Confused by tech pitches? Sort through the hype
Confused by tech pitches? Sort through the hype
Watch for these red flags
Does a system claim to be the "be all, do all" for your patient access department's issues, such as an eligibility system verifying benefits for all payers? If so, be skeptical.
"The truth is that not all payers can provide detailed benefit information, particularly if the plans are administered through a third-party administrator," says Ed Erway, chief revenue officer at University of Kentucky (UK) HealthCare in Lexington.
"Even the major payers have issues supplying specific deductible information, since deductibles are based on when claims are submitted, not when they are incurred," says Erway. Therefore, deductible information may change between the time of pre-registration and claims payment.
To avoid pitfalls, Erway suggests these steps:
Do a detailed request for proposal (RFP), including input from front-line employees and supervisors.
Your evaluation should involve a number of individuals from the front-line staff who understand the day-to-day issues. Include the end users of the information, whether clinical staff or administration. "Finance should also be involved, to assure that budgetary and financial outcome requirements are met," says Erway.
You may learn that the users of the system find it to be very problematic. It may increase the time it takes to schedule a patient, or take an unexpectedly long time to verify insurance. If this is the case, staff will probably try to find short cuts in order to take care of the patient's immediate needs.
"It is, therefore, critical to have the input of the front-line staff before and during the implementation process," says Erway. "Feedback is crucial to continuous monitoring of the operation of a system."
Check references and do site visits to validate the vendor's claims.
"Certainly, an on-site demonstration of the system's solution is appropriate," says Erway. "Secondly, I would like to see the system in production at another provider and have an in-depth discussion with that provider."
Investigate the best practices of systems, and compare these against the RFP responses.
"Research through the Internet is amazingly easy these days," says Erway. "There are a number of research organizations that can provide detailed answers to questions you have."
Develop a network of peers online, by using list-serves of groups your employer belongs to.
"Check with the administration of your organization if you are not aware of the organizations of which your company is a member," says Erway.
Be sure the vendor makes timely updates to its systems in order to recognize federal and state mandated changes.
Examples are Local and National Coverage Determinations for the claim, Advanced Beneficiary Notifications, and the ICD-10 conversion. "Any of these will require fundamental changes in any system that has diagnosis codes embedded in the data elements," says Erway.
Be sure the system is able to accommodate requirements for the various providers.
This is increasingly important as more and more health care providers are becoming systems and integrating physicians and hospitals. Scheduling systems may require multiple templates of scheduling types for physicians, and more standard time-based systems for the hospital's ancillary departments.
Consider the issue of standardization.
Standardization is often thought to be unacceptable when you have a variety of specialty services. "However, one must also consider that unsustainable variation can cause problems in patient access systems, when you try to report on outputs such as third available appointment, average appointment length, or patient cycle times," says Erway.
[For more information, contact:
Ed Erway, Chief Revenue Officer, University of Kentucky HealthCare, Lexington. Phone: (859) 323-5502. E-mail: [email protected].]
Does a system claim to be the "be all, do all" for your patient access department's issues, such as an eligibility system verifying benefits for all payers? If so, be skeptical.Subscribe Now for Access
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