Transcript TERROS West Outpatient (Mercy Care Advantage Services Collection Team) September 2008 to May 2009

TERROS
West Outpatient
(Mercy Care Advantage Services Collection Team)
September 2008 to May 2009
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Improve Collections from Mercy Care
Advantage at the West Outpatient Clinic
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Secondary Aim: Train future leaders in Process
Improvement
Baseline collections: 30%
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Oct.-08: Front Office will Color Code charts to
identify the MCA clients (allows communication at
site so everyone knows this client chart needs to be
handled differently)
Nov.-08: Re-route the authorization forms
received from MCA from the billing dept to FO
Manager (increases communications between
departments and ensures front office staff are
aware of TPL appointment)
Dec.-08: the ‘clean-up’ authorization project
(brought all auths up-to-date and got all existing
client’s new auths for the new year and tracked
which provider auth was given for so appointment
was scheduled with appropriate provider)
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Jan.-09: Front Office manages Authorization
Maintenance (Developed tracking tool to manage
re-authorizations. Allowed staff to get
authorizations timely, schedule appointment with
correct provider, and request appropriate
authorizations needed for type of service and
ongoing treatment)
April-09: Re-routing the chart (Chart is given to
FO manager following medical appointment.
Business Office Manager (BOM) checks for
changes in diagnosis in order to request updated
authorization when changes are made)
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Billing processes from past need updated to bill
TPL
Current process in computer system do not allow a
clean method to track collection of payments
Need to identify TPL accurately and in order of
primary and secondary TPL responsibility
Unable to determine if changes through process
improvement affected collections
TPL is a complicated process
Need persons identified at site who understand
and will manage TPL issues
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1. The initial auth for services is problematic
insofar as the client has not yet been seen by
either the clinician or the med provider. At this
point we are using the dx provided by Mercy
Care (which is a medical dx, not a behavioral
health dx).
2. It has been nearly impossible to get accurate
payment data to establish any collections
improvement.
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Call Center
Call Center will identify insurance at scheduling
 TPL information is entered into electronic referral system
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 Hard copy referrals scanned and processed
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Email ClaimTrak referral to business office manager
(BOM)
Outpatient Sites
BOM forwards referral to TPL CSR who maintains site’s
TPL log & to the person preparing the intake folder
 TPL CSR follows process for creating color coded folder
 Therapist completes pre-authorization request for
upcoming psych evaluation
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TPL CSR
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Prior to TPL appointment verify the following
 Guarantor in ClaimTrak is correct
 Ensure authorization is in place
 Appointment scheduled with wrong provider? Attempt to
change appointment to correct provider or submit new preauthorization request.
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Log information in TPL spreadsheet
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All existing clients were registered in the
electronic billing system with their TPLs
And properly identified primary, secondary,
tertiary insurances
Meetings are scheduled to determine that the
‘collection’ process links dollars to the correct
TPL
* Bob Mason * Charlotte Crow * Donovan Lusk *
* Gayle Stocking * Kathy Randazzo * Marianne
Watts * Saffron Wanger * Trish Johnson *
John Greenawalt – Team Coach
Debbie Tinsley – Team Leader