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Review of reimbursement issues related to mid-level providers.
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17 Eliminating Scheduling NON-DHS Patients to DHS Outpatient Facilities Advocacy Plan Harbor-UCLA Medical Center Improving Patient-Centered Care By Eliminating Scheduling NON-DHS Patients to DHS Outpatient Facilities Nicole R. Codd Mount Saint Mary University July 16, 2017 The Problem Harbor-UCLA hospital emergency staff is not efficiently identifying NON-DHS managed care patients and continues to schedule appointments that negatively effects patient-centered care and contributes to lost revenue for the medical center. When a patient arrives at the emergency room, a nurse performs the intake, and an ED registration staff obtains patients information to determine medical coverage to cover the ER visit. It is important to identify the medical coverage accurately and correctly because ED providers always advise a follow-up appointment after an Emergency Room visit. The Emergency Department staff create appointments for NON-DHS managed patients that fill appointments that should be filled with DHS-managed care patients. When an NON-DHS managed care patient receive medical services at Harbor-UCLA Medical Center, the hospital does not receive any payment. NON-DHS managed care patients have primary care providers that receive capitation payments every month for medical services. Harbor-UCLA Medical Center are treating NON-DHS patients for free when they arrive at Harbor-UCLA outpatient clinic. At times, outpatient staff can recognize the error and redirect the patient to their primary care provider, which the patient can become irritated that leads to poor patient care. Harbor-UCLA Medical Center have at least 2% of NON-DHS managed care, self-pay and out-of-county that have appointments to outpatient clinics. Harbor-UCLA Medical Center’s emergency department have over 7,136 visits per month with patients that have all different types of health insurance (DHS-Office of Planning; DHS Housing for Health). The emergency department accepts all insurances. However, Harbor-UCLA emergency department should only schedule follow-up appointments for DHS-managed care patients to improve patient-centered care and increase revenue. Current Policy and Procedures for NON-DHS PATIENTS The Emergency department have several policies in placed to avoid scheduling NON-DHS patients’ appointments to outpatient clients: 1. During registration, the Registration staff inputs NON-DHS primary care provider (PCP) information into the patient’s accounts and the information is available for Emergency department staff such as the doctors, nurses and clerks. Problems with this procedure: a. Registration staff not properly identifying the patients’ insurance correctly from the Health Care Eligibility Benefits. Registration staff putting incorrect information. b. Clinical ED staff (providers, nurses and clerks) bypass the insurance information and schedule NON-DHS patients to outpatient clinics. c. No indicator pop-ups to direct the clinical ED staff to vi ...
17Eliminating Scheduling NON-DHS Patients to DHS Outpatient Faci.docx
17Eliminating Scheduling NON-DHS Patients to DHS Outpatient Faci.docx
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