Patient Access Services Quality Assurance Bon Secours Virginia

The Revenue Cycle FINANCIAL COUNSELING INSURANCE VERIFICATION PRE-REG & PRE-CERT SCHEDULING REGISTRATION & POS CASH COLLECTIONS CHARGE CAPTURE & ENTRY MEDICAL MANAGEMENT MEDICAL RECORD & CODING CLAIMS SUBMISSION THIRD PARTY FOLLOW-UP PAYMENT POSTING REJECTION PROCESSING DENIAL & APPEAL MANAGEMENT CONTRACT MANAGEMENT EDI-capability FOCUS AREA Regulatory compliance Metrics & KPIs CDM

Revenue cycle Front End (Access Services) Scheduling Gathering PreReg/PreCert Insurance Verification Financial Counseling Registration/Point of Service Collections Patient Access Quality Assurance Audit Sits between Data Capture/Data Entry and Insurance Claim generation Provides timely, “accurate” billing Reduces rework

Case Study - Bon Secours Virginia Access Services – QA Process Overview Policy Procedure Daily Monthly As Needed Questions

Policy Policy of Patient Access Department to provide quality control audits on a daily/monthly basis, using the reports and material provided so that all patients are registered accurately and consistently across the local system.

QA Procedure Daily Access Metaviewer and pull up the following reports for each facility: Doctor Report Patient/Guarantor Address Report Employer Information Audit Report Medicare Audit Report Auditing Code Check Report Backdated Admission Report Insurance Auditing Report Key errors into an Excel spreadsheet for each hospital. Correct the errors into SMS for each hospital.

QA Process cont’d Monthly Send the error spreadsheets out to each manager/supervisor before the 10 th of each month to include in staff evaluations As Needed Assist in training of new employees Notify Manager/Supervisor if you notice an employee is consistently making the same error Re-train Employees in areas needed Keep New Employee training material updated

Questions?

Contact Info Jillian B. Surace