Among the many challenges facing health care

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1 The Value of Visit Management at Your Organization BY ELIZABETH WEIDMAN, SENIOR ANALYST Catch Data Systems April 2014 Among the many challenges facing health care organizations today, few have the potential to bring modern medicine to a grinding halt the way problems with patient scheduling and billing can. Patient workflow blockages, insurance assignment inaccuracy, data capture difficulties, and user workflow duplications can all reduce patient volumes and delay or deny crucial revenue at a time when it is critical that organizations be as efficient as possible. However, technologically savvy physician and hospital provider organizations can avoid many of these issues by employing GE Centricity Business Visit Management software. Visit Management can unify and measurably improve integration between: Scheduling systems, such as Enterprise Wide Scheduling (EWS); Revenue cycle systems, such as Ambulatory Billing (BAR) and Transaction Editing System (TES); and, External systems, such as the hospital Admissions, Discharge and Transfer system (ADT) and the hospital billing system. What is Visit Management? Visit Management is a software application within the GE Centricity Business suite that introduces the concept of a visit to enhance the management of patient access and billing at your organization. The visit captures episodespecific information, such as appointment and insurance Visit Management is a software application within the GE Centricity Business suite that introduces the concept of a visit to enhance the management of patient access and billing at your organization. The visit captures episodespecific information, such as appointment and insurance data and ties this together with claims. This enables Visit Management to provide a convenient historical record of a patient s visit activity at your organization. data and ties this together with claims. This enables Visit Management to provide a convenient historical record of a patient s visit activity at your organization. When a physician is working in a practice setting, the scheduled appointment serves as the mechanism that gathers all information necessary to create the visit and bill professional claims. The main purpose of a visit is to create a container to hold the payer information for a specific point in time. In a physician practice setting the visit is created several days in advance of the patient s appointment. This allows insurance eligibility and verification staff the opportunity to verify that visit insurance collected at the time the appointment is created is accurate, well in advance of the patient s arrival. When a physician sees a patient outside the practice at the hospital, the visit can be created in Visit Management with visit level insurance through an interface. Visit Management receives hospital registration and insurance information into Centricity Business and uses the data to create a visit with visit-specific insurance. This enables

2 the physician practice to capture professional charges associated with the patient s hospital visit through BAR or TES, and subsequently bill the charges to the correct It is important to understand that registration level insurance only captures the patient s current medical insurance. This limitation often requires staff to use workarounds to capture visit insurance in the absence of a system like Visit Management. payer insurance. Visit insurance contains information specific to the payer responsible for the services provided to the patient for a visit. Typically, the patient s medical insurance is the responsible payer, and that information is captured and maintained with the patient s registration. Sometimes however, the responsible payer is an alternate insurance that is different from the patient s medical insurance, such as workers compensation plans, no-fault liability insurance, automobile insurance, or a clinical trial. Another common patient insurance scenario arises when patients change often between assistance plans such as Medicaid, county assistance, charity care, and self pay. It is important to understand that registration level insurance only captures the patient s current medical insurance. This limitation often requires staff to use workarounds to capture visit insurance in the absence of a system like Visit Management. With Visit Management, the visit insurance is assigned at the point when the visit is created: several days in advance of the date of service. This allows prearrival workflows to include registration and insurance eligibility and verification in advance of the visit. Any necessary referrals or authorizations may be collected and in place prior to the patient presenting for the visit. Copay collection may be done in advance or at the time of the visit. All of these steps done in advance of service to the patient result in a clean billing process and faster payment of claims. How is a Visit Created in Visit Management? There are several ways that Visit Management creates a visit to reflect each patient s care episode within your organization. In a physician provider setting, a Visit Management visit is automatically created from a scheduled appointment in Enterprise-Wide Scheduling (EWS). Subsequent appointments for the patient may be linked to an existing visit, or may create a new visit if appropriate. Information collected during the appointment scheduling and arrival is passed to the visit. Visit insurance may be assigned during the creation of the appointment, either explicitly by the user or automatically based on the patient s visit history and other factors affecting insurance assignment, such as the type of visit, location, physician, and frequency. Both the creation of the visit and the assignment of visit insurance for recently treated patients are typically automated if desired, using rules to promote minimal user intervention. Patient appointments created months in advance of the date of service are queued up so that Visit Management can create the visit just in time. Visits are created days in advance of the patient arrival so that current visit insurance can be assigned appropriately, eligibility can be checked and insurance verified in a timely manner. Providers often need to keep track of inpatient stays and outpatient services provided and tracked in systems outside of Centricity Business, such as in an external hospital system. By receiving the interfaced visit information from the hospital system, physician billing requirements and data for claims are collected and billed appropriately. No hospital or ancillary visit is missed. Finally, visits can be created manually by users directly in Visit Management. Visits from standalone enterprises outside the organization are sometimes overlooked (for example, Skilled Nursing Facility visits). Manual creation of a visit can be done at any time in Visit Management. Models of Visit Management There are two fundamental models of Visit Management oriented toward the operational and business processes of physician and hospital provider organizations:

3 Ambulatory Visit Management (AVM) is used in large clinics and physician practices. It enhances the functionality of the scheduling and billing applications, as described above; and, Enterprise Visit Management (EVM) is used primarily in hospital enterprises. EVM includes the same functionality as the AVM model, with the inclusion of bed management capabilities and tools. Both models of Visit Management enable ambulatory and hospital organizations to communicate with one another using the concept of a visit. A Visit contains a shared repository of data that physician and hospital provider organizations have in common with one another. Visit Management has the ability to integrate even disparate systems as if they were one on the Centricity Business platform. Visit Management accomplishes this by creating a visit for every patient s care episode, allowing your organization to collect and maintain insurance information for every visit. This is useful for provider organizations that care for patients on a regular basis and find that their insurance coverage can change frequently from visit to visit. It allows for streamlined, consistent pre-arrival and arrival workflow processes across your organization. This timely data collection helps to ensure complete and accurate insurance information for the claim. It also enables the collection of referrals, authorizations, co-payments and outstanding patient balances well in advance of the patient s arrival, or during the arrival process while the patient is checking in prior to receiving services. BENEFITS OF VISIT MANAGEMENT Pre-Arrival and Arrival Workflow Improvements Visit Management s pre-arrival and arrival workflows include worklists and processes that drive the collection of insurance information and insurance verification to the front desk of your organization. This timely data collection helps to ensure complete and accurate insurance information for the claim. It also enables the collection of referrals, authorizations, co-payments and outstanding patient balances well in advance of the patient s arrival, or during the arrival process while the patient is checking in prior to receiving services. Insurance Captured for the Visit With Visit Management, insurance is assigned to the visit for each care episode to be billed on a claim. For patients whose current medical insurance is to be billed, insurance information from patient registration can be used to create the visit level insurance for billing purposes. For patient visits that require an alternate insurance such as workers compensation plans, no-fault liability insurance, automobile insurance or a clinical trial, visit insurance plans, with unique follow-up questions for these payers, is used. The history of insurance-by-visit is maintained within each visit. In addition, Visit Management keeps track of alternate insurances separately, so that they are not confused with the patient s current medical insurance. System Alerts to Ensure Data Collection and Accuracy for Claims An alert notifies users that a visit is not ready for correctly billing the insurance because of missing or inaccurate data on the patient or visit record that may cause a claim to edit. For example, the visit insurance may be missing the subscriber ID or group number. Visit Management offers several worklist solutions for efficiently completing

4 alerts: Alerts Manager Worklist; Hold Bill/Alerts Worklist; Visit Manager Worklist; and, Visit Management Hold Bill/Alerts Summary View from Enterprise Task Manager (ETM). The beauty of alerts in Visit Management is that they push the completion or correction of data needed for the claim to the beginning of the revenue cycle. Checking for alerts can start as soon as the patient calls for an appointment during the pre-arrival process, and continues through the arrival process when the patient presents for their visit. This approach to pre-billing is more pro-active than waiting until claims processing to flag missing or inaccurate data via a claim edit. Capturing Additional Visit Information Insurance payers often require that additional information be included on claims before payment is made. Visit Management is ideal for meeting this requirement because it is well integrated with other Centricity Business applications such as the Managed Care Application (MCA) and Open Referrals, which enable collection and tracking of referral and authorization numbers. Visit Management also includes standard functionality for collecting data required by Medicare billing rules, such as self pay responsibility, UB condition, value, occurrence, and occurrence span codes, clinical trial study numbers, and patient reason for visit. Visit Management enables you to bring many of your paper processes online using standard Notes screens. Notes are permanently added to the patient visit using a combination of prepared phrases and free text information provided by the user. Many customers use Notes to track information related to patient access and billing. Finally, Visit Management is flexible enough to allow you to add your own screens to the pre-arrival and arrival workflows in order to capture and display information that is unique to your organization. Building Bridges to Other Systems with the Visit Physician and hospital provider organizations often need to keep track of stays and outpatient services provided and tracked in other organizations systems outside of Centricity Business. These organizations include satellite facilities not using Centricity Business, affiliated hospitals and reference labs. This tracking ensures that physician billing requirements and data for claims are collected and billed appropriated, and no hospital or ancillary visit is overlooked. Visit Management accomplishes this by electronically receiving visits and tracking updates from other systems in order to ensure that billing for these visits is executed, and revenue is not lost. The illustration below shows Visit Management as the central point of integration and repository for an organization with both hospital (ADT) and physician visits to track and maintain. This integration allows the patient access department to utilize pre-arrival and arrival worklists and take advantage of visit alerts and worklists within Visit Management early in the revenue cycle. The organization is also able to assign insurance at the visit level, allowing them to tap into other patient financial information related to visit insurance, such as eligibility checking, front desk collection and financial counseling. Visit Management s standard functionality enables the collection of additional data, such as authorizations and referrals, Medicare Survey information, UB codes, clinical trial numbers, and Patient Reason for Visit. Finally, the visit is the entity to which professional invoices are linked to capture valuable visit information needed for payer claims. Visit Management [is] the central point of integration and repository for an organization with both hospital (ADT) and physician visits to track and maintain. This integration allows the patient access department to utilize pre-arrival and arrival worklists and take advantage of visit alerts and worklists within Visit Management early in the revenue cycle.

5 CONCLUSION The discussion above outlines implementation needs of physician and hospital provider organizations that are currently using a combination of GE s Centricity Business Ambulatory Billing (BAR), Enterprise Wide Scheduling (EWS), Transaction Editing System (TES), and Managed Care (MCA) applications to manage patient access and billing at their organizations. Visit Management is ideal for improving patient access workflows. It enables your organization to start the patient pre-arrival process earlier in the revenue cycle. When the patient arrives for services all of their information has been accurately collected, and they spend a minimal amount of time in the arrival area. In addition, Visit Management brings the concept of visit-level insurance and alerts to your organization. This helps to eliminate errors and re-work in billing resulting from insurance that is not collected correctly or accurately, and saves your organization time and money otherwise spent chasing down the correct insurance and re-working claims. Visit Management helps to streamline patient access workflows, improves the insurance assignment process, and simplifies claims submission to payers. Many physician and hospital provider organizations that use applications in the GE s Centricity Business suite have implemented Visit Management and achieved measurable improvements in the form of a(n): Increase in co-payment collections from patients at the front desk; Increase in patient satisfaction from the simplification of pre-arrival and arrival workflows; Decrease in edits from missing or incorrect insurance data during claims processing; Decrease in the number of claim denials and rejections; and, Decrease in the number of claims requiring re-work and re-billing. All of the above has led to an improvement in the collection of accounts receivables from payers and patients. At this time, you may want to begin to evaluate how your organization can use Visit Management to improve your revenue cycle processes. Consider the following questions about your organization s patient workflow processes and revenue cycle challenges: Does your Patient Access department struggle with collecting accurate patient and insurance information in advance of patient appointments?; Is your organization required to keep track of hospital visits in external systems in order to bill for physician professional services performed at the hospital?; and, Does your Patient Financial Services department experience a significant number of denied or rejected claims because of missing or inaccurate visit or insurance data? The answers to these questions may determine if your organization would benefit from the implementation of Visit Management. If you answer yes to any of the questions above, Catch Data Systems can help, either by providing technical guidance, functional analysis or even serving in the role of project managers. Catch Data offers measurable solutions that can assist with the implementation of the Visit Management system. We can help assess your needs and investigate areas where Visit Management s functionality may add value to your organization. In the end, the client was more efficient, better organized and well suited to work together as a whole.

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