Post on 21-Aug-2020
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Murry Ford, MBA, MHADirector, Revenue Strategy, Emergency Registration Grady Health System Atlanta, GA
Minda McMann Sr. Director, Product ManagementExperian Health
Introducing:
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Driving Revenue OpportunityThrough
Coverage Discovery On-Demand
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953 bed, Level I trauma center
Verified burn & stroke centers
Safety Net for Fulton & DeKalb Co., Ga ($250m uncompensated care)
Teaching facility for Emory & Morehouse Schools of Medicine
Over 140,000 ED visits
135,000 EMS trips in city of Atlanta
Epic version 2014 (Live October 2010) Interstate 75/85 @ “The Grady Curve”
About Grady Health System
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About Grady Health System
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Agenda
What is Coverage Discovery
How On-Demand is helpful
How it functions
Implementation
Results
Lessons learned
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User-driven utility that finds potentially unknown coverages
270/271 transactions to deliver data electronically
Accessible in Health Information System or through Passport eCare NEXT
Limits exposure to “phishing” as data is queried in internal Experian networks
What is Coverage Discovery On-Demand?
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Batch process
Automated
Checks all self-pay accounts
Next day resultsOn-Demand
Triggered
Check any account
Results within seconds or minutes
What is Coverage Discovery On-Demand?
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When patients do not communicate insurance status
MVA patients who don’t think it’s their responsibility
ACA & other high deductible policy holders not wanting to use coverage
Patients who are medically unable to communicate
Dependents who may not know insurance status
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Denial avoidance
Late inpatient admission notification denials
Authorization denials
Timely filing denials
Billing the appropriate party
Incorrectly billing the patient
Coordination of Benefits
How is On-Demand Helpful?
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1) On-Demand coverage queried by Access Rep.
2) Record queried against Experian
database with scoring algorithm
-SSN, Name, DOB, Address
3) Identified coverage appears as new response in response history
4) Access Rep. attaches coverage
How On-Demand works
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How On-Demand works
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Original workflow involved Financial Counseling use of Epic patient WQ to find and attach coverages not attached at TOS
Counselor completes Inpatient admit notification if applicable
System action adds “Found by Coverage Discovery” billing indicator for reporting purposes
Currently using in ED, Inpatient & Ambulatory Surgery
New workflow leverages Epic ADT confirmation records
How On-Demand works
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How On-Demand works
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6-8 weeks implementation timeline (4 weeks if already using batch)
Interface setup (270/271)
On-Demand plan code build
Bad plan code detection plan mapping
Patient workqueue build
Unattached coverage workflow
Registrar training & tip sheets for On-Demand
Implementation
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Bad plan code detection plan mapping
Facilitates identification and attachment of On-Demand coverages
Started with largest commercial payors
Difficult out-of-network exchange plans
Medicare/Advantage plans
Implementation
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Training
Training minimal due to use of current Epic workflows
Registration/Financial Counseling all-hands discussion
Tip sheets on how to query using the On-Demand coverage record
Implementation
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Workqueues & process monitoring
Registrars attempt real-time attachment
Routed to dedicated patient WQ
Financial Counseling ownership
► Coverage attachment
► Inpatient admit notifications
Billing prevention setup to avoid billing patient with On-Demand found coverage
Implementation
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Results$7.3m in On-Demand assisted payments over 7 month period
Source: Passport Analytics/
Epic Clarity
Commercial44%
Blue Cross21%
Medicare Managed Care21%
Medicare7%
Medicaid Managed Care
3%
Commercial Non-Contract
2%
Medicaid2%
Average age of Medicare patient found through On-Demand Coverage Discovery =45 years
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Use automation where possible
Lessons Learned
Leverage Epic confirmation records to trigger On-Demand vs. patient WQ approach
Admit to Inpatient ADT confirmation message currently in use
New RTE status of “Eligible-CD” to track On-Demand attachments
Discharged ED/Observation under development
Trigger based on Address Verification under review for all accounts
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Bad plan code detection plan map testing should be conducted by insurance SME
Lessons Learned
Testers may understand technology but may not familiar enough with insurance to spot mapping issues
May lead to incorrectly mapped coverage records
Can lengthen project timeline
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Coverage Discovery®
Product Updates and Strategic Direction
Minda McMann
Sr Director, Product Management Experian Health
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Coverage DiscoveryYear in Review Highlights
Fall 2016: Duplicate Inquiry
Re-Use Rules
*NEW*:Power
Reporting for Coverage Discovery!
Launched January 2016
16.5%Average Found Coverage Hit Rate
34.74%Commercial Coverage
65.26%Government
Coverage
1.3+ millionFound
Coverages
370+Payers
Benefitting 284 Clients
Coverage Discovery Core Improvements
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Coverage Discovery 2.0 Initiative
Coverage Discovery®
will be the market leading discovery solution for all integration points in
the Revenue Cycle.
Enterprise Coverage Discovery: Advanced Analytics End-to-end Workflow Safety Net Feature Risk-Free Option Claims Reconciliation Increased Intelligence Increased Data Assets
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Coverage Discovery 2.0Primary Focus
Connected intelligence – Front End / Back OfficeCombined data for all discovery touchpoints for actionable insight; Leverage additional data assets and industry intelligence to continually enhance the discovery engine
User experienceDiscovery specific workflow, action oriented specific alerts, enriched address + identity data for action clarity
Safety net processLeverage industry intelligence rules based triggers and data mining technology for non-user-triggered primary and secondary coverage opportunities
ROI analysisDiscovery reconciliation to Claims + Remit data for concrete ROI
Executive insight Data consolidation; advanced analytics; strategic performance dashboards
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Coverage Discovery 2.0 – Key ComponentsEnterprise Functionality Detail
Comprehensive Workflow: Patient Centric View “Maybe” Work Queue Address + Identity Data Actionable + Informational Alerts
Advanced Analytics: Monthly Trending: User, location, account
trigger analysis Source and Trigger Analysis Data-Based Training Recommendations
Goal: Create an evolving engine to continually reduce noise for the users, streamline questions, quantify non-productive found coverages + policy limitations, and focus efforts on actionable data.
Learning Intelligence: User Disqualification Process Auto-Exclusion Queue + add-back workflow Account Question + Resolution Process
Goal: Provide executive level reporting on value of the discovery touchpoints, and highlight both high and low performing departments/users for ongoing process optimization insight
Goal: Provide all levels of Coverage Discovery users with actionable intelligence for process improvement, with specific recommendations based on usage to find patterns.
Goal: Continually empower and educate users and managers with easy to understand, actionable data and directed workflow.
ROI + Billing Reconciliation: Lifetime Value Dashboard Fiscal Year Value Dashboard ROI + A/R Days improvement No Claim Submitted Report Payment Pending Report
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Current Feedback + Open Discussion
Why was coverage missed initially?
Could it have been prevented?
Did my team act on the
found coverage?
What was the actual value of the found
coverage to my organization?
Is there additional coverage opportunity
in my non-self pay accounts?
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