The Patient Contact Center: Finding My Way!

Transcription

1 The Patient Contact Center: Finding My Way! Presented by James Hawkins SVP, Patient Contact Center Convergent 1

2 For Today s Discussion Market Conditions ANI Survey Results Patient Contact Center Overview Phase I: Post Discharge Phase II: Patient Access Service Unit Phase III: Full Optimization Revenue Cycle Impact / Outcomes Summary / Q&A 2

3 ANI Survey Results What solutions are you looking for at ANI this year? Patient Access / Up front collection workflow tools (53% of surveys) Patient balance estimation tools, Patient financing solutions (28% of surveys) Insurance eligibility & benefit validation (28% of surveys) What are your top pre-service revenue cycle improvement plans for the next 12 months? Price transparency, Estimation of patient financial responsibility, Front end patient collections (51% of surveys) Registration Accuracy (24% of surveys) 3

4 ANI Survey Results What are your top priorities to improve patient satisfaction? Proactive communications, Pre-service price estimation, Easy to understand statement (68% of surveys) More payment options, patient portal (15% of surveys) Which Self Pay trend do you see most likely to occur over the next 36 months? Your hospital will most likely outsource self pay (53% of surveys) Top reason = Lack of time and resources (37% of surveys) 2 nd Top Reason = Lack of tools to manage self pay (28% of surveys) Your hospital will work self pay in house (47% of surveys) Top reason = Larger portion of revenue, Better manage patient engagement (74% of surveys) 2 nd Top Reason = Reduce cost of collections (26% of surveys) 4

5 Revenue Cycle Market Conditions Patient Access Challenges High Wait Times Need to Better Manage Patient Expectations Difficult to Navigate Revenue Cycle High Abandonment Rates / Turnaround Time Financial Challenges Patient Access Specific Denials Opportunity to Increase POS Collections Opportunity to Decrease BAI Erroneous Patient Information Fragmented Operational Process Centralized vs. Decentralized Limited Accountability Lack of Focus on Measurable Outcomes Technology Challenges Resources, IT Challenges, Budget Limitations CapEx Restrictions And Many, Many More 5

6 Patient Experience Market Conditions 86% Of customers will pay more for a better patient experience 89% Of customers began doing business with a competitor following a poor customer experience 6 Source: RightNow Technologies

7 Case for Change: Why Centralize? Decentralized Centralized Future Optimization Negatively impacts the patient experience Disparate scheduling models Fragmented / non standard scheduling workflow practices Inefficiencies consume resource time Inability to cross train Non-compliance with existing centralized models Positive impact to the patient experience Ensures standardization Efficient and effective management Increased physician satisfaction Competitive advantage achieved thru outbound scheduling practices Ultimate patient experience Further refinement of processes and staffing models Proactive, forward-thinking initiatives to better prepare for changing industry regulations and new challenges 7

8 Patient Contact Center: A Phased Approach Compliance Post Discharge Self-Pay BAI Collections Feedback Loop to Front End Phase I: Post Discharge Phase II: Patient Access Service Unit Pre-Service Pre-Registration Financial Clearance Consulting & Training Technology Overlay Patient Satisfaction Scoring Patient Education Concierge one-call routing Phase III: Full Optimization 8

9 Phase I: Post Discharge 9

10 Phase I: Post Discharge Skills-based routing Multi-Lingual patient service representatives Increased collections & Improved patient satisfaction! Blended inbound/outbound calls Recording of all calls Propensity to Pay Modeling Patient-friendly billing notices Interactive Voice Response (IVR) Real-time, on-line credit card processing Online Patient Portal Continuous feedback loop to front end to drive clean claim process 10

11 Technology Components Skip Tracing / Demographic / Cellular Phone Scrubbing Automated Insurance Scrubbing Uninsured accounts Timely billing turnaround and reporting on discovered insurance Statement Solutions Patient Friendly Automated return mail workflow Guarantor billing Integration to Online Bill Pay Integrated payment plan monitoring Credit Card/ACH Processing Automated CC/ACH payment posting to reduce average handle time Operational Account Scoring Specialized work efforts to match High Dollars, Exceptions, Found Insurance, etc Operational intelligence based on account status, service location, balance, call results PBX Call Management Real time and post-call analytics 70/30 service level ; < 5% abandon rate Effective Call Routing Skill based and Bi-lingual call routing 100% digital call recording Outbound Call Solution Right Party Connects RPC s Automated voic messages Identify bad phone numbers Local Call Connect Local phone# on Caller ID IVR Self Service Solution Payment analysis and utilization reporting Obtain account balance, pay by phone Patient friendly menu options with easy access to speak with a customer service rep. 11

12 Phase II: Patient Access Service Unit 12

13 Financial Clearance Financial Clearance Provide Financial Clearance for Scheduled Services Document the following activities for scheduled patients: i) conduct insurance verification; ii) obtain and record benefits; iii) verify authorizations; and) calculate patient liabilities for scheduled patients. Generate out-bound phone effort in order to attempt to complete patient demographics, validate payor key data elements for financial clearance and complete MSP for Medicare Patients. Then conduct pre-service financial counseling calls to scheduled patients explaining insurance benefits and estimated patient liabilities, and accept payments for liabilities prior to services within ADT, if the patient so desires. Appropriately document patient accounts financially cleared, as well as, a reason for those patients not financially cleared (e.g., due to no authorization for scheduled services, patient has limited or no benefits, patient reaching life time maximum). Escalation to facility stakeholders for patients not meeting minimum payment standards as per facility financial clearance matrix. Reschedule accounts lacking authorization. 13

14 Pre-Service Activities Scheduling Performs Scheduling for Ancillary and Clinic services by means of inbound calls from Patients and or Physicians. Also responsible for Order Facilitator/Tracker Financial Clearance (Insurance Verification) Performs eligibility and benefits for scheduled IP/OP services, completes liability calculation, secure timely authorization for services and also provides inpatient notification of admission. Scrub/Creation Provides pre-registration support by creating patient accounts in the facility ADT and identifies the appropriate CPT code for the given procedure description, if not provided at the time of scheduling Pre-Registration & Financial Counseling (One Call Solution) Obtains/Validates patient demographic information, completes Medicare Secondary Payor (MSP), and provide the patient an explanation of their benefits with financial matters to better assist with collection and expectation of payment for services. Clinical Authorization Services Specialized unit that secures authorization for scheduled IP/OP Ancillary, Surgical, and Clinic based services. Account Resolution Team locates missing and or invalid key criteria elements required for verification to avoid delayed services. 14

15 Best Practice Processes Develop and adjust workflows to best practice levels Follow rules-based processes to ensure accurate and thorough work Schedule inventory worked 30 days out from DOS Utilize order tracking and follow-up for patients to be scheduled Automate eligibility benefits and patient liability estimation Prepare a pre-arrival packet for processing Follow a ABN Loop Back Process Implement "Easy Pass Lanes Evaluate Strategic Outsourcing Partnerships 15

16 Phase III: Full Optimization 16

17 Components of Optimization Pre-Registration & Financial Clearance, Price Quote Line Concierge Call Routing Self Pay / BAI Collections Patient Satisfaction Surveys, Education & Follow Up Marketing Concierge Call Routing Consulting & Training Strategic Partnerships 17

18 Expected Outcomes Enhanced Patient Experience resulting in higher levels of satisfaction and brand loyalty for the regional facilities (i.e. reduction in wait-times, reduction in delayed appointment times) Improved Physician Satisfaction with the Pre-Access Processes resulting in increased referrals / confidence Reduced Patient Access-related Denials / Lost Profits Increased POS Collections; reduced lost opportunities Reduced Bad Debt associated with Patient Responsibility Improved Overall Facility Profitability & Satisfaction Results 18

19 Efficiency & KPIs Average call length Pre-registration rate Authorization Rate Agents available Medicaid Conversion Rate Abandonment % Cancel / Reschedule Rate Longest call waiting Patient Satisfaction (Department Specific) Total calls offered Days Out Financially Cleared from DOS 19

20 Revenue Cycle Impact Enable a Great Front Door Patient Experience Physicians Patients Enable a Smart Start to the Revenue Cycle Access Management Ordering, Scheduling, Registration Processes Right Call, Right Place Utilize Resources Accurately and Optimally Care Delivery Processes Billing & Marketing Processes 20

21 Questions? Contact Us: James Hawkins SVP, Patient Contact Center, Convergent (800) , ext

22 Thank You 22