Monthly Archives: February 2017

How To Quickly Capture Health Insurance Changes

Jobs change; marriages happen; children are born; open enrollment starts. Throughout the year, a patient’s health insurance coverage can change via these four options or many more. Although most organizations focus on updating insurance information each January, it’s important to do it year round. Capturing accurate insurance information ensures smooth clinical operations and medical billing. Use these five resources to prioritize catching health insurance changes as they happen.

Image by Wellness Corporate Solutions (www.wellnesscorporatesolutions.com)Front line staff: Staff the front desk with smart, well-trained healthcare administrative employees.  Since they frequently talk with patients, these staff members play a vital role in capturing a patient’s insurance. Instruct these staff to ask the patient to confirm their insurance when scheduling appointments and at check-in.  Train these staff members on how to properly update a patient’s insurance, either in the patient’s file or in the electronic medical record.  Also teach these staff members how to use resources to

The patient: Most patients come to the doctor’s office prepared.  They should be able to tell you which insurance they have, and what their identification numbers are.  If they are unable to provide proof of active insurance (i.e. a health insurance card), front line staff should be aware of the preferred course of action.  For example, some organizations will allow the patient to check in with the promise that the patient will update it later.  Other organizations will instruct staff not to check in the patient without proof of insurance.

The patient’s insurance card: Although they like to change things all of the time, there is one thing that healthcare organizations can count on.  And that is the fact that a patient’s health insurance card will be a treasure trove of information.  Typically, this is where you can find information about a patient’s member and group identification numbers as well as the billing address to send the bills to the insurance company for processing.

An updated list of health insurance changes:  Create a list (or another tool) that captures the insurances that an organization is contracted with and the ones that the organization is not contracted with. This tool should be available to all staff members who update or work with a patient’s insurance.  Since changes frequently happen, regular updates to this tool are required.

Access to an eligibility portal: Investigate if there are online eligibility portals that staff can use to confirm eligibility or referral authorization.  These are time saving tools, because it minimizes the number of times that staff have to call a patient’s insurance.

Regardless of size, it is important for all organizations to quickly capture any insurance changes for a patient.  After reading the list, take a moment to consider what is working well and what could be better.  Adjust as needed.

The Role of the Social Worker

See Social Worker Openings Here!

Social workers play an important role on care teams, because they can do psychosocial assessments for patients.  Often these assessments identify outstanding challenges that a patient is facing.  Then social workers can work collaboratively with the patient and provider to provide guidance and education to improve patient experience and outcome. For those who do not regularly work with medical social workers, here is an overview of their role.

Social Worker

What Settings Do They Work In?
Depending on the organization, social workers can be found in outpatient and inpatient settings.  One social worker may be on staff at a clinic with a vulnerable population.  Other social workers may work with a variety clinics to support patients as they move between departments.  Precise staffing of social workers depends on the needs throughout the individual health care organization.  Nursing homes also have social workers who support the facility residents and their families throughout their stay.

What Do They Do?
Usually, social workers only see the patients who have been referred to them.  During the first conversation with a patient, a social worker typically does a psychosocial assessment.  The results of this assessment help to determine what support the patient needs from the social worker.  Although patients will need different levels of support, social workers will usually assist with care coordination and behavioral health services.

Care coordination needs vary.  Some patients will seek continuing care within the same organization.  Others will return to their established provider.  Another group of patients will need to identify new providers to transition care to.  While specifics differ, social workers can help coordinate a patient’s care in each of these scenarios.  When needed, they will guide the patient through the organization’s medical records release process.  Additionally social workers may contact outside organizations to discuss a patient’s medical care or identify appropriate providers to transition care to.

After an initial assessment, a social worker may offer continuing behavioral health services to a patient depending on their needs.  As a part of an interdisciplinary medical team, social workers will work collaboratively with other providers to identify and address issues that need continuing support.

What’s Their Educational Background?
Social workers in health care settings typically have a master’s degree in social work.  To provide clinical care, they must be licensed with the state’s department of health.

 

By providing psychosocial assessments, social workers can identify challenges and support a patient as they navigate the health care system.  The insights from a medical social worker can help patients achieve better outcomes.


Healthcare Social Workers. United States Department of Labor: Bureau of Labor Statistics, 30 March 2016, https://www.bls.gov/oes/current/oes211022.htm. Accessed February 10, 2017.
Medical Social Work. Wikipedia, 7 December 2016, https://en.wikipedia.org/wiki/Medical_social_work. Accessed February 11, 2017.
Social Workers. United States Department of Labor: Bureau of Labor Statistics, 17 December 2015, https://www.bls.gov/ooh/community-and-social-service/social-workers.htm. Accessed February 11, 2017.
Social Work Profession. National Association of Social Workers, https://www.socialworkers.org/pressroom/features/general/profession.asp. Accessed February 11, 2017.

Streamline Your Referral Process

Effective patient care relies on a patient’s referrals between primary and specialty care. Primary care Photo credit www.ccPix.comproviders refer patients out to specialists for their help identifying an appropriate care plan. Specialists may refer patients between disciplines for further assistance with the patient’s care. Since referrals between providers facilitate a patient moving between medical disciplines, healthcare organizations should have strong referral process. Below are some broad questions to help create a referral process that will work well for your organization.

What are the limitations around referrals?

Start with the first step of the process. Identify how your organization can receive referrals. Many organizations accept faxed or mailed referrals. Some also accept referrals within a shared electronic medical records system.

Clinically, identify which conditions your providers can see and which ones they cannot. While this is a simple step, it helps staff identify misdirected or inappropriate referrals. Also consider any exclusions to receiving care in your clinic. Does the patient need to meet any clinical standards to be seen by one of your providers? Also, consider if there are any questionnaires, tests, or imaging that a patient needs to complete before being scheduled.

What information do we need about the patient in order to process this referral?

When a referral has complete information, staff can better triage the referral and contact the patient.

Obtaining required private health information helps to ensure that the patient’s first appointment is beneficial. Recognizing these requirements early in the referral process will help clinical staff explain what information is needed prior to beginning of their care.

What about insurance?

Insurance is a tricky topic. After all, each healthcare organization negotiates their own contracts with different insurance companies. To avoid future complications, it is important that a patient’s insurance be identified during the referral process. Including this information will help staff identify if the patient’s insurance is contracted—or what additional payment options are. Staff should be aware of all potential payment options so that they can give patients correct information while scheduling.

Healthcare leaders can strengthen their organizational referral process by identifying referral limitations, information, and insurance requirements. Then leaders should share it with their front line staff. Specific answers will vary depending on organizational needs. Yet considering and sharing these answers will help staff quickly triage the referral and contact the patient.

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Community Highlight: Sunnyside


Tucked in Yakima County, Sunnyside is a city with 6.63 square miles and a unique history.  The name “Sunnyside” was borrowed from a nearby canal project.  When they named the town, residents also believed that the Sunnyside Canal would help irrigate the surrounding area.  Unfortunately, the project was pulled after the 1893 economic crash.

Around the same time period, the German Baptist Progressive Brethren chose Sunnyside as the new location for their Christian colony.  After buying the town’s development company, they put morality clauses into the deed of every piece of land that they sold.  The city was officially incorporated into Washington state in September 1902.

Proximity
Located in central Washington, Sunnyside is 177 miles southeast of Seattle and 225 miles southwest of Spokane.  Sunnyside is also 181 miles northeast of Portland.

Population
The 2010 U.S. Census listed 15,858 residents living in Sunnyside. 2015 population estimates indicate that the population is closer to 16,325.
Climate
Sunnyside has a unique cold desert climate. During the summer, Sunnyside is warm and dry. Average summer temperatures range from the mid-40s to the low 90s.  Winter temperatures are dry and cold.  Average winter temperatures range from the low 20s to the low 40s.  Regardless of the season, the city averages 1 inch of precipitation per month (or 12 inches per year.)

Education
The Sunnyside School District has 5 elementary schools, 2 middle schools, 1 high school.  Nearby colleges include the Yakima Valley Community College and Central Washington University.

Activities
Outdoor enthusiasts love Sunnyside’s proximity to Mount Rainier National Park.  (The middle of the park is only 100 miles northwest of the city.)   The Hanford Reach National Monument also offers hunting, fishing, and boating opportunities.   For those who prefer different options, there’s the Sunnyside Historical Museum and the Steppe Cellars Winery.  Each December, Sunnyside hosts annual Lighted Farm Implement Parade, which features decorated pieces of farm equipment. It’s a one-of-a-kind experience that many wait all year for.
In the late 19th century, the German Brethren chose Sunnyside as a beautiful respite for their Christian colony.  Since then, the city has changed, a lot.  Yet it still offers unique benefits to residents and visitors alike.  It offers warm summers and cold winters; many people find these seasonal signals comforting. Annually it only averages 12 inches of precipitation.  Additionally, with 16,000+ residents the city is perpetually growing and changing.   Take time to see what today’s Sunnyside looks like, and help imagine what the city will look like in the future.

 


Becker, Paula. “Sunnyside Incorporates on September 16, 1902.” February 27, 2003. (http://www.historylink.org/File/5316) retrieved September 25, 2016.

City-Data.com. “Sunnyside, Washington.” (http://www.city-data.com/city/Sunnyside-Washington.html) retrieved September 25, 2016.

Spring Harvest Fiber Mill. “Events.” 2013. (http://www.springharvestmill.com/index.php?option=com_content&view=category&layout=blog&id=8&Itemid=119) retrieved September 25, 2016.

Steppe Cellars.  “About Us.” 2014. (http://www.steppecellars.com/about-steppe-cellars-winery) retrieved September 25, 2016.

Sunnyside School District. “Sunnyside School District: Learning Today for a Better Tomorrow.” (http://www.sunnysideschools.org/) retrieved September 25, 2016.

U.S. Fish and Wildlife Service. “Hanford Reach National Monument.”  May 3, 2013. (https://www.fws.gov/refuge/Hanford_Reach/Visit/Plan_Your_Visit.html) retrieved September 29, 2016.

Wikipedia. “Sunnyside, Washington.” August 31, 2016. (https://en.wikipedia.org/wiki/Sunnyside,_Washington) retrieved September 25, 2016.

Introduction to the Olympic Medical Center

Centered in Clallam County, Washington, Olympic Medical Center provides primary and specialty care to more than 70,000 residents.  Since its 1951 founding, the organization continues to meet the health needs its local community.

Mission and Values
Olympic Medical Center’s mission is working together to provide excellence in healthcare. The organization focuses on improving individual patient experience, improving the community’s health, and financial stewardship.  Additional organizational values include quality, safety, teamwork, compassion, respect, integrity, and stewardship.

History
Olympic Medical Center has advocated for the health of local residents since it was founded in November 1951.  As the community’s needs grew and changed, so did Olympic Medical Center.  After joining the Washington Trauma Designated Hospital System in 1995, Olympic Medical Center became a Level 3 trauma center.  It is one of two Level 3 trauma centers on the Olympic Peninsula
In 2007, Olympic Medical Center advocated for the health of its community when it took over ownership of a Virginia Mason primary care clinic.  This move ensured that thousands of residents maintained access to primary care services.  Clallam County residents passed a 2008 tax levy to reinvest money into Olympic Medical Center.  Funds helped support the emergency, maternity, and other hospital services.   It also helped the organization continue to serve the uninsured and recruit and retain physicians.

Locations and Scope of Services
Today’s Olympic Medical Center offers comprehensive medical care throughout Clallam County and west Jefferson County.  The hospital offers labor and delivery services, a surgical center, acute care, and a Level 3 trauma emergency room.  There are also 12 clinics in Port Angeles and Sequim that provide outpatient care including: primary care, cardiac, imaging, cancer care, rehabilitation therapy, laboratory services, and nutrition education.  Throughout its 66 year history, Olympic Medical Center has grown to meet the needs of the local community.  Regionally, the organization is a top medical provider and one of the largest employers with over one thousand employees.

Clallam County is one of the Washington state’s more scenic areas.  Throughout the area there is easy access to many of the state’s natural wonders including the Strait of Juan de Fuca, the Olympic National Forest, the Dungeness Spit, and many more.  For the past 6 decades, Olympic Medical Center has played an important role of meeting community health needs by providing medical care to over 70,000 residents.  Physicians and staff at the medical center get the opportunity to work in a large organization with a local community focus.


Clallam County, Washington. Wikipedia, 20 December 2016, https://en.wikipedia.org/wiki/Clallam_County,_Washington. Accessed January 8, 2017.
History. Olympic Medical Center, 2017, http://www.olympicmedical.org/default.aspx?ID=12. Accessed January 8, 2017.
Mission| Vision| Values. Olympic Medical Center, 2017, http://www.olympicmedical.org/default.aspx?ID=111. Accessed January 8, 2017.
Olympic Medical Center. Olympic Medical Center, 2017, http://www.olympicmedical.org. Accessed January 8, 2017.
OMP Clinics in Port Angeles and Sequim. Olympic Medical Center, 2017, http://www.olympicmedical.org/default.aspx?ID=69. Accessed January 8, 2017.