Revamped admissions save time and money
Revamped admissions save time and money
Staff team up with peers in patient finance
Looking at ways to perform insurance verification more efficiently, the University of Texas Medical Branch (UTMB) in Galveston devised a new admitting process that has dramatically reduced both the daily rate of incomplete admissions pending and the number of patients discharged as indigent or self-pay.
Because virtually all UTMB patients go directly to their rooms before admission, there are unique challenges involved in making sure they’re registered in a timely and efficient manner, explains Christine Cuddeback, assistant director of inpatient registration and eligibility screening.
"The patients go to the room and then we find them, so we were having some problems with getting everything we needed," she says. "We didn’t have an automated way to keep up with which patient [accounts] needed something or were incomplete."
Previously, admitters were doing admissions and then turning the accounts over to insurance verifiers to complete that piece of the process, she says. While working to streamline insurance verification, Cuddeback and the director of patient finance decided to revamp the entire process. Traditionally, admitters would take the list of patients "admitted by nursing station," draw a line through the completed admissions, count the rest, and then divide and distribute them for work assignment.
Under the new procedure, admissions are divided by financial class rather than by nursing unit, and one person handles the whole process, including insurance verification. Self-pay, indigent, and Medicaid pending accounts are grouped together, Cuddeback explains, because they are labor-intensive, requiring longer interviews. The second grouping includes Medicaid, Medicare, and Star Health (Medicaid managed care in Texas); and the third comprises the rest managed care and traditional indemnity plans.
"We realized our shortcomings," she says. "We didn’t have an accurate mechanism for tracking patients that were still missing some part [of the registration], like the precert number, going over the advance directives, or getting the consent for treatment. We also developed the Hospital Policies and Payment Information form, a checklist to go over with the patient showing we have reviewed this information with them." (See copy of form, inserted in this issue.)
There were notes in the system on each admission, showing what was missing, Cuddeback adds, "but it doesn’t make sense to review 500 patients."
A solution was found when a manager in patient finance discovered a pay scale indicator in the hospital’s own computer system that alerts admitting staff that a patient needs financial screening. Use of this indicator "allows us to create a report that runs every morning that downloads into the Excel spreadsheet," she explains. This report, which has been in place since May 5, gives the backlog from previous days of incomplete admissions, including patient name, account number, pay scale, patient location, and length of stay. It allows employees and Cuddeback to know at a glance the workload status, she adds.
UTMB’s information services department is working to program a comment code into the computer system that also will tell admitters exactly what’s missing from an account, whether it be a precert number, a signature, or some other piece of information, Cuddeback says.
One of the assistant directors in patient finance determined that there were software applications available to enhance the insurance verification process. Using Rumba, which is coordinated by the hospital’s own managed care office, TexMed Net, and Florid Share, UTMB now verifies benefits on-line with Medicaid, Medicare, and several managed care plans. Each employee has the applications loaded on his or her computer terminal, she says. Normally, UTMB’s system is updated within 24 hours of any changes in the various payers’ eligibility data, Cuddeback notes.
Also, as part of the new admission process, UTMB admitting financial coordinators are partnering with their peers in patient finance, Cuddeback says. "If they get in a jam, they can call their counterpart in that department and say, for example, I have a problem with a CHAMPUS patient. This is what I’ve done. What do I need to do now?’"
These one-on-one partnerships also let patient finance personnel know who to call in admitting if they discover a pattern of errors that is causing bills to be rejected, she adds.
If changes are made in an insurance plan, the admitting department’s resident expert in that area will get a call. Even though such changes are registered in the computer system, the personal communication gives employees more ownership of the process, she notes.
UTMB’s 12-person admitting staff performs registration functions for every patient admitted, including those who come through the emergency department, a total of more than 100 admissions per day. Most of those come in after 5 p.m.
The day the new admission procedures were instituted, 53% of the department’s admissions were incomplete, Cuddeback says. While that figure might seem high, the missing element could be as simple as an authorization number from the insurance company, she says. Two months later, that figure is averaging 25%.
Screening of patients who need financial assistance also has improved. In April, the error rate showing how many patients initially registered as self-pay or indigent without being fully screened to see if they could qualify for Medicaid was 15%. In June, the error rate was 5%, she says.
Before April 1, admitters referred, on average, 10 to 15 patients a month for interviews with the facility’s on-site Department of Human Services employees. In April, even before the new procedures were officially launched, that figure increased to 85. In May and again in June, it surpassed 150. Roughly 60% of those who follow through with applications are granted assistance. "By increasing the number of Medicaid referrals, we increase the reimbursement to the hospital," Cuddeback says, "and it helps the patient, who may not have had health care coverage before."
She expects the benefits from the new admission procedures to continue to benefit the facility’s bottom line. "By identifying the insurance sooner and getting the precert sooner, we don’t get dinged with late notification, which is a reduction in benefits," she explains. "We have good information on patients sooner."
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