Wall chart keeps track of managed care data
A simple chart and color-coded stickers help the staff at Platte Medical Clinic in Platte City, MO, keep up with ever-changing insurance company regulations and coverage for patients. The practice has contracts with about 80 HMOs and preferred practice organizations, according to Ame Thatcher, the clinic’s practice manager.
"It got so overwhelming to keep track of all the insurers. The physicians needed a way to make them more autonomous and not dependent on somebody in the business office to look up the information," says Lori Norris, former practice manager, now employed by North Kansas City (MO) Hospital, owner of the practice.
Her solution was a huge wall chart that included the names of all the plans, a general phone number, a referral phone number and a pre-certification phone number for each, requirements for referrals, the names of the hospital and laboratory the plan utilizes, and other information.
"It’s very helpful for the physicians and nurses. Anybody can walk up to the window in the business office and see what they need to do," Thatcher says.
Before the chart was posted, a physician or nurse would have to rely on someone in the business office to provide the information or plow through pages and pages of manuals to get the correct information. Sometimes the person who could help them was on the telephone. When the practice had after-hours clinics, no one was in the business office to help.
"The chart is a quick reference guide. It keeps people from making mistakes, and it eliminates having to dig the information out of a book," Thatcher says. Having the chart saves time for physicians and nurses and improves the patient flow. It eliminates the problem of sending patients to the wrong lab and having the insurer refuse to pay for the lab work.
"It makes it easy for the doctors to know what the requirements are so we get proper paperwork done in order to be paid," she adds.
The chart has evolved to include additional information such as durable medical equipment vendors, approved home health agencies, and physical therapy referrals.
"If we found ourselves having to go to the manuals frequently for the same information, we added another column on the chart," Norris says.
Eventually, the chart took up an entire wall in the business office. The practice also came up with the idea of using stickers that identify a patient’s insurance company. The stickers are on the bottom right-hand corner of the patient chart. The copay information is also included on the stickers. "Every insurer is different, and it changes weekly," she adds. The stickers help the physician match the insurance company with the correct formulary and referral information.
"Insurance companies frequently merge and change names. If patients change insurance companies, the front desk changes stickers. We got so everybody was tuned into looking at the stickers," Norris says.
Typically, the insurance companies provide the stickers. If the company didn’t give stickers out, the staff used different colored stickers to designate certain companies.
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