In this special Speaker Series, Becker's Healthcare caught up with Marco Shelby, MSN, RN, denial management coordinator for utilization management & discharge planning at University of Illinois Hospital & Health Sciences System in Chicago.
Mr. Shelby will speak on a panel during the Becker's Hospital Review 4th Annual Health IT + Revenue Cycle Conference on "Denials, Management, Charge Capturing and Revenue Cycle," at 2:00 p.m. Thursday, Sept. 20. Learn more about the event and register to attend in Chicago.
Question: In the past 12 months, how have you adapted to new patient experience expectations in the age of consumerism?
Marco Shelby: In the age of Medicaid managed care, I have learned that patients believe because they have a commercial name, like Blue Cross, now attached to their Medicaid plan, the old Medicaid issues are now resolved. Meaning, they now believe they have the same type of access as one with a traditional Blue Cross Preferred Provider Organization, for instance. I have found that being frank, transparent and explaining to the patient that some vendors are reluctant to accept their type of Medicaid insurance has helped broker realistic expectations. I place emphasis on the word "Medicaid" to remind the patients that, although I will do whatever it takes to assist them, some aspects of discharge planning may be beyond the purview of my control. This has enabled, in my opinion, the patients to be more patient and understanding when I am attempting to find services for them post hospitalization.
Question: How has your organization improved the revenue cycle process in the past year?
MS: Here at UI Health, in addition to monthly denial meetings to discuss denials trends by payer and diagnosis, we have started to have more collaborative meetings with major stakeholders that affect the revenue cycle in a profound financial manner. Currently, we have a team that includes patient accounts, the outpatient and inpatient surgical leadership, denial coordinator for inpatient services, and the director of utilization management & discharge planning. These stakeholders have been engaged and charged with developing strategies for compliance with regulations, such as obtaining observation notices, in addition to denial avoidance by using the inpatient-only list for Medicare patients to avoid admission order discrepancies.
Question: What is your No. 1 dealbreaker when it comes to evaluating vendor partnerships?
MS: Vendors that promise more than they can honestly deliver. I have had situations where vendors have promised to take any and all of our Medicaid managed care plans. And, unfortunately, after receiving only those types of patients, they began to complain and request patients with Medicare, in particular. I found this to be alarming because this was not what the vendors promised, and it is also illegal and unethical. All patients have the right to choose their vendor, but Medicare has explicit guidelines regarding patient choice.