September 28, 2013

Article: Trace Panel at National Case Management Conference

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At a Trace-sponsored panel session at the NICM-ACMA conference in Orlando, attendees had the opportunity to hear from four case management leaders who are using Trace to increase revenue, productivity and accountability at their facilities.

The panel included Allison Thomason from WellStar Douglas Hospital in Douglasville, Ga.; Theresa Rainwater from Southeast Hospital in Cape Girardeau , Mo.; Sally Finley from Deaconess Health System in Evansville, Ind.; and Gloria Noell from Providence Little Company of Mary Medical Center in Torrance, Calif.

How They Use Trace

Allison  Thomason shared how WellStar has used Trace to challenge a payer that routinely  issued denials for the level of care approved. “Once we got Trace, we were able to show exactly what had been  approved, and it only took one or two phone calls to clear everything up.”

Theresa  Rainwater mentioned that Southeast Hospital’s social services department  appreciates Trace for the efficiency it brings to discharge planning. “Through FaxCert they can fax the  information to ten nursing homes with just one fax instead of having to input  that information ten times. That was a time saver for us.”

Trace has helped Sally Finley streamline communication between the access and case management teams at Deaconess. “With Trace we were able to link [the notification person and the nurse] because the person with precert can start the call, get the initial Trace tracking number and then give that number back to the case manager.” Trace has helped communication with the billing department as well.

Having proof of phone calls has saved the emergency room staff at Little Company of Mary from denials related to insurance notifications. Gloria Noell shared, “At night, the insurance companies are closed so when a patient would come in to the emergency room we would have to notify the payer that their patient was there by leaving a message. Then the insurance company would claim they were never notified of the admission, so they wanted to deny a lot of those claims. Trace allows us to come back with documentation that they were notified.”

How Trace Supports Case Managers

Sally  Finley commented that Trace helps her staff learn the appropriate lingo to use  when dealing with payers and claims. “It  helps in teaching staff how to ask and use the right terminology with payers,  because sometimes our staff will think they said the right thing, but then  we’ll play back the recording and it turns out they didn’t.”

One  employee of Theresa Rainwater’s was having a problem talking too fast, and  payers could not understand what she was saying. When confronted, the employee  didn’t see the problem. “We then had her  listen to a recording and she was able to see what she was doing wrong.”

All of  our panelists found that once payers, physicians and staff know they are being  recorded by Trace they tend to be on better behavior. One physician in  Theresa’s hospital found this out the hard way.  “We had one physician that was  very irate and not using very professional language with a case manager, so we  took the recording and the transcript to the physician excellence committee. It  has definitely made a difference with how our staff now interacts with each  other.”

Getting Started with Trace

Panelists  shared that training staff with Trace is simple, even for those who are less  technically savvy. Sally Finley said that a precert clerk often resistant to  new technology finished a 1- 2 hour training session and was immediately ready  to use Trace. “She literally walked  upstairs and used it; it was very easy. Plus the Trace staff developed such a  great relationship that to this day they identify with her.”

After  training, panelists noted the importance of monitoring Trace usage, which also  helps in evaluating staff performance. “We  use it as a productivity measure,” says Sally, “I very easily graphed out how many calls and faxes two of our workers  had and showed it to the one who hardly had any.” Sally also mentioned that  the process of working denials is much easier when using Trace. “The first time our employees have to do a  denial where they didn’t use Trace – writing an appeal letter and going through  that process is so tedious – it really proves the point.”

Why They Love Trace

“We went with Trace five years ago, and  now the other hospitals that we have are coming on board because of the denials  being decreased. We’ve been able to overturn 2 million dollars this year.”   – Gloria Noell

“Trace is part of our everyday  communication, and within 14 months of purchasing we had a payback on our  initial investment which was 3 months earlier than what we had projected. In  less than a year we overturned $368,000 in denials, and within two years it was  $689,000.”  –Sally  Finley

“Once we could monitor a call or a fax  to show what was approved, it only took us one or two phone calls and it was  resolved.” –Allison Thomason

“Our denial rates have gone down. Once they find out you have a system where  you are recording, you’ll see a decrease in your denials. Once they know you  have something in place to keep them in check, they won’t challenge you as  much.” –Theresa Rainwater