and that emphasize the importance of the actions they must take and the timeline in which they must be taken. 3. Construct a feedback mechanism through which our admin asst can follow up on making sure that everything is in place prior to the patient's visit 4. Be able to dump the patient's demographic and insurance information into our Electronic Medical Record system (EMR) 5. That all of these functions can be carried out in a web browser (multiplatform environment for Mac or PC and for EI, Safari, Firefox and Opera,? Mobile devices)

7 Special Considerations 1. HIPAA (Health Insurance Portability and Accountability Act) laws have strict guidelines for security of PHI (Protected Health Information). Security measures need to be strong and encryption will be a necessity. 2. Our offices run in a Mac environment and communicate over the internet, but some of our staff accesses information from home on their Windows machines. Patients will have a variety of systems they are working from. 3. It will be convenient for patients if some portions of the form can auto-fill from their stored information. 4. Important to prevent typos (Can we require double entry of certain items) and have information format standardized (e.g., parentheses versus dashes in phone numbers) 5. I'd like the pages to be very simple, but attractive. Perhaps we can have some judicious use of color. Certainly our logo and real world information at the top of each page.

8 Content Concept - The Invitation When we create the appointment in Google Calendar, we will send an "invitation" to the patient. This will include the location, a greeting and also the link to the site where they can enter all of their information. Our will say something like this: "Thank you for scheduling your speech therapy evaluation with Voicewize. We look forward to meeting you. Please use the following link to set up your registration information and get instructions regarding your insurance referral. This should be completed one week prior to your appointment. Feel free to contact us if you have any questions. Sincerely, Barbara Wilson Arboleda" When they click on the link, they will be taken to the site you are constructing.

9 Content Concept - Registration Center Page 1 Each page they see will have our logo and real world contact information on top and also our web site information On the first page there will be an introduction followed by three links as follows: Welcome to the Voicewize speech therapy registration center! Please use the following three links to ensure you are registered and that your insurance company is prepared to cover your services. Step 1: Enter your personal and insurance information for our records Step 2: Make sure your insurance company will pay Step 3: Print out and sign your intake forms (bring to your appointment

10 Content Concept - Registration Center Step 1 Link Patient Information This will have the guts of what you are designing. They will enter their demographic and insurance information. This will then be dumped into the database when they click "Submit" (When they submit, they should be brought back to the first page in the registration center for "Step 2") - I'm presuming it will be form-based - Auto-fill capability, if able - Double entry of crucial information (e.g., insurance plan number and date of birth) - There should be lots of white space and flow clearly from one field to the next (dummy-proof) - Data fields should be standardized in format (e.g., state, phone numbers, etc.) - Use large type size

11 Link 1: Patient Information This is our current demographic/insurance registration/intake form. We will still need something like this to be able to be printed out, as our billing woman needs to get all of the information into our billing system (Emdeon) and track payments on visits.

12 Content Concept - Registration Center Step 2 - Referral/Authorization Info I would like to have them retrieve information for their specific plan: Ideally, I'd like them to see the request: "Please select your insurance company from the list below Blue Cross Blue Shield Harvard Pilgrim Health Care Tufts Health Plan Other" When they click on their insurance company, then company specific information will come up. I will provide content for those pages and would like to have the ability to edit them as plan information changes and to add new links for when we add new insurance contracts.

13 Content Concept - Registration Center Step 3 - Intake Forms This page will include 3 forms in PDF format that they need to print out and bring to their appointment. We do not currently have a way to accommodate electronic signatures for these...unless you can suggest something! The forms are: - General agreement form - Privacy Practices form - Cancellation policy

14 Back End - Retrieval of Information Our admin needs to know when new information is added to the database and have a vehicle for retrieving the information and shunting it into Clinicsource. It would be great if this could be web-based as well...or otherwise as automated as possible. She also needs to follow up regarding the referral and make sure it's in place prior to the appointment date.