1 Patient Access Management Leveraging Best Practices

2 Emdeon Proprietary & Confidential Discussion Points Best Practices within the Patient Access Process Core Fundamentals Are these part of your strategy? Best Practices Definition of the best practice How a healthcare organization can support these best practices How a vendor should support each of Best Practices Looking ahead into 2014 and beyond Where our focus may be in a few years

3 Emdeon Proprietary & Confidential Patient Access Best Practices Assumptions : Your organization is committed to providing a high level of customer satisfaction Your organization is committed to and supportive of a financial clearance approach We recognize the following statements to be true  ‘If you’ve seen one hospital, you’ve seen one hospital’  ‘If you’ve seen one successful process, you’ve seen one successful process’

4 Emdeon Proprietary & Confidential Core Fundamentals These are ‘must haves’ to be successful with Patient Access Best Practices Defined Patient Access Process Clearly documented and current Belief Hiring the right individuals and appropriate wages Training Investment in a solid training process/unit Adherence to new hire training Regimented training(retraining) calendar for existing employees Consistency!! Investment in technology Organizational ‘buy in’ to a financial clearance process Physician office relationships and scoring (accountability)

5 Emdeon Proprietary & Confidential Patient Access and its role in Financial Clearance By leveraging sound best practices, Patient Access contributes to the accuracy and completeness of the patients account. Scheduling Pre-Registration/Pre-Visit Verification Authorizations/Certifications Point of Service Next day audit Discharge Patient Accounting Pre Claim Submission Remittance Advice

6 Emdeon Proprietary & Confidential Patient Access and its role in Financial Clearance Critical data element validation points throughout the Patient Access process. Benefit Information  Insurance company  Insured  Patient share of cost o CoPays o Deductibles o Estimated Patient Responsibility Address Information  Current Address  Static Address Employer Information Credit Score  Fraud detection  Payment sources Authorization Requirements

7 Emdeon Proprietary & Confidential Patient Access Best Practice Workflow Scheduling The first interaction with the patient sets the tone for the rest of their experience. Demographic Information Accuracy  Patient name  Date of birth  Social security number  Address  Telephone number Insurance Information Accuracy  Insurance carrier identification  Policy Number / Member ID / Subscriber Number  Subscriber name  Subscriber Relationship  Pre-certification / Authorization Phone number Service accuracy  Servicing Physician (or Nurse Practitioner)  Location  Referring Physician information

8 Emdeon Proprietary & Confidential Patient Access Best Practice Workflow Pre-Registration/Pre-Verification The Pre-Registration process gives the organization the best opportunity to capture and validate. Insurance verification  Determine coverage  Service level Co-Pays and Deductibles  Establish who is insured  In Network and Out of Network benefits Address verification  If not previously performed in last 90 days Patient Bill Estimation Payment capture of patient cost of share

9 Emdeon Proprietary & Confidential Patient Access Best Practice Workflow Pre-Registration/Pre-Verification The Pre-Registration process gives the organization the best opportunity to capture and validate. Credit scoring  Establishing patients likelihood to pay  Fraud alerting  Sources for payment  Employer verification Establish Authorization Requirements  Patient requirements  Provider requirements Pursue funding options for uninsured or under-insured  Charity  Medicaid  Local funding sources Identify Payer Readmission risks

10 Emdeon Proprietary & Confidential Patient Access Best Practice Workflow Point of Service By establishing a Best Practice Pre-Registration process, the patients experience is that of CARE versus FINANCIAL. Re-verification of benefits:  If greater than 24 hours since last verification  First day of the month Form execution If ED patient or Urgent Admission:  Insurance verification  Address Verification  Patient Bill Estimation  Credit scoring  Authorization requirements  Uninsured funding  Readmission Risk

11 Emdeon Proprietary & Confidential Patient Access Best Practice Workflow Next Day Audit/Discharge The best processes and technologies do not ensure end user compliancy. Identification of existing discrepancies  Insurance benefit  Name  DOB  SS#  Member ID  Address  Diagnosis codes

12 Emdeon Proprietary & Confidential Technologies that Support Best Practice Workflow A single solution is the key to preventing leakage and end user compliance/acceptance to the best practice workflow. End user familiarity and similar workflow Minimizes integration points with HIS and HER Central repository for data Centralized patient view Single source for data integrity Owned solutions versus multiple partnerships Data content leader  Content is king!

13 Emdeon Proprietary & Confidential Beyond 2013…… The direction the industry is going……… More automation……less people Voice enabled technology The patient will play a larger role in the registration process Kiosks/Smart screens Patient portals Increase in services to support ACA requirements

14 Emdeon Proprietary & Confidential 14 Questions?