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8 Event Date: 1/29/2013 Current Date: Event Number: 1 Facilitator: David Solawetz Revision: Location: Kremmling conference room Review Team: A3 Description: Rehab charge capture work group Executive Sponsor: Cole White Team Leader: David Team Members: Sharon Justice, Sharon Waggoner, Jacob, Cordie, Sarah, Marie, Kori, Laurie, David VS Process Owner: Sharon Justice 1. REASON FOR ACTION Capture accurate rehab charges within 24 hours of patient visit. 4. BARRIERS / OBSTACLES No consequence for patient being late Aides wearing multiple hats, time management Lack of surgery, xray, etc information New patients, complex patients Two EMRs, neither designed for Rehab Therapist doesn t know HL visit number 7. COMPLETION PLANS Action Whom By When Experiment entering charges in HL Sharon Justice David 2/5/12 Met 3/28/13 Obtain scanner for Granby Rehab Sharon Justice 2/14/13 ongoing Obtain copier for Kremmling Rehab Sharon Justice 2/14/13 ongoing Obtain Trans-engine card swipe for Kremmling Sarah / Cordie 2/14/13 Met 4/15/13 Create standard work for obtaining op-report / visit note Cordie / Julie 2/21/13 On going Create standard work for notifying pt of consequences Sarah / Cordie/ Julie 2/21/13 ongoing Rearrange billing sheet add D/C and 10 day Sharon Wagner 3/28/13 Met 2. INITIAL STATE Use 3 electronic information systems; none are designed for rehab practice Takt (available time/demand) = 60 min. C/T (cycle time) = 75 min. LT (Lead time) to charge capture = 21 days Work in Progress (WIP) = 482 hours Wastes: Creating daily Excel spreadsheet Reconcile daily Excel spreadsheet Waiting to document until lunch, end of day or next day Waiting 3 days to enter charges into Excel spreadsheet Aide double checking charges in Excel spreadsheet Waiting 14 to 21 days to enter charges into Healthland Entering charges multiple times in multiple places (data redundancy) Waiting for patient to arrive Waiting for patient health information Walking to mail room to make copies - Kremmling Walking to PFS to take patient co-pay - Kremmling Under utilizing aide to help therapist 5. SOLUTION APPROACH Schedule new patients for 90 min. Therapist enters charges into HL Increase scanning capacity Granby Rehab Increase coping capacity Kremmling Rehab Tell new patients they may not be seen, or treatment time shorten if they re late Increase payment capacity - Kremmling Rehab Test- Jelly bean Marie G&C modifiers through ECW Test Therapist entering charges in HL-Rehab (look up pt by name in charge/credit/approve) 8. CONFIRMED STATE Sharon Wagner Marie Nancy and Sharon Justice 3/28/13 Met 3/28/13 Met 4/23/13 - Capturing Charges ranges from point of care to 21 days. 5/31/13 89% of charges captured within 24 hours of visit. Eliminated the following wastes: o Creating daily Excel spreadsheet o Reconcile daily Excel spreadsheet o Aide double checking charges in Excel spreadsheet o Waiting 14 to 21 days to enter charges into Healthland o Entering charges multiple times in multiple places (data redundancy) Increased utilization of PT aide to assist therapist Reduced labor utilization by 10 hours per week, resulting in not having to hire one replacement staff annual cost savings $11, TARGET STATE Pt on time, 15 min early Scan paper work Therapist paper work ready Procedure Document Charge entry One piece flow procedure, document, charge entry before seeing the next patient Schedule patient to arrive 15 min. early Schedule 90 min. for new patients Eliminate walking to mail room Take payments in Kremmling rehab dept without going to PFS Utilize aides for tasks that can be charged 6. RAPID EXPERIMENTS Make obtaining operation report and visit note from outside referrals standard work Schedule new patient for 90 min. at Granby Rehab Entering charges into HL with minimum steps Try using one additional scanner in Granby Rehab Try using a copier in Kremmling Rehab Create standard work for tell patient consequences of being late Try Trans-engine card swipe payments at Kremmling Rehab Send jelly bean through ECW to Marie of G&C modifiers Therapist entering charges into HL via Rehab module charge/credit/approve (look up by pt name) 9. WHAT DID WE LEARN? 4/13/13 Unable to schedule 90 min. for new patients because of demand /capacity Charge capture - charges needed to be rearranged for PT/OT/SPEECH. G codes were renamed and entered so more user friendly Still unable to enter C modifiers and 59 modifiers from clinical side Either ing or using Message jelly bean in ECW to notify HIM to enter C Modifiers and 59 modifiers this is working well. Not all players realized the difference between G codes and C modifiers because they had been left out of the initial discussions. Once HL system is up not anymore time consuming than excel spread sheet. Modifiers may be able to be entered by PT manager or office manager. One on one training therapists this week to enter interventions in ECW note and enter charges either at point of care or at end of day. Each therapist given 1 hr. at end of first day to allow for learning curve and mistakes.

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