Revenue Cycle

Improving communication at Children's Atlanta

Patient Access Weekly Advisor, October 1, 2008

At Children’s Healthcare of Atlanta, with 489 beds in three campuses and 15 neighborhood locations, we saw a big opportunity to get proof of all communication exchanges from scheduling, pre-registration, pre-certifications, authorizations, notifications and verification of eligibility via e-mail, fax or phone call.

As in many hospitals, our staff members use a variety of methods such as phone, fax, and web to communicate with physicians and payers, obtaining eligibility, benefit, and authorization information. Our department was challenged with disparate processes for documenting and managing these routine communication exchanges. Sometimes these communication events were scanned or filed within each area of service or, more frequently, due to other competing priorities, they were never scanned or filed.

As a result, we had denials involving thousands of dollars that we could not appeal simply because we did not have the proof of what we said we did. Our access and appeals staff members spent much time going back and forth in an attempt to obtain proof of what was done at the front end to secure payment of services rendered.Not only was this inefficient, it created extra stress between departments.

We also had disputes between what was scheduled and what the physicians or parent/patient said they called in to have done. Since we didn’t always have proof to back up our claims, it came to “he said, she said,” leading to more frustration for all parties. We knew we needed to have a communication event management system to document all the steps taken to secure payment for our services before ever receiving a denial, and to be able to retrieve this information.

Without the option of adding more staff, we had to accomplish more in less time, reducing rework and inefficiency between departments. So, we looked for a tool that would help streamline our process without adding to the workload of our already “stretched” staff.

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