Consolidated billing can smooth operations

Hospital, physicians share patient data

It’s looking an awful lot like the future at Heartland Health in St. Joseph, MO, where billing for the hospital and its 14 medical group physician practices has been consolidated and centralized and all entities share a master person index (MPI). "We share the same medical record number," says Cheryl Field, CHAM, patient access team leader. "When a patient is registered at the physician’s office, the information is stored on the registration level of the [Eclipsys] system, which all entities share.

"Transitioning the physician offices to our hospital system [scheduling, registration, patient accounting, billing, and collections] has really been our big achievement," Field notes. "The physician office obtains demographic and insurance information during the patient visit. When the patient arrives at the hospital, we rely on this information and do not replicate patient demographic and insurance questions."

Heartland was to have been implemented on Aug. 1, 2001, an on-line process for monitoring rejected and denied claims that are precipitated by registration, coding and billing errors. The hospital and clinics will share this on-line process, she adds, to ensure the accuracy of the access processes and reduce rework during the billing cycle.

The sharing of information via the MPI and the merging of hospital and clinic billing has been facilitated, Field says, by Heartland’s use of products from Boston-based software vendor Eclipsys for scheduling, registration, patient accounting, billing and collections. Heartland’s clinical order-entry system is TDS, which has merged with Eclipsys, she adds. "When a patient is registered for a visit in the hospital, the information reflects on the clinical side as well," Field notes. "The sharing of the information on the system allows the clinical and financial employees to work closely together."

"Eclipsys Sunrise is the software product that enables physician offices and the hospital to share information on the registration level," she explains. "An additional level, the visit’ level for the hospital or encounter’ level for physician offices, contains information on the specific visit," Field adds. "This information is kept separate for each entity."

Follow the audit trail

One of the system’s most helpful features, she says, provides an audit trail whereby any changes made in the registration level can be retrieved and viewed. When a correction in a Social Security number or a patient’s date of birth is made, for example, both the old and new value will be seen. "For any demographic changes, Eclipsys shows the date, time, the initials of the user who made the change," Field says.

This function allows Field to review access representatives’ work and determine who is responsible for a particular error, she points out. "If someone says, This isn’t accurate. How did you get this?’ With audit trail tracking, I can see that the information was put in at this time by this person." This capability is particularly helpful with changes in insurance, Field notes.

Heartland’s process for monitoring rejected and denied claims, she says, works as follows. When a claim is denied by the insurance company and returned to the hospital, the mail clerk receiving the denial enters the date and the denial code or reason for the denial from a menu of codes/reasons into an access file, Field explains. "We’ve mapped each denial code to the appropriate area, such as access, billing, coding, etc.," she adds. "A designated follow-up person for that area can retrieve [the information] on-line to review or print a work list."

The follow-up person reviews the Eclipsys audit trail to see the user ID of the access representative who registered the patient, Field continues. If, for example, the denial reason was "ineligible on date of service," the follow-up person determines that the access representative did not check insurance eligibility, she indicates it is a valid denial and assigns the responsible rep’s name to the error.

"The rep [who made the mistake] can go in later and bring up her own report so that she can review comments, the reason for the denial, and know what she did wrong," she says. "At the end of the month, each access representative prints out her list of denials and signs it, indicating that she has reviewed the denials and gives it to her supervisor," Field adds. "That way, we have a record that she’s getting the feedback."

The denials can be grouped by financial class: Medicare, Medicaid, or commercial claims, she notes. "This helps identify if there is a specific payer we want to target for additional education."

An enhanced list

Many of Heartland’s innovations, Field points out, are a result of its active role in the Eclipsys Users Group. "We strive to maximize the capability and capacity of software applications." Heartland submits enhancement requests at the user group meetings, she adds. After being prioritized, the list of enhancements is presented to Eclipsys, which evaluates the feasibility of implementation. Heartland has been able to improve its system functionality by using that approach, Field notes.

An endeavor on Heartland’s horizon, she adds, is implementing Envoy, the Eclipsys product for on-line eligibility verification.