Leveraging Best Practices Patient Access Management 1 Discussion

Leveraging Best Practices Patient Access Management 1

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 Emdeon Proprietary & Confidential 2

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’ Emdeon Proprietary & Confidential 3

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) Emdeon Proprietary & Confidential 4

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 Emdeon Proprietary & Confidential 5

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 Co. Pays o Deductibles o Estimated Patient Responsibility § • Address Information Current Address § Static Address § • Employer Information • Credit Score Fraud detection § Payment sources § • Authorization Requirements Emdeon Proprietary & Confidential 6

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 § Emdeon Proprietary & Confidential 7

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 Emdeon Proprietary & Confidential 8

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 Emdeon Proprietary & Confidential 9

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 Emdeon Proprietary & Confidential 10

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 Emdeon Proprietary & Confidential 11

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! Emdeon Proprietary & Confidential 12

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 Emdeon Proprietary & Confidential 13

Questions? Emdeon Proprietary & Confidential 14