KentuckyOne Health Adjusting Revenue Cycle Management Policy Effective March 1
Monday, February 06, 2017
Top Stories - Physicians
KentuckyOne Health is enforcing its revenue cycle management policy effective Mar. 1. This policy ensures scheduled (non-emergent/urgent) patients are financially cleared prior to receiving services. In the absence of such clearance, the process to postpone non-emergent/urgent services until such time that financial clearance is complete will occur.
“KentuckyOne Health Revenue Cycle will now operate more like a free-standing surgery center,” states Jim Wentz, chief financial officer, KentuckyOne Health. “Those centers would not consider providing a service if an authorization or payment was not previously secured.”
The policy outlines the responsibility of the Financial Clearance area within Patient Access to verify that the patient/guarantor’s insurance plan is active and verify the plan coverage. This includes medical necessity requirements and pre-authorization. It is the responsibility however of the physician to secure an authorization and/or pre-certification for all outpatient procedures (diagnostic and surgical) 48 hours prior to the scheduled procedure and provide that information to the Financial Clearance Team.
Please note, elective procedures are not limited to only cosmetic procedures. This applies to non-emergent cases such as a total joint replacement.
If the patient/guarantor’s financial obligation cannot be met prior to services being provided, the patient/guarantor will be educated on postponement options, including rescheduling service(s). Financial Clearance will notify the respective service line manager or director via e-mail, telephone and/or mutually agreed communication method of the possibility of patient postponement of services. The referring physician will be contacted and notified of the missing information and will be asked to determine whether the service is elective or other medically necessary. Should the referring physician disagree with postponement of service, the facility CMO will be called for a peer-to-peer review. The CMO will then determine if the case is postponed or performed as originally scheduled.
If a service is deemed to be postponed, additional scheduling options will be provided to the ordering physician and/or provider. The physician or physician office staff is to contact the patient and/or guarantor with recommendation(s). The patient’s prior scheduled appointment will be postponed to a later date of service.
Financial clearance reduces the risk of KentuckyOne Health performing services without appropriate insurance reimbursement or payment while enhancing the physician and patient experience. All processes comply with Federal and State laws and/or regulations. Patient liability education and pre-service collections are performed in accordance to Emergency Medical Treatment and Labor Act (EMTALA) and Health Insurance Portability and Accountability Act (HIPAA) regulations.