Penn State Hershey Medical CenterPenn State Hershey Medical Center

Penn State Hershey Medical CenterOutpatient Pre Arrival ServicesPenn State Hershey Medical CenterOutpatient Pre Arrival Services

Presenters Mary Stephens, Manager, Inpatient

Access – Previously a Coordinator inOutpatient Pre Arrival Services (6 yrs)

Linda Cranston, Manager, of Out Patient Pre Arrival Service

LeAnn Stringer, Manager, Eclipsys Application

Penn State Hershey Medical CenterPenn State Hershey Medical Center

500 bed Tertiary Care Academic Medical Center

Adult and Children’s Hospital

Level 1 Trauma Accreditation (adult/pediatric)

Penn State Cancer Institute

588 Faculty Physicians

Annual Clinical Activity Annual Clinical Activity

Inpatient admissions – 27, 615

OR Cases Inpatient – 10,125 Outpatient – 6,564

Emergency Room visits – 47,163

Outpatient Visits Booked - 1,412,255 Actual - 779,520

HMC Systems HMC Systems

Eclipsys AM/PFM Eclipsys Registration data interfaces to

20 systems

Other Systems used at HMC

Cadence (Scheduling) Cerner Clinicals GE Centricity (Radiology) Mysis (Laboratory) Pyxis Seimens (Signature-Professional Billing)

Redesign of Front End ProcessesRedesign of Front End Processes

Multi-Disciplinary Team Approach Patient Financial Services (PFS) Nursing Physicians Inpatient Access Health Information Services Information Technology Representatives from various outpatient

clinics

HMC Identified Financial OpportunitiesHMC Identified Financial Opportunities

Reduce Accounts Receivable Hospital & Physician AR

Reduce write offs (revenue deductions)

Decrease check in time for outpatients

Team RecommendationTeam Recommendation

Form the Outpatient Pre Arrival Services (OPAS) Department (2001)

OPAS Goal Obtain accurate patient and insurance

information prior to the outpatient visit to ensure full reimbursement of services

Facilitate gathering and verification of sensitive information to ensure HIPAA compliance and increase patient satisfaction

OPAS Department GoalsOPAS Department Goals

Decrease facility accounts receivable days from 86 to 45-55

Decrease professional account receivable days from 81 to 51-57

Decrease facility write offs from 3.2% to 1.3-1.7%

Decrease professional write offs from 2.8% to 1.3-1.6%

Decrease average check in time from approximately 6 minutes to less than 1minute

OPAS StaffingOPAS Staffing

Initial Pilot (3 month period in 2001) 4 new FTEs 2 clinics (Dermatology and OB/GYN)

Currently 70 FTE’s (existing and new staff) 43 clinics

Pre-Arrival ProcessesPre-Arrival ProcessesProcessProcess Improvement GoalImprovement Goal Decision Decision

Pre-Registration/Registration

How often should patient demographic information be updated/validated

Suggested 60-90 days

Pre-Clinic % of scheduled patients pre-registered prior to date of service

100%

Insurance Verification

How often should insurance be verified (this will vary by payer and all services)

Each encounter/visit (100%)

Pre-Arrival ProcessesPre-Arrival Processes

ProcessProcess Improvement GoalImprovement Goal Decision Decision

Referrals % of referrals obtained prior to service

100%

Authorization/Certification

% of scheduled patients authorized prior to service

95%

Authorization/CertificationWalk Ins

pre-registered patients that have authorization/pre-certification verified within 24 hrs of arrival

100%

System EnhancementsSystem Enhancements

Scheduled appointments 28 days out (Cadence Report) Eclipsys pre-clinic visit creation Eclipsys Worklists by service and location Identify & refer S/pay accounts to Financial Counselor

Self Pay ProcessSelf Pay Process

Price estimate of service is obtained Review patient’s account for payment

history Credit report Patient is contacted

Provide estimated cost of service 75% of estimate is requested MA process is discussed Financial Risk process

Physician makes the decision (based on medical necessity) whether appointment is canceled or postponed

Improved Outcomes in ClinicsImproved Outcomes in Clinics

Decreased denials due to 100% verification of insurance and ability to obtain referrals and authorizations prior to the clinic visit

Reduced check in/check out time for patients

Increased point of service cash collection approximately $750,000 monthly

Financial Improvement OutcomesFinancial Improvement Outcomes

Facility accounts receivable days reduced from 86 to 45

Professional accounts receivable days reduced from 81 to 45.2

Facility write offs reduced from 3.2 % to less than 0.5 % of revenue

Professional write offs reduced from 2.8% to less than 0.5 % of revenue

ConclusionConclusion

Questions