PAC
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The Patient Access Center serves as the initial contact point for patients and providers, handling scheduling, referrals, eligibility verification, and financial counseling. It aims to create an ideal patient experience through partnerships with clinical departments. The Center is part of the integrated revenue cycle and works closely with billing, coding, and collections teams. It utilizes the Epic electronic medical record system to manage scheduling, track performance metrics, and improve workflows. The goal is providing the right care, at the right time, in the right place to increase access, grow practices, and ensure patient and physician satisfaction.
PAC
- 2. At the end of this training you will be able to define and describe: What Patient Access is? Mission & Goals The Center’s role in the organization Organizational Structure Our connectivity to Integrated Revenue Cycle Our structure and functions Role and responsibilities of the center Revenue Cycle Practice Management Patient Experience Objectives:
- 3. What is Patient Access: o Scheduling Office o Communication Center o Referral Office o Place for patients to call when they need to get in touch with their provider o Initial contact point for any outside caller o All the above
- 4. Jeff D’Agostino MUSCP COO MUHA CAO Matthew Long Enterprise Director of Patient Access Eric Peterson, Sr. Manager of Patient Access Ops Adam Bacik Manager of Access Ops Andrea Swartz, Sr. Manager of Quality Service Capacity Management Team Patient Access Supervisors/Coordinators Scheduling Agents PATIENT ACCESS CENTER
- 5. Our Mission: We are the Voice of the Organization dedicated to creating the Ideal Patient Centric Experience with Every Connection
- 6. WHAT, WHERE, HOW DO WE FIT??
- 7. The Integrated Revenue Cycle encompasses the entire customer engagement and payment process from Access to Guarantor Collections for the Physicians (MUSCP) and the Hospital (MUHA). Access Pre-Arrival Arrival Coding & Charge Capture Billing Guarantor Payments Patient Financial Interactions
- 8. Access Pre-Arrival Arrival Coding/Charge Capture Billing Guarantor Payments Leadership & Goal Alignment
- 9. Pre-Arrival • Access (Cadence) • Registration (ADT/Prelude) • Eligibility (RTE) • Referral Management • Pre-Certification • Financial Clearance • Fee Estimation • Collection Arrival • Check-in (Cadence) • Check-out • Admitting and ED (ADT) Referral Management (Cadence) • Eligibility (RTE) • Payment Collection (SBO) • Reconciliation • Charge Capture Post-Arrival • Coding • Charge Reconciliation • Billing • Claims Generation • Insurance Payments • Insurance Follow-up • SBO Guarantor Payments • Internal Collection Unit • External Placement Patient Financial Responsibility
- 10. The Revenue Cycle begins with Access Patient Scheduling • Right Physician, Place & Time • Access Initiatives Demographics • Accurate & Timely Insurance • Real-Time Eligibility (RTE) Performance Measures • Abandon rate <5% • Average Speed Answer 45secs or less • ACD: 3:00 or more • 100% Call monitoring Patient Financial Interaction • Every Opportunity to talk about patient financial responsibilities • Scheduling linked to Point-of-Service Collections Access Patient Scheduling Registration Real-Time Eligibility (RTE) Patient Financial Interactions
- 11. Referral Management • Insurance Referral Verification Eligibility Verification • Real-Time Eligibility (RTE) • Batch & Websites • Rules based (eligibility last received date) Pre-Certification • Benefits Verification • Rules based (Insurance & Procedure) Financial Counseling: • Fee Estimation (MUHA & MUSCP) • Counseling • Funding Options Patient Financial Interaction: • Every Opportunity to talk about patient financial responsibilities Pre- Arrival Referral Management Eligibility Verification Pre- Certification Financial Counseling Patient Financial Interactions
- 12. Access Capacity Management Access Center Operations Patient Advocacy Department/Clinic Patient Access is creating the Ideal Patient Experience through a true partnership between physicians and our operations.
- 13. Patient Scheduling: Capacity Management Capacity Management Practice Management Epic Build Education/ Implementation Evaluation Optimization Scheduling process begins with Capacity Management Practice Management • Goals & Strategies for Growth • Physician Profile & Template Build Epic Build • Physician Master Template • Clinic Cancellation • Subgroups Education & Implementation • Template Training & Job Aids • Live in System Evaluation • Ease of Scheduling • Clinics full not overstuffed • Patient & Physician Complaints • Practice Goals Optimization • Refine templates to construct better workflow to improve patient experience
- 17. Inbound (Calls) • Appointment Requests/Reschedule • Clinical questions • Informational Outbound • Epic Message • Physician Referral Workqueue • Bumps/Recalls • Clinic Calls Navigator • Schedule Management • Wait List • Consecutive/Horizontal Clinic • Workflow & Patient Experience • Communication Clear Physician Satisfaction • No gaps or errors • Not excessive overbooking Patient Scheduling: Access Center Operations Patient Inbound Outbound NavigatorClinic Physician Satisfaction
- 18. Department/Clinic Partnership/Customer Marketing Confidence Patient Loyalty Patient Scheduling: Department/Clinic Partnership/Customer • Meetings, Feedback, and Solving Problems Marketing • Locations • Providers – using subgroups • Overall knowledge of their practice Confidence • Knowledge of templates and system • Extension of their practice Patient Loyalty • Relationships with patients • Managing up Providers and Practices • Use of EMR
- 19. Patient Scheduling: Access Language
- 20. Patient Scheduling: What’s Success?
- 21. Patient Scheduling: “Your Role” • Think About your life’s purpose, why are you here, what do you wish to accomplish? • What are your core values that will guide your behavior as you attempt to live life “on purpose”? • What can people expect from you? • What do you expect from people?
- 22. Patient Scheduling: Patient Advocacy
- 24. Our Mission: We are the Voice of the Organization dedicated to creating the Ideal Patient Centric Experience with Every Connection
- 25. Takeaways
Editor's Notes
- #2: Preparation for this training. (1.5 hour training take breaks as needed) Need the Clothier (LDI) Video prep, Epic up, CMS handouts (Daily Report), Call Monitoring Sheets, Agent Scorecard. Flip Chart of the Capacity Management terms. Along with quiz handout. Participant Workbooks Start the class by welcoming everyone… do an icebreaker have people introduce themselves then ask them what they would do if they won the lottery. Loosens everyone up.. Remind that this training is a facilitative training which means we promote discuss and questions. Have a parking lot sheet hung up for topics we did not cover or cannot cover in this lesson, but will address at the end.
- #4: Present as a question to the group and have them respond. The answer is All of the Above. Then ask them if there are any other functions we do…
- #5: Review organizational chart and then instruct participant to fill in the names in their workbook…. Then do a flip chart of how our teams are organized by service along with Supervisors (This should be prepared prior to the training)
- #6: Our mission is … What words resonate with you? How does that make you feel? Allow several people to respond and make sure the idea of patient advocate comes out in this discussion. Write this down in your workbook. We are going to come back to this when we talk about your role.
- #7: Now that we have a better understanding of the access center the question is What, Where, and how do we fit into MUSC Health?
- #8: In our organization, the Revenue Cycle includes: Access, Pre-Arrival Services, Arrival, Coding and Charge Capture, Billing and Guarantor Payments. In July 2014, we went live on a fully integrated system for the revenue cycle. It is important to note, we are on Epic because it offers a suite of integrated products that supported our goal of being a best performing revenue cycle. One of the strategies for achieving that goal, is an integrated revenue cycle.
- #9: We are still a little new at integration. We began integrating the revenue cycle in 2011 when we hired our first CRO. It is challenging and we discover new opportunities to improve our overall performance almost daily. To be successful it takes a team of dedicated leaders that are constantly thinking about best performer strategies and how they fit into an integrated model. A great example of integration is this orientation. Prior to this session, MUHA and MUSCP staff did not come to a combined Revenue Cycle orientation. This is a great opportunity to welcome new employees, review the operations and overall set-up of the revenue cycle and talk about what integration looks like. As you can see, there are a lot of pieces to this puzzle and we must collaborate with teams and leaders that do not report directly to our CRO. Access: You’ll notice Access doesn’t report to the revenue cycle directly, but it is a major component of what we do every day. Epic Revenue Cycle: Same scenario. To be successful, to achieve our best performer goals, we don’t have to report to the same people, we have to be committed to collaborating and working with others across the enterprise. We share common goals but we may have different strategies within our teams of achieving them. An example may be patient satisfaction goals: Matt Long’s team strategy will be different from a revenue cycle strategy. We may focus on training that improves the quality of insurance information to promote a clean claim or POS collections. Matt may focus on scripting phone calls or call audits. The goal is the same. Ask any questions?
- #10: Three major components to the Revenue Cycle: Pre-Arrival, Arrival and Post Arrival. And our operations are where the cycle all starts Access, Registration, Eligibility and Referral Management we start the Patient Journey as well as the revenue journey. When you look at the entire cycle what word do you consistently see throughout the 3 major components? You will notice that collection – patient financial responsibility is in each column. This is because we know, that taking every opportunity to talk to patients about their financial responsibility is considered best practice for revenue cycle performance and it increases patient satisfaction. Top performing revenue cycles are continuously evaluating and improving performance. How can we improve service and reduce our cost to collect. Now lets take a closer look at each part of the revenue cycle
- #11: You will notice throughout the components of the revenue cycle we talk about performance measures, may referred to as KPIs (Key Performance Indicators) and patient financial interactions. PATH initiative has been essential to increase our patient volume and throughput – right physician, place and time for the patient. This is our world and what we do everyday when scheduling an appointment, of course this is not all the calls we take. In Access our primary goal is to get New and established patient appointments, that meet their needs and get them to the right providers. Access is key to growing our business and helping patients and their families to receive the highest quality of care. We will go into more detail when we review our Metrics
- #12: In the pre arrival piece you can see where we overlap with Registration especially in Referral Management and Eligibility Verification. Insurance Referral Verification - we need to make sure we are capturing this so revenue journey continues smoothly, as well as the patient is not blindsided by upfront costs they were not aware of or prepared to pay at the time of their visit. This would be a huge dissatisfier.
- #13: The biggest piece of Access is the PATIENT. Ask: Why? Responses – business, reputation, care, - want the group to arrive at being a true Patient Centric Organization. Workbook
- #14: Capacity Management is responsible for building, managing, and refining the scheduling template. Their workflow starts with a meeting with the Practice to review their current access and scheduling templates, discuss scheduling strategies and clinic workflow. Then the template is Approved and built (this group also does clinic cancellation as that is seen as a change/adjustment to template), education and implementation – evaluation step encompasses the team and scheduling verifying that the template is working the way intended so let’s review the bullet points. Ask the group: In your role how do you think you help with this evaluation? Response; We are touching the schedules everyday and speaking with the patients are the templates matching the patient’s needs. Here are some questions to think about when you are scheduling : Is the template set up so we can easily book into? Are you consistently being asked to overbook? Are we satisfying patients – what are the comments you hear? Ask: What other questions or things can you offer to let Capacity Management know the template is working or not? Write them in your workbook. Also fill in the workflow and let’s take a moment to fill in the Capacity Management part of your workbook. Pause here and ask the group – does this make sense have I confused anyone do you need any further clarification? Before we move onto the other parts of our operations, Let’s see what CM Team does...
- #15: Master Scheduling Forms are used to change a scheduling template or establish a new provider. As you can see this form is focused on patient access just to cover the pieces of it so the group has a general understanding of it… Now let’s look at when a provider
- #16: What you see here is actual physician profile that the capacity management team works with the department to construct. Review the parts with the group. This profile page them gets built in Epic and becomes this go to the next slide.
- #17: The actually scheduling template in Epic…. Does that make sense to everyone?? Any questions? Okay let’s move on..
- #18: Access Center Operations is focused on the Patient so let’s review the parts of our operations: Inbound – Review the bullet points Outbound – Review the bullet points These two are really the majority of our work everyday. Is there anything we missed? Navigator is the critical to the entire process. Ask: What do you think Navigator means in our operations? Yes we are the experts of the template and therefore we need to be the one’s knowing where to appoint and advise the patient, if Tuesday is at 90% but Thursday is 25% booked, should we see if the patient can come on Thursday –Yes or No (yes because we are not stuffing the clinic and patient will have a better experience) How about wait lists – how should they be used? Response to fill cancellations and ensure no gaps. Consecutive –horizontal – reference the example of overstuffing clinics Clinic: When we are scheduling we are creating the clinic workflow this not just a widget it is a person (patient) who is coming for care. So we need to understand how we are appointing - New verses a Return in the slot, etc. Physician Satisfaction: Most physicians want to see a full clinic without any gaps as well as no errors a new in a return will hold up clinic – no excessive overbooking. How does this impact patient experience? Answer: A doctor who is rushed because we have stuffed his/her clinic does not have time to spend with the patient and so short with them. This is why your Role as Patient Advocate is so important let’s discuss this in more detail
- #19: In Access our Department/Clinics are our partners and customers – we meet with them regularly to inform them about their access and overall business as we are their front door. Also provide feedback and help them to solve problems. Ask what do we mean by customer – Help to get new patients, growth, and also ensure internal referrals are getting through. How about Marketing: Confidence and Patient Loyalty. Ultimately, we need to see ourselves as an extension of the clinics and departments we support. We help them manage their practice and ensure the patient experience is optimal. Along with our operations and understanding the parts there is a language associated with Access so let’s look at the key words you hear..
- #20: Within our Access Center based on function and the tools we use everyday there is a certain language that is used. This language is made up of key words. Let’s review these together. Give them the handout. Review the Scheduling and Capacity Management terms. Highlight each them and then ask is anyone has questions concerning them.
- #21: We have talked a lot about MUSC Health and the access center operations, but what does success look like to us.. What are the things we monitor and measure. Handouts of Patient Experience, Daily Report, Call Monitoring Sheets, as well as Epic Messages Data and reports helps to ensure our business running smoothly and we are operating efficiently and successfully. But ultimately the only way we can be successful is with – Ask was the key element: Wait for response. You our agents and what you do everyday.
- #22: We have talked a lot about MUSC Health and the access center operations, but the key component to our success is You and Your Role. Right now I want to ask each of 4 questions and get everyone to take a few moments to answer the question in your workbook then we will ask you to share your answer. So we can hear different points of view from everyone. Ask the first question allow for people to write down their responses and then go through other 3 provided ample time for everyone to answer. (workbook) Okay you are ready let me ask for a volunteer to share Discussion each response and with each highlight a key element of being a patient advocate, ownership, pride, helping. What they expect from others. Once you have discussed them now ask why do you think I asked you all of those questions – you want to facilitate the discussion to arrive at their role as patient advocates and commitment to it. Now let’s talk about Patient Advocacy.
- #23: When you hear Patient Advocacy what words and images come to mind? Group Discussion + Flip Chart Write down the key words associated with advocate and advocacy. Once the group has listed about 10 to 20 then ask how does this apply to your role and our operations. We want this to focus on the patient and their experience. So now let’s listen to one our patients..
- #24: I believe this video really summarizes why and how we make a difference everyday at MUSC health as patient advocates. Play Video. After that ask for feedback from the group. I like for us to look at our mission statement one more time ….
- #25: Now does what we just talked about change what you originally felt about our mission statement. How about your role? Let the group speak. Really zero in on the words that are impactful and resonate with the mission.
- #26: So as we close today I like to ask first have we covered all the objectives outlined. Did we miss anything? Questions? Now what are the takeaways.. Write them on a flip chart. Look for ones that reinforce the main concepts and then repeat them back to the group. Thank them and let them know their supervisors will be reviewing what they learned with them as well as small quiz will be given to them about this learning. Review the workbook before they leave the training.