State-of-the-art call center at UPMC boosts billing accuracy, collections

Central location simplifies management and training

Developing a new off-site call center for the University of Pittsburgh Medical Center (UPMC) was the mission. The challenge, says Georgina Trunzo, director of patient access services for the health system’s hospital division, was combining the cultures of six different hospitals and establishing common policies and procedures.

Six weeks after the move — which followed about a year of preparation work — Trunzo says she was seeing a decrease in unbilled reports (cases in which patients are discharged without being final-billed) and a decrease in "dollars out there due to insurance verification not being done."

In addition, she notes, "we’re able to trend our denials and identify the root causes — what is done at pre-arrival vs. what is done on site. Having all the employees in one location, we’re able to economize on management and do more training."

Having the financial functions in the same building — the pre-arrival call center is located on the same floor as the health system’s physician financial services and central payer offices — has enhanced the collaboration between physicians, hospitals, and care management, Trunzo adds.

The central business office for the six hospitals is on the floor below the call center, she notes, which allows daily interaction between the two revenue cycle components.

Going into the project, which UPMC did in conjunction with the consulting firm Cap Gemini Ernst & Young, some initial parameters were set, Trunzo says. "We wanted to centralize pre-arrival function, including pre-registration, insurance confirmation/authorization for outpatients and insurance verification/pre-certification for inpatients. Each facility was doing it differently –– some were doing all [the functions], some were doing part. We wanted everybody to do them consistently."

The goal, she said, is to do "100% of financial clearance of scheduled cases," including inpatient, observation, same-day surgery, and outpatient accounts of more than $500, and to clear within 24 hours the accounts of all unscheduled inpatients.

The six facilities that will be served by the call center include the two largest teaching hospitals, Trunzo notes, and another four hospitals that are on the same computer system — MediPac, by McKesson HBOC in Atlanta.

What the six hospitals also have in common, she adds, is that Trunzo oversees directly the site management of the access departments.

The system’s remaining 10 hospitals, Trunzo points out, have been closely involved in the planning that led to the call center’s opening. "They helped review procedures and offered insights." The policies and procedures for those hospitals will be identical to those of the call center, she adds, so patients will have the same experience throughout the health system.

The actual move took place between Feb. 18 and March 30, Trunzo says, with employees from the six different hospitals gradually phased into their new quarters in a building off-site from the hospital. The fact that the building was brand new, with pristine employee workstations located near the windows, was a great morale booster, she notes. In this case, she adds, the managers have the interior office space.

Another plus was that for every person who became part of the call center staff, the move was a promotion, Trunzo says, because the job was more challenging. Every employee has to be able to multitask, she says, meaning pre-register, verify, and do financial counseling. She estimates that the cross-training necessary to get everyone comfortable with the duties will take at least 60-90 days after the move.

Individuals who already were doing insurance verification, or in the case of the nurses, clinical pre-certification, at one of the hospitals, were eligible to make the switch to the call center, Trunzo notes. Otherwise, those interested in the new positions had to apply. Pay grades and policies and procedures were established in advance, she adds, which was crucial to the project’s success.

"The big thing was to get the human resources departments involved early," Trunzo emphasizes, "to develop job descriptions and pay grades and to help communicate the information to employees."

Each new employee will receive 64 hours of MediPac training, as well as training on the pre-arrival functions and 12 hours of continuing education. Even for those who already know the job, she points out, it’s important to ensure that everyone is doing it the same way.

The call center houses 80 full-time equivalents (FTEs) at present, Trunzo adds. "We have built in room for growth — the floor has an extra 60 workstations."

Four lead positions were created, she notes. Also included in the 80 FTEs are 10 nurse FTEs, who do pre-certification and screen for medical necessity and appropriateness of care, and four financial data-quality specialists, who review reports, edits, and denials. "Bills drop three or four days post-service," Trunzo says, "so they review them to make sure mistakes are corrected before [billing]."

The facility’s head of training receives daily data-quality reports, which are used to give feedback to staff, Trunzo adds.

Staff response to the call center "has been wonderful," she reports. "People were scared and had anxiety at first, but we did a lot of communication up front. We didn’t have a building to show them at first, but we had an open house and invited them to see the bricks and mortar." Employees recently were invited to bring their children to the new center during "Take Your Child to Work Day," Trunzo adds.

There are plans to build shops, restaurants, and a movie theater in the office complex, as well as a nearby walking trail, she says. That will provide a nice contrast to the previous work setting for many of the staff, Trunzo notes, who were located at UPMC’s flagship hospital in a congested downtown area.

Lots of prep work’ done

Before the call center became a physical reality, Trunzo points out, there was "lots of prep work." Working in conjunction with Indianapolis-based Cap Gemini manager John Woerly, RHIA, MSA, CHAM, and other Cap Gemini consultants, UPMC did training at the different sites to make sure pre-arrival and financial clearance policies were consistent and that customers were treated the same across the system, she adds.

When it came to the call center technology, says Woerly, UPMC went with some relatively inexpensive systems to help do the work. It can cost between $10,000 and $12,000 per workstation to install a top-of-the-line customer relationship management (CRM) system, he points out. "We didn’t go that route here — it was too expensive."

Cap Gemini has devised a four-step progression for a call center, with increasingly complex technology at each higher level, he points out. (To see chart, click here.) "Most people think of either the basic telephone or the other extreme, and they don’t see the middle ground.

"It would be wonderful to be at the top of the heap," Woerly adds, "but that may not be affordable. The operation can be just as effective as the third level, which is about where UPMC is," he notes.

"We took the approach of seeing how we could leverage our existing technology," Trunzo says. "Cap Gemini was helpful in providing a technology assessment, looking at what we could do now and what we may look at in the future."

UPMC does not have the CRM technology, she notes, that would allow call center employees to identify patient preferences from past encounters and say, for example, "I see that you like appointments at this time."

That still is the vision for the call center, Trunzo points out, and will be part of the enterprise solutions on which UPMC will work with Kansas City, MO-based Cerner Corp.

With the existing technology, however, super-visors can do "service observing," which means they can listen to telephone calls and voice recordings and give feedback to staff on the length of calls and the call-abandon rate, Trunzo adds. "This lets us know how many calls a person can handle."

Patient access reporting tools developed by Cap Gemini allow UPMC to run reports "to see what work hasn’t been done that needs to be," she notes. "This includes exception reporting and creates work lists with patient names. We’re in the process of rolling out this system." 

"We’ve also worked to develop, via our infonet,’ a benefits engine," Trunzo says. "It is not integrated into MediPac, but allows payer information and contract information for our top 10 payers to easily be viewed. This allows registrars or radiology receptionists to click on and be able to see the payer-specific issues for a patient that wants to schedule, what the copayments are, whether they need authorization, and the numbers to call."

The benefits engine was expected to be in place "within the next few weeks," Trunzo adds.

Meanwhile, a pilot program is under way that allows patients to register on the Internet. The idea, she notes, is that patients who are hard to reach will have another outlet for contacting the call center.

Lessons learned

What she’s learned from the call center effort so far, Trunzo says, is that to successfully combine the cultures of six different hospitals, good communication is essential. "We also have to know what’s going on not only in our world, but in the other world [of the 10 hospitals that are not included in the call center]," she adds. "You have to engage all stakeholders — you can’t do this in a vacuum. I would think I had covered every base and still find one stone unturned."

To streamline the transition for medical staff offices, for example, Trunzo made communicating with the new center as easy as possible. "If they used to send faxes to Point A, we kept the same numbers and had them rerouted to the fax machines. It took a lot of planning and a lot of hard work."

During the transition, Trunzo says, she met with the call center staff every day at 4 p.m. "We identified what they saw, what issues needed to be addressed," she explains. "They had to learn to use new telephones, fax machines, copiers — everything was new. You don’t assume everything is basic to everyone."

Because the employees were brought over in phases, Trunzo notes, she had to be conscious of going over the same material with each group of new arrivals.

Response to the call center so far has been wonderful, she says. Trunzo has gotten e-mail thank-you notes from staff. But she says she is very aware that the "real work" now begins. "We are a work in progress," she adds.

[For more information, contact:

  • Georgina Trunzo, director of patient access services for the University of Pittsburgh Medical Center’s hospital division. Telephone: (412) 432-5050. E-mail: trunzog@msx.upmc.edu.
  • John Woerly, Cap Gemini Ernst & Young, 10 W. Market St., Suite 1300, Indianapolis, IN 46204. Telephone: (317) 977-1171. Fax: (317) 977-1301.]