SIGNATURE
Presentation
Debbie Harkins
Patient Accounts IT Coordinator,
Central Business Office
Baycare Health System, Oldsmar, Florida
Annette Yanna
Senior System Analyst
Baycare Health System, Clearwater, Florida
Dale Sahlberg
Senior System Analyst
Baycare Health System, Clearwater, Florida
What is SIGNATURE ?
SIGNATURE is an integrated outpatient
management & outpatient accounting application.
Front-office functions include registration,
scheduling and report writing tools.
Business office functions manage accounts
receivables with collection tools to maximize
reimbursements.
Has advanced collection tools (target files) to maximize allowable
reimbursements based on payers and collectors
Generates 1505 medical billing claim forms (combined charge for
services and physician - example: chest X-ray)
Produces UB04s - same as an inpatient hospital bill with surgery
billing for nurse, facility and supplies ( surgeons do their own billing )
Has a combined Patient Management and Patient Accounting
database (integrated application) that allows charges to be entered
and bills produced that same day (day-end)
Utilizes SCHEMES that allow multiple insurance plans to meet the
different ambulatory care needs
A patient was registered at the Imaging site for a annual diagnostic
mammogram and ultrasound with Medicare and Medicaid plan
providing coverage.
Scheme 1 - established with insurance plans Z01 Medicare with a
priority of 1 and Z25 Medicaid Fl with a priority of 2
The patient was in an auto accident later that day and returned to
the Imaging site to have a MRI of the cervical spine.
Scheme 2 - established with I16 Auto Allstate Insurance with a
priority of 1
The patient was scheduled for a knee arthroscopy due to a work
related injury that occurred the previous week.
Scheme 3 - established with 0041 Commercial Risk Work Comp with
a priority of 1
The original SIGNATURE
application was based on a
3270 terminal design.
The Siemens enhanced
SIGNATURE version
employs browser technology
called OAS GOLD.
3270 version
Original SMS model design for GOLD
The Siemens GOLD model was
sent to the Baycare body shop
to be
reprogrammed, redesigned,
repainted and
enhanced
Baycare SIGNATURE GOLD
GOLD has new graphical features such as:
check boxes, radio buttons, labels, selectable lines with
banners, combo boxes, a calendar, text boxes, images,
scroll bars, data evaluators & controllers
• Edits on name and address fields to remove
bad characters !@#$%/&*)+? that cause
interface errors. Example of a bad character # GOLD
will automatically remove:
• Warning notices to prevent the selection of
expired insurance plan codes
• Educational messages to guide the user
through a process:
One shared main menu with variable options
based on job role
Users have an access tcl that determines
what functions are available
When the Accounts Receivable staff signon they see:
When the Patient Management staff signon they view:
• HIPAA compliant notices
• Billing warning messages
Previous accounts had bad information. Previous accounts were bad debt.
Previous accounts were charity. Previous accounts had billing problems.
Tooltip help has full sentences & detailed information
for a field
Inquiry screens are enhanced for faster searches, such
as doctor name inquiries with “quick picks”
• "Minor as the Guarantor" reasons that are easy to
select (rather than type in)
Radio button selection will appear as a comment
• VIP
BOARD MEMBER FRANCISCAN ORDER CLERGY
FOUNDATION FRIEND COMMUNITY LEADER
GOVERNMENT OFFICIAL FINANCIAL DONOR
STAFF PRIVILEGED PHYSICIAN CELEBRITY
Checkmark lights up green if an HDX inquiry is possible for
this plan. Eliminates wasted HDX inquiries for unsupported
insurance plans.
Immediate messages if the data entered is not
correct, such as the Insurance Company name.
Customized documents and patient face sheets with
full insurance company mailing addresses
Custom Features
Mail statistics:
• 23.6% of all mail in the U.S. is incorrectly addressed.
• 2.7% of the total mail volume is undeliverable as addressed.
• 1 out of every 32 pieces of first-class mail is undeliverable.
Causes:
• Incorrect spelling of street or city
• Misread the address from a document
• Transposed numbers in street or zip code
• Misunderstood the person verbally providing the data
Address Verification Benefits
Address validation confirms that a given address is a
deliverable address within the United States as defined by
the United States Postal Service.
Address verification for bills and statements will also improve
the ability to collect fees for services rendered.
The USPS standardizes the address in accordance with USPS
guidelines – example: Road will be abbreviated as Rd
Additional Benefits of Address Verification are:
• Improve collections by eliminating returned bills & statements.
• Reduce staff time & costs formerly spent processing returned mail.
• Achieve data integrity through correctness & standardization.
Former 3270 screen was unable to verify a
patient’s address with the US Post Office
The customized GOLD screen can verify online a
patient’s address with the US Post Office
Address Verification
There is an online address verification for both
the patient and guarantor addresses
The verified USPS address is automatically
returned to the screen
Corrects the address: 13618 N FLORIDA STREET
that should be 13618 N FLORIDA AVE
Corrects the zip code: 33631
that should be 33613
The US Post Office returns a message if more
information is needed (apartment or lot number)
If the address was not found, then the
US Post Office returns the following message:
Option: GOLD also can inform the user verbally of an error message.
IMPLEMENTATION
PROCESS
THREE SIGNATURE REGIONS
St Joseph's Diagnostic Center … 4 Imaging Centers
Morton Plant Health Services … 3 Imaging Sites
1 OP Surgery / Endo site
Baycare Ambulatory Care … 3 Imaging Sites
2 St Anthony
1 Med Specialist
1 OP Surgery Site
5 Mental Health Sites
Analysis Phase
Examined the model SIGNATURE GOLD application at Siemens
headquarters
Made site visits to other hospitals
Reviewed the Baycare Invision GOLD application which has a
similar design
Made phone calls to other SIGNATURE users
Checked the SNUG users web board for information about
current issues
Sent Emails to other SIGNATURE users
Held many meetings and had extensive collaboration between
the Central Business Office, Registration areas and Information
Services
Then a list of the current
3270 issues was compiled.
These issues became the reasons
SIGNATURE was converted to the
GOLD version …
CHALLENGES
– Experienced significant HDX model issues that were unique to the
GOLD combined insurance pathway
– Standardized insurance plan codes for all outpatient sites
(example: where A01 means AETNA for all sites)
– Made revisions prior to the GOLD live to an estimated 1000 pre-
registrations that were using the old insurance plans
– The 3270 Patient Face Sheet had been customized to include full
insurance company mailing addresses - which was converted to print
GOLD combined insurance fields
– Needed popup panels to notify users when insurance plans were
terminated (should not be selected for a new registration)
– GOLD now requires address information be entered for all
miscellaneous insurance plans … that used to be an optional PF9
secondary screen in 3270
Build Phase
Examined the current 3270 SIGNATURE
pathways
Reviewed the Siemens model
SIGNATURE design
Created a composite GOLD version of the
above two applications
Testing Phase
• Used predefined scripts for the Patient
Management and Accounts Receivable
pathways
• Verified interface transmissions to other
systems (such as IDX)
• Validated facesheets & bills were generated
• Emulated real patient scenarios for the types
of insurances used (managed care, workman's
compensation, Medicare, Medicaid, etc …)
Integrated Systems Tests
EAD (Enterprise Access Directory)
US Post Office address verification
HDX (insurance eligibility)
ImageCast (Radiology)
EDM (Electronic Data Management)
Lawson - General Ledger & refunds
Target Files
TSI (Managed Care)
Training Phase
Two training sessions:
• PM – Patient Management
• AR – Accounts Receivable
Training Manual
PATIENT MANAGEMENT
Training Manual
ACCOUNTS RECEIVABLE
LIVE Implementation
Morton Plant Hospital went live first
Other two regions are going live in
the following months
ACBO (Ambulatory Care Business
Office) is the final live event
ONLINE DEMO
OUTPATIENT
CARE
REGISTRATION
PATHWAY
Staff can select a printer from this first menu.
Patient Management
EAD inquiry options
After demographic data is filled out, the system will
automatically
Original address data US Post Office abbreviated the
AVE and corrected the zip 33613
Further information is needed
The USPS supplies
a list of known
addresses to
select from
More information
is required - such
as an OFC, LOT
or APT number
The US Post Office verified address is then transferred
through this screen and parsed into the street, city, state
and zip code fields.
The corrected address is automatically copied to the
demographic screen. The user then adds LOT 71 to
complete a full mailing address.
GUARANTOR information – will automatically copy
all patient data and “gray out” the screen to protect data
Bottom part of the GUARANTOR information screen is
shown … with COMMENT and EMPLOYMENT options
INSURANCE
Click on PLAN to access a “quick pick” help screen
Insurance Company help screen with “quick pick” options
Select an insurance plan
ZZZ identifies a terminated plan
The managed care plan automatically had a 1 appended to
the plan code 102 and an MC filled in for the CONTRACT.
The HDX button lit up indicating an HDX inquiry is available.
The INSURANCE flow returns to the
GUARANTOR screen where the button is activated
so the user can continue on to the CASE screen
CASE
Once all required data is completed
the system will show the button.
ACCOUNTS
RECEIVABLE
PATHWAY
Accounts Receivable
Main Menu
A R Follow-Up
A R Inquiry
Vital functions automatically selected (radio buttons)
A R Summary
Collector Name and Comment automatically valued from codes
Detail Summary
CALCULATOR and EMAIL options added to the Navigator
Additional Details
REASON codes custom feature added
Internal email information is automatically filled in with AR
detail … saving time and preventing transposition errors
Are there any questions ?