New team system speeds billing time
New team system speeds billing time
Workers cut across jurisdictions
Work teams that shepherd accounts from preadmission to post-discharge have streamlined workflow, reduced FTEs, and slashed billing time at UCLA Medical Center in Los Angeles, says Ruth Irwin, manager of patient administrative services (PAS) for the department of admissions and registration.
Based on the principles of patient-focused care, PAS team functions include portions of admissions, registration, utilization review (UR), medical records, and patient accounting. (See principles used as guidelines, p. 53.)
As a result of consolidating those tasks, the average time it takes to get a bill out the door has been reduced from 30 days or more when the teams began operating in 1994, to 18.95 days in 1995 and 12 days in 1996, Irwin says.
When an outside consulting group looked at improving performance efficiency, the department began examining, among other things, functions performed to get a bill out and how many days it took, she explains. "We found functions being duplicated." A task force identified these major problems:
• long waiting times before patients reached their rooms;
• multiple phone calls for preadmission;
• delay in getting patient charts to medical records;
• delay in initiating treatment;
• delay in billing;
• high number of days in accounts receivable.
As part of the performance improvement initiative, nursing was grouping patients with similar conditions together; the decision was made to assign a PAS team to each of those patient units, Irwin says. Depending on the size and complexity of the patient population they serve, the PAS teams consist of one or two financial counselors and one or two administrative service associates (ASA). The teams also may have a senior admitting worker.
An ASA performs multiple tasks, she notes, while the senior admitting worker is in a support position that covers preadmission and admission functions. Although PAS teams are based on individual patient units, they report directly to the admissions and registration department.
The teams handle everything from the time a physician decides to admit a patient until post-discharge, Irwin says. "When the account leaves our department, it goes straight to the billers."
When a patient is discharged, the PAS team retrieves the medical record from the nursing unit, does all the abstracting outlining how the patient was admitted, the number of consults, operative reports, and other state reporting requirements and then sends the record to the coders, who code the account for billing. It then goes to the medical records department.
In the past, financial counselors would enter financial summaries, then patient accounts would hold the account for billing until all requirements were met, such as obtaining discharge summaries or hard-copy certifications, she says.
Extensive training
When all these functions were consolidated into the PAS team, patient accounting, utilization review (UR), medical records, and coding decreased staff proportionately, Irwin says. There also was an overall decrease of 10 FTEs among the five departments involved.
The PAS teams initially processed all Medicaid continued stay reviews, but after a while it was determined that this was not an efficient use of time, so the task reverted to UR. However, the teams still handle Medicaid extensions for transplant patients.
PAS team members all of whom had to apply for their positions underwent an extensive four-module training program, spending two to three weeks in each department whose duties they were taking on. Members of those departments conducted the training. After about 18 months, Irwin says, the admissions and registration department took over the training, with support from technical advisors from the other departments.
Key to the program’s success was the development of an ASA timeline showing when certain tasks had to be completed, because the team’s duties affect the operation of other departments, Irwin points out.
"Every other area’s performance is contingent on receiving work from us, so it was important to [establish] when discharge folders had to be processed, when the chart information had to be sent to UR, and when the medical record had to be in the coding department," she says. "For example, for patients discharged yesterday, the medical record is required in coding by 1 p.m. today within 24 hours. This was crucial. We wanted to make sure we didn’t negatively impact the departments we were assisting."
Although the teams report to admissions and registration, they are stationed full time on the nursing units and become part of the team on the floor, Irwin says. "They’ve already dealt with [the patient] during preadmission, so if there is any question in-house regarding that account, the financial counselor is there to handle it."
PAS team members work with unit secretaries to obtain charts, and the admissions and registration department provides periodic inservices for the secretaries on issues such as proper chart order and the need to obtain medical records on a timely basis, she says.
"We stress that what they do impacts reimbursement, that if the chart is out of order, [medical records] may miss something major and decrease the amount of money the hospital gets paid."
The inservices with unit secretaries are done in conjunction with a representative from medical records or coding, Irwin notes.
The task force that created the eight PAS teams continues to meet bimonthly, she says, and the ongoing collaboration has created a strong sense of teamwork and an atmosphere in which employees are "less likely to point the finger" at others.
Adding to the cooperative spirit is "Partners in Excellence," the hospital’s incentive program in which teams throughout the facility are assessed on performance, Irwin says. Meeting certain goals brings cash bonuses. For this program, the 28 PAS team members, plus additional coding, UR, patient accounts, and medical records employees about 116 people are part of one team.
In addition to having a tremendous impact on account receivables, the PAS teams have given the admissions department a different focus, Irwin says. As an example, she cites the answers that department employees gave to consultants when they were asked to name their primary goal.
Instead of offering typical "admissions answers," such as "getting patients admitted quickly," the employees mentioned things like getting a completely secured account or maximum reimbursement for the hospital.
"Our staff is very focused on the receivables end," Irwin says. "They have a much-enhanced awareness."
The PAS teams have prompted positive feedback from patients and physicians, she notes. Patients appreciate going directly to the floor upon arrival and dealing with the same employees during admission and for any follow-up questions or concerns, she says. Physicians like knowing who to ask if they have questions about, say, home health coverage for a particular patient.
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