Mercy Medical Center
Cedar Rapids, Iowa
Schedule Maximizer® Reduces Pre-authorization Claim Denials
Enables Clinicians to Focus on Delivering Care, Not Scheduling Appointments
The Challenges
The line of patients waiting for their outpatient appointments to be processed at the front registration desk was not giving a good first impression of Mercy Medical Center. Delays were common due to inconsistent pre-registration processes among departments, insufficient information and the need to handle 15 to 20 different insurance plans. Some patients had a pre-authorization number, others not. The result? Too frequently insurance claims were being denied because proper pre-authorization had not been obtained before services—and the business office wanted to know why.
According to Nikki Woods, manager of the new Central Scheduling department at Mercy Cedar Rapids, pre-registration used to vary widely across the hospital. “Any change to an appointment caused an uproar in departments still doing paper scheduling with pencils and huge erasers.” People scheduling appointments—often the technicians themselves—did not have the necessary tools to do the job the way it needed to be done.
Clearly, the outpatient scheduling process was broken, but it would take a “Lean Event” process improvement proposal to change the way Mercy Medical Center had been doing scheduling for more than 100 years.
The Goal
The lean event initiative requested centralized scheduling to develop and enable consistent pre-registration processes across most outpatient services mainly to stop $250,000 in annual write-offs from pre-authorization denials. Once skeptical managers saw the impact centralized scheduling would make on their department’s administrative workload, they were willing to relinquish control and gave their buy-in.
The Solution
Mercy’s Central Scheduling department was created in May, 2008, and with the lean group, began searching for software to meet the unique requirements of each specialty as well as enforce the strict pre-authorization rules of Iowa’s biggest health insurers. Familiar with SCI through Order Facilitator, SCI’s comprehensive access management solution, Schedule Maximizer, stood out among the five to10 competitive demos. The team liked its web-based capabilities for customizing for specific rules and specialized reporting. Evaluators also saw how the Worklist would help ensure pre-authorizations were not missed and its self-guiding workflow would lead Mercy’s non-clinical schedulers through the exact processes for each department.
Despite flood damage and diverted hospital resources, Mercy implemented Schedule Maximizer in October 2008 for four high-dollar outpatient areas and continues to add more. “Getting started with SCI software was one of the most painless builds and installations I ever experienced,” Woods said.
Mercy’s IS management backed the technology decision as long as Central Scheduling could support it. “There’s really not much for us to support,” said Woods, “so that isn’t much of a problem.”
Now every exam is set up in Schedule Maximizer in minutes. “Our goal is to answer every call in less than a minute, with a talk time of three minutes,” Woods said.
Schedule Maximizer prompts schedulers to identify and obtain necessary authorizations and shows them the patient’s existing pre-authorizations. Storing each insurance plan’s rules for which procedures or tests require pre-authorization, SCI also links patients’ previous authorization details to one or more scheduled appointments. If a requesting physician’s office does not have an authorization, Mercy will go ahead and schedule the appointment but puts it on SCI’s Worklist of authorizations that must obtain a number prior to service. “This pending file is monitored closely for timely follow-up with the office,” Woods said. “We never miss one.”
Some departments are now trained to do their own scheduling, while others want access to our Worklist functionality. “A few departments asked to use our Worklist to track their co-pays,” said Woods, “so we set them up to use it.”
After patient exams, staff matches CPT codes and double-checks that what was authorized was actually performed. If the test was changed onsite, they have 24 hours to obtain pre-authorization for payment. Scheduler’s can pull all the tests by task and by health plan for yesterday, today and tomorrow, making this job easier.
Schedule Maximizer provides complete authorization management, from the plan-specific rules to supporting scheduling and pre-registration and passing the authorization number to the billing system.
The Results
The business office couldn’t be happier with the new normal. Pre-authorization denials are all but eliminated.
- First year reduction of annual pre-authorization denial write-off of $250,000 dropped to $8,000—and that due to an on-site change made without notifying Central Scheduling
- It’s the extent of unexpected value Mercy is realizing from standardizing scheduling processes that surprises even its initiators.
- Volume of patients increased 5 percent in departments using the system, significantly exceeding original estimate of 1 percent
- Six non-clinical schedulers handle 7,500 calls a month for outpatient appointments, with answer times averaging 32 seconds, and calls lasting three minutes, 10 seconds
- Physician offices appreciate one call, one source efficiency for all appointments and the leeway to schedule an appointment before having an authorization number
- Patient satisfaction improved noticeably, and the 15 chairs formerly in the registration waiting area have been reduced to only two
- Centralized scheduling and automatic appointment reminders have saved hours of phone time for clinical departments
- Process standardization ensures compliance for each appointment scheduled
- Nothing is forgotten during pre-registration, no plan detail overlooked, no deadline missed
Congestion at the front registration desk has disappeared since Mercy pre-registers every scheduled outpatient appointment. Patients now bypassing this delay go directly to their appointments on time.
“Getting patients in sooner for tests is a huge physician satisfier,” Woods said. The first customer survey after implementing Schedule Maximizer gives the hospital high marks. Responses from 26 of Mercy’s most vocal clinics shows more than 80 percent prefer the new centralized process over previous de-centralized scheduling.
According to Woods, Schedule Maximizer has restored the intended order of healthcare priorities. “Clinicians and technicians don’t have to deal with scheduling appointments and can now focus on what their training meant them to do.”
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client quote:
“SCI Order Facilitator has streamlined our orders workflow, increased provider and patient satisfaction and reduced operational delays.”
Mary Godwin, Manager Centralized Scheduling
Baptist Health Care
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