Access tool tracks, sorts accounts that need work

User can tailor-make’ report

At its new off-site pre-arrival call center, the University of Pittsburgh Medical Center (UPMC) is making use of a patient access-reporting tool, known as PART, created by Cap Gemini Ernst & Young.

"What we are doing is creating an automated method for tracking patient accounts that require and lack benefit authorization, pre-certification, referrals, and notification of admission," explains Jonathan Bluth, a Cap Gemini consultant.

There are "hundreds of thousands of rules," he notes, and the likelihood that access personnel might forget one of them. "What we’re able to do is establish a list of requirements and any account [that matches one or more of them] will hit the work list. Once it’s complete on the ADT [admission/discharge/transfer] system, the account will no longer appear on the work list."

The way PART is being used at UPMC is that a designated team runs a work list for the full staff, he says. "What differentiates this from standard reports is that we are able to adjust the output of the report each time we run it. The user is able to select a whole variety of activity — to sort by patient type, location or service code, and by financial class or insurance plan code."

Outstanding accounts can be segmented according to whether they are Medicare, Medicaid, Blue Cross Blue Shield, etc., Bluth says, and can be split alphabetically by last name, making it easy to divide the work by teams.

"What we’ve seen is that a lot of other systems have work-list capabilities, but they are either not flexible or you can’t easily change the output," he adds. Some of the hospitals he has worked with have standard reports that include every account that requires verification, Bluth notes. "[Those hospitals] might have the Blue Cross team working off the same 50 pages as the Medicare team."

The advantage with PART, he says, is that "the user printing the report can tailor make it for staff work flow [and] can adjust it in a variety of ways."