Spotlight: St. Rita's Medical Center (Lima, OH)

“Our volumes are rising and payer precertification expectations are increasing. Staffing remains stagnant. We need to work quicker, smarter and faster; and that’s what TRACE is all about.”
- Cheri Martin, Director, Patient Access

 

Who We Are

• Serve West Central Ohio
• Founded by the Sisters of Mercy
• Part of Catholic Healthcare Partners

 



Diana Carter

TRACE Champion in Outpatient Express Testing

 

How We’re Using TRACE

• Document patient eligibility from payer web sites
• Record precertification calls to payers
• Use records to prevent and overturn denied claims
• Manage and store inbound physician orders
• Store and retrieve prenatal records sent by physician offices
• Monitor records for quality/customer service
• Retrieve needed information in a timely manner

 

Expected Outcomes

• Prevent and manage denials
• Improve efficiency
• Enhance patient safety
• Strengthen referring physician relationships
• Reduce paper storage
• Enhance patient and physician satisfaction
• Support staff with objective proof of communication

 

Future Plans

• Record scheduling calls in Physical Medicine/Rehab
• Provide access to physicians offices

Top Proof Points of the Quarter
(Overturned Denials)

Kings Daughter Medical Center (KY)
Department: Case Management
Communication Type: Call to request inpatient precertification
Payer’s Initial Response: Provided reference number
Reason for Denial: Invalid reference number
Proof Point: TRACE proved that hospital used reference number provided by payer
Billed Charges: $193,977.00
Net Recovered: $78,210.55

 

Trinity St. Joseph (MI)
Department: Admitting
Communication Type: Call to obtain benefit info and effective date of policy
Payer’s Initial Response: Said inpatient notification not required for in-network facilities
Reason for Denial: Lack of notification
Proof Point: Call transcript proved that payer said notification not required
Billed Charges: $62,599.00
Net Recovered: $60,500.00

 

Froedtert Memorial Lutheran Hospital (WI)
Department: Admitting

Communication Type: Online authorization for inpatient stay
Payer’s Initial Response: Authorization provided through payer’s web site
Reason for Denial: Lack of authorization
Proof Point: Electronic record proved authorization
Billed Charges: $11,343.11
Net Recovered: $7,157.52

 

Top Proof Points of the Quarter (Other)

Atlantic Health System
Challenge: Patient overbilled for service
Benefit: Proof of benefit info from payer
Result: Patient bill adjusted
The Story: An account rep in Patient Financial Services called a payer to request outpatient benefits and eligibility information for a radiation oncology procedure. The payer replied with the patient's benefits and eligibility information and the effective date of the policy. The payer stated that the patient had a $35 copay per visit. After the claim was processed, the payer billed the patient for a $200 copay per visit. For 12 radiation oncology visits, the total bill was $2,400. Patient Financial Services located the TRACE call record and provided a transcript of the call. The call proved that the payer said the copay was $35. The payer adjusted the bill to $35 per visit. TRACE saved the patient a total of $1,980.

 

Froedtert Memorial Lutheran Hospital
Challenge: Denial for lack of notification
Benefit: Proof of notification to payer
Result: Recovery of $19,998.40
The Story: An insurance verifier in the Admitting department called to notify a payer of an inpatient admission through the Emergency Room. The verifier left the information on the payer’s confidential voicemail. The voicemail was recorded and archived in TRACE. The claim was processed, and the payer denied the claim citing lack of notification. Patient Financial Services located the TRACE call record and called the payer using a three-way conference call. The hospital played the recorded message left on the payer’s voicemail. The payer overturned the denial, and the hospital recovered $19,998.40 of the original denial for $20,148.40.

 

TRACE News & Events

TRACE Customer in
Healthcare Finance News

 

Angela Greener

CAO, West Jefferson Medical Center

 

The November issue of Healthcare Finance News features a commentary about a hospital’s use of TRACE to document and manage communication. Written by Angela Greener, CAO at West Jefferson Medical Center, the article describes the effectiveness of TRACE in documenting routine exchanges across the revenue cycle.

 

West Jefferson has used TRACE to accomplish the following:

 

• Reduce administrative burden on staff
• Resolve he-said, she-said scenarios
• Monitor quality and customer service
• Prevent $650K in medical necessity denials

  

To view this article, click here.

TRACE Training Options

Web Tutorials

Visit www.twsg.com/training for web tutorials on the following:

• DCR Tracker
• PC Call
• PixCert
• Monitored Call

 

Webinar/Phone Training

To schedule a custom webinar or phone training session for your staff, e-mail Training@TWSG.com.

 

Onsite Training

Please schedule through your TRACE Account Manager.

Share Your TRACE
"Proof Points" and Win!

 

ThePowerofProof.com is a web site dedicated exclusively to sharing success stories from hospitals like yours. Please take a moment to visit this site and see the variety of ways that TRACE adds value for customers in areas such as financial success, quality, efficiency and staff support. Do you have a Proof Point you’d like to share from your facility? Complete the proof point submission form at ThePowerofProof.com, and send it in. If your Proof Point is posted on our web site or published in an upcoming issue of the TRACE Times, you’ll receive a $50 gift certificate!*

*Note: Limit one per customer per quarter. To be eligible for the gift certificate, Proof Points must be submitted through the online form.

 

Coming in 2009...
TRACE User Stories

 

Beginning in 2009, you will receive a monthly email featuring a story from one of our TRACE customers. These e-newsletters will highlight new and unique uses of TRACE, hospital success stories and customer testimonials. If you would like your hospital to be featured in a TRACE User Story, please contact newsletter@TWSG.com.