TERROSWest Outpatient

(Mercy Care Advantage Services Collection Team)September 2008 to May 2009

Improve Collections from Mercy Care Advantage at the West Outpatient Clinic

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)

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)

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

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.

Call Center Call Center will identify insurance at scheduling TPL information is entered into electronic referral

system Hard copy referrals scanned and processed

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

TPL CSR 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 pre-authorization request.

Log information in TPL spreadsheet

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 CoachDebbie Tinsley – Team Leader