Out-of-Network Transfer/Admission Notification Process Improves Door-to-Registration Time, Patient Repatriation, Through-put and Lost Revenue

Aim: : The current Out-of-Network Process has led to wasted time and resources, rework, delay with patient through-put, and ultimately a lack of revenue. The new process aims to standardize a notification process that eliminates this waste.

Framework:: Lean Six Sigma

Setting:: A 238-bed acute care hospital with a 72-bed emergency department in San Diego, California that has over 100,000 ED visits per year

Stakeholder Team:: Melvin Russell (CNO), Thomas Siminski (ED Director), Joseph Parker (Transitions Officer), Sharon McGee (Manager of Case Management), Andrea Arriaga (Patient Access Supervisor), Donna Foley (NUS), Rocio Brown (NUS), Constanza Nider (NUS), Michelle Schafer (NUS)

Methods: : -Resource binder created by Unit Secretaries. All phone/fax numbers were validated/updated.
-Equal work distribution implemented for Unit Secretaries so that the majority of the calls were not going to one pod.
-Standard notification process to insurance plans created with defined timelines for actions.
-Scanners added to Unit Secretary workstations so that they can scan the notification into the chart.
-Standard documentation template implemented to ensure the correct information is captured in the chart to challenge denials if notification took place.
-Registration workstations moved to the emergency department lobby.
-Registration workflow changed so that full registration now takes place in the lobby before the patient goes back to a room.
Number of Out-of-Network Denials and lost revenue measured pre- and post-intervention. Door-to-registration times measured pre-and post-intervention.

Outcomes:: Decreased the number of insurance denials per month from an average of 15 to 10.
Decreased money lost from lack of notification from an average of $364,416 to $49,842.
Increased money reimbursed by $314,574 per month.
Decreased door-to-registration times from 120 minutes to 60 minutes.

Implications:: This initiative Increased collaboration between the emergency department unit secretaries, case management, and the registration team. Using a standardized notification tool with defined timelines provided guidance and set expectations for repatriation.