July 20, 2015
The challenges facing the healthcare industry today span everything from clinical to financial, but the bridge that connects it all is care coordination. In order to maintain great care coordination, West Jefferson Medical Center knows that clear communication is key.
Darlene Gondrella is VP of Care Coordination at WJMC which is a 427-bed not-for-profit hospital and health system located in Marrero, Louisiana. They have on staff over 400 physicians, over 1900 employees, 67 volunteers, 23 nurse practitioners and over 350 contracted employees.
Darlene knows first-hand that communication can be complex because like a lot of other hospitals, the staff at WJMC communicates across multiple venues leaving the potential for important conversations to be overlooked.
Here are two steps they took to prevent communication breakdown among their teams…
“We make sure all departments affected in any way, sit around the table together to discuss the roll out of any new service. As a nurse myself, we know that clinicians think about what they can do clinically to help our patients, but someone has to think about the charging, coding and billing process in order to ensure payment for the great services we decide to implement.
Thus, involving all the players is essential to the success of rolling out a new service.”
“We all know that consistency and accuracy in our workflow prevent errors which could lead to unnecessary denials. In addition, staff turnover can also lead to an increase in errors due to learning curves of new staff. So the number one thing we can do is constantly educate.”
While these steps helped push them towards their goal of bridging the communication gap, there were still problems that arose with documented communication. Problems such as…
Medical Necessity Denials
This included he said, she said challenges, discrepancies over number of days approved, appropriate level of care, as well as disputes over payment when the Case Manager gave clinical but the payer had no record of the call.
This included the inability to document routine communication other than manually, and when it was documented it would sometimes be inaccurate or incomplete. Sometimes patient account numbers would be transposed, putting the information in the wrong account and preventing retrieval later on.
There was a constant rework in collections (back and forth between business office, case management and payer). Sometimes the payment would be delayed 30 to 60 days. WJMC also experienced increased medical necessity denials and underpayment for services rendered.
How call recording and information indexing through Trace helped to solve those problems and bridge WJMC’s communication gaps…
“Trace gives everyone access to the same information, and it is time stamped. This allows departments like Patient Access Services and Case Management to record calls (both incoming and outgoing), and keep track of authorization logs and denial letters from the payers so that if there are any payment discrepancies on the back end, the business office can just look in Trace and pull up the information. Once retrieved, they can share that information with the payers’ claims department to resolve any issues we have with underpayment of claims or false denials.”
Other benefits? Trace allows WJMC to avoid initial denials from payers by showing documented proof of calls. It’s improved turnaround time on claim payments by 30-60 days.
Having Trace has increased the percentage of medical necessity denials overturned by providing proof of clinicals or insurance logs with days certed and level of care. Also, they’ve been able to reduce the number of medical necessity denials.
Communication is complex. Trace makes it simpler.
“As you can see – from eligibility and benefits, to precert to authorized days, to physician communication and discharge placement – communication is complex!
Implementing Trace allowed us access to transparent, timely patient information and data which is another way that we bridge the communication gap and integrate care management into the revenue cycle.
With the ever changing rules and regulations from CMS as well as continued Medicare cuts to both hospitals and physicians, it is essential to have a revenue cycle team in place that includes care coordination. This will lead to better outcomes, decreased denials, penalties and improved transitions of care through improved communications.”