PFS New Direction – An Update CMC September 15, 2011

2 History Original work done in 2001 Vision The patient is ready to be seen at the time of the appointment; no delays caused by the PFS Process The patient will give demographic and insurance information one time The PFS process is clear and consistent with minimal hand-offs The PFS process is supported by: o Motivated, well-trained, empowered staff o Effective use of electronic system(s) o Common tools

3 The Past Pre-Visit Time of Visit Post-Visit Scheduling Insurance Verification Registration Obtain Referrals Authorizations Limited Counseling POS Collections Fee Ticket Collection and Completion Registration and Insurance Corrections Coding & Charge Entry / Claim Edits Post-Billing Collection Follow-up and Claim Denials / Appeals Insurance Re-verification and FSC Re-assignment Claim Write-off and/or Bad Debt Losses

4 PFS New Directions Pre-Visit Time of Visit Post-Visit Scheduling / Registration / FSC Assignment & Insurance Verification / Obtain Referrals & Pre- Authorizations / Financial Risk Identification/ Financial Counseling Customer Service Verification / Document Imaging POS Collections More Customer Service Charge Entry Charge Edit Corrections Exceptions Processing Compliance Payment Posting Post-Billing Appeals QA

Work Group Department Participants Marsha Cannon (OB/GYN) Cindy Flynn (Pediatrics) Cindy Gewinner (Surgery) Dianne Griffith (Orthopaedic Surgery) Kathy Hoertel (Surgery) Christy Picard (Medicine) Dana Sterbenz (Surgery) Jeanne Thoma (Anesthesiology) FPP Participants Charles Albach Connie Belcher Laura Ingersoll Andrew Johnson Karen LaClear Kelley Mullen

Updates PFS standards, guidelines, and recommendations – review, edits, additions, and final draft complete Required registration fields – update complete PFS policies and procedures – scheduling a 6 hour session to update templates for distribution to departments Management reports – scheduling a 2 hour session to redesign reports

7 PFS standards, guidelines, & recommendations Added: Definitions for FSC and Plan Process areas for each statement, i.e., compliance, insurance assignment, scheduling, pre-arrival, point-of-service, charge entry, and AR follow-up Column for which PFS policy and procedure the statement ties to Pulled insurance assignment out of other areas of the PFS process Split statements to stand on their own, rather than grouping statements

8 PFS standards, guidelines, & recommendations Compliance CMC responsible for an on-going quality assurance plan to define performance measures and accountability Annual review process Financial information should only be scanned into GE, not Allscripts Insurance Assignment Certified plan assigners are required to attend annual refresher education Insurance additions, changes, or deletions should be done a the visit level, not the FSC level All G-plans should be moved to P-Plans within 1 business day Electronic eligibility responses should be worked within 24 hours

9 PFS standards, guidelines, & recommendations Scheduling All departments move to Scheduling Hubs over time (guideline) Patients will be given an explanation of their financial responsibility Pre-Arrival Missing insurance information will be obtained a minimum of 7 business days prior to the appointment date Referral information is entered on the scheduling appointment data form or AVM visit shell Patients receive information regarding their appointment prior to arrival (recommendation) Appointment reminders are done using HIPAA compliant communication methods

10 PFS standards, guidelines, & recommendations Point of Service GE/Allscripts used to manage work flow and house information Appointments statused within one business day Front desk staff work any remaining alerts New or changes registration/insurance information immediately entered into GE No other forms used for the collection of registration information P-plan assignor available at all times to practice sites If plan assigned at point of service is not verified, eligibility verification should be done within 2 business days Use of patient responsibility forms and Medicare advanced beneficiary notice Insurance card scanned when patient is new to GE, insurance has changed, or annually

11 PFS standards, guidelines, & recommendations Point of Service AOB, patient responsibility forms, ABN’s, paper referrals, and arbitration agreements are scanned into GE Patients asked for co-payments and outstanding departmental balances Patients asked to make payment on school-wide balances (recommendation) Charge Entry Charges should be entered within 48 hours

12 PFS standards, guidelines, & recommendations AR Follow-up Default to secondary payor or self-pay when an eligibility rejection is received is discontinued AR groups will contact the payor or patient before changing the account FSC to self-pay Rejections for eligibility will be worked at least weekly FSC change report will be worked daily, if possible, and at least weekly Self-pay patients who call to report new insurance are referred to PBS All charges must flow through TES

13 Required Registration Fields Defined fields that are required versus important to obtain Added fields users are branched to for completion Identified which steps in the PFS process fields are required, scheduling, pre-arrival, or point of service Added fields required for aMPI, Meaningful Use, and Patient Portal

14 Next Steps Consolidate patient responsibility forms into one, school-wide PFS policies and procedures – scheduling a 6 hour session to update templates for distribution to departments Management reports – scheduling a 2 hour session to redesign reports