1. Keys to Successful Financial Clearance, Pre-Registration, and Pre-Service Collections
Monday, October 17th, 2016

2. Steward Health Care Patient Assistance Center
Centralized business office function dedicated to financial clearance and pre- registration services for:
8 Acute Care Hospitals
3 Ambulatory Surgical Centers
Large Network of Affiliated and Employed Physicians
Financially Clear Scheduled Services and Inpatient Admissions
Pre-Register Scheduled patients and collect estimated responsibility
Coordinate with local registration staff to ensure all patients are financially cleared for service
Denial Prevention Analyst II
Denial Prevention Analyst I
Facility Registration

4. Scope of Services Urgent Inpatient Admission Notification
Complete inpatient notification process for ~380 admissions/day
Verify eligibility
Notify plan of admission to Steward facility
Secure authorization for inpatient stay
Financially Clear Elective Scheduled Services
Financially clear ~370 High Tech Radiology & ~530 Elective Procedures/Surgeries each day
Verify eligibility, validate medical necessity, and estimate patient responsibility
Review prior authorization & referral requirements
Confirm on file with payer or contact ordering provider to secure prior to service
Pre-Register Scheduled Services
Pre-Register ~860 patients/day
Confirm financial and demographic information prior to service
Communicate estimated liability and collect ~$30,000 per day over the phone
Place 1,500 outbound phone calls & field 400 inbound calls each day
Staggered shift to accommodate inbound calls between 8am – 6:30pm, Monday through Friday

5. Driving Consistent & Predictable Results
Formal On-Boarding Process
Dedicated Coach/Trainer
Promoting Top Performers from Within
Quality Assurance Program
Daily & Weekly Reporting
Creative Staffing Models
Leverage Worklisting Tool
Investing in Key Technology
Tools for Driving Pre-Service Collections

6. Recruiting & Retaining Key Talent
Hiring efforts focused primarily on pre-registration representatives
Formal on-boarding program
Dedicated trainer
Competitive bonus program
Weekly quality assurance reports
Financial Clearance vacancies pulled from top performing pre-registration representatives
Pre-Registration Rep
High Tech Radiology Rep
Elective Surgery Rep
Urgent Admission Rep
Cross-Trained Inpatient/Surgery Rep

7. Managing Performance Across the PAC
Pre-Registration Daily Scorecard

8. Managing Performance Across the PAC
Financial Clearance Daily Scorecard

9. Daily Reports

10. Weekly Dashboard Review
Standing meeting to review prior week performance
Key metrics for all teams
Primary focus:
Cash collections
Call Volume
Completion Rates
Authorizations
Deferral Notifications

11. Quality Assurance & Customer Service
Balance production with quality
Robust QA program that evaluates 100% of accounts worked
Ability to add new criteria as reporting opportunities are identified
Manual review of rep phone calls
Appropriate greeting
All required questions reviewed
Cash collection script followed & attempt made
Able to respond to all patient questions appropriately
Overall tone of voice and interaction

12. Creative Staffing Models: Financial Clearance
Authorization & Referral Obtainment (5 Reps)
High Tech Radiology
(7 Reps)
5 Reps cross-trained to cover both functions and float between teams
Urgent Admissions (5 Reps)
Elective Surgery
(9 Reps)
2 Reps cross-trained to cover both functions and float between teams

13. Creative Staffing Models: Pre-Registration
High Tech Imaging
Low $ Opportunity
High $ Opportunity
Elective Surgery

14. Systems Supporting Our Process
Worklist Accounts
Eligibility Verification
Estimate Liability
Medical Necessity
Prior Authorization
Pre Register
Pre-Service Collection
Revenue Protect
Experian Passport
MedAssets CarePricer
Craneware
Passport eCareNext
Cisco Call Queue & Recording
ePay Payment Processor

15. Shared Services Model Scheduling of services
Coordinating potential service deferrals
Communicating to appropriate resources on site at each facility
Transitioning incomplete work to hospital staff

16. Daily Strategies for Driving Cash Performance
Dedicated cash collectors assigned to call on estimated patient responsibilities greater than $500
Assigning new reps only to call on balances under $100
Campaign Hours
Competitive in nature – This is a way for Reps to perform at an optimum level
Incentivizing
Raffling gift cards to boost our collection performance
Providing instant gratification to the young professional demographic
Constant motivation and reinforcement
Encouraging reps to achieve daily goals will ensure quality performance and staff gratification

17. Cash Collection Scripting
Providing a guide to handling all types of interactions with collections
Asking “How would you like to ” instead of “Would you like to” has proven to be extremely effective
Providing different payment options. (i.e. Payment Plans, Post-dating and Partial Payments)
Laminated “hand-holder” guide for all reps to remind of keywords, phrases, and explanations

18. Challenges We Face
An ever-growing list of procedures that require prior authorization.
More of a lean on the patient for cost-sharing responsibilities. i.e. Copays, Deductibles and Co-insurances
Timeliness of authorization payer reviews, some taking up to 2 weeks.
Establishing accountability from all parties:
Providers: Ordering exams that are not medically necessary.
Payers: Delayed authorization approvals.
Patients: Unaware of insurance benefits and their responsibility.