# Presentation: 170376

## Patient Account Management System(PAMS)Status of Project

**January 26, 2005**

## About the Speakers

- Sandra Lahi, RHIA, CPC
- 	Office of Information Technology
- 	IHS Lead, PAMS Project
- Terry Rice
- 	Consultant, Choctaw Nation of Oklahoma
- 	CCG Tribal Consortium Lead, PAMS Project

## Overview of Discussion

- Background and Objective
- Importance of Business Process Changes
- Updated Preview of PAMS
- Preparing for PAMS
- Patient Registration 7.1
- Business Process
- PAMS software installation
- Current Timeline Status

## Vision

**PAMS is a collaborative effort between IHS and the CCG Tribal Consortium to develop a integrated Third Party Billing (3PB) and Accounts Receivable (AR) software package that will serve two primary purposes:**
**To integrate with RPMS, including the Electronic Health Record (EHR), and**
**To provide a solid foundation for optimal billing and collections.**

## Background

**The CCG Tribal Consortium is comprised of: **
**the **_***C***_**hoctaw Nation of Oklahoma, **
**the **_***C***_**hickasaw Nation of Oklahoma, and **
**the **_***G***_**ila River Healthcare Corporation**
**The CCG met informally and discussed a concept to resolve common Third Party and A/R software issues**
**IHS acknowledged the need for an integrated 3PB/AR application and became an active partner early in the PAMS project.**

## Goal

**All organizations agreed to develop an integrated software package that would: **
**Combine 3PB and AR applications into one patient accounting software**
**Define front end edits**
**To assist with reducing rejected claims **
**To enable more timely submission of claims**
**Incorporate a Graphical User Interface (GUI) system, as used with the EHR **
**Support the need for business process improvement**

## PAMS and Support for Business Process Changes

**One system that supports the complete revenue cycle**
**Business Process changes provides an “opportunity” to increase third party revenue**
**Change Management by changing Business Process**
**Emphasis on accurate data capture at Check-in/Registration ****using:**
**An “ account per encounter” philosophy**
**Mandatory Registration fields and Fatal / Warning edits**

## PAMS and Support for Business Process Changes “Opportunities”

**Improved medical documentation and coding **
**Potential to integrate with and implement charge master systems**
**Enhanced reporting capabilities for real time monitoring**
**Canned reports **
**Timely printing without User Intervention**
**Easier access to patient account information to:**
**Establish baseline performance measures**
**Improve posting / collection process with electronic notes**

## An Updated Preview of PAMS...

## Patient Account Management System Sign on Screen

##  Check-in link to RPMS Scheduler

-  Check-in link to RPMS Scheduler

##  Check-in patient search.  Items in red are missing or need updating in patient reg.

##  Pop-up warning that displays before a new visit can be created.  Each site will decide if they want to be able to continue with the visit or must have the information correct before the patient is seen

-  Pop-up warning that displays before a new visit can be created.  Each site will decide if they want to be able to continue with the visit or must have the information correct before the patient is seen

##  Check-in screen

-  Check-in screen

## PAMS Account Number Created At Check-In

**PAMS Account Number Created At Check-In**

- 040806 = August 6, 2004

- 0001 = First account for above date

- WE – Suffix for White Earth Health Center

- A = Ambulatory Visit

**Notes:**
This is the message that come up when the visit is successfully checked in.  The first two digits are the year, then the month, then the day of the month, the next four digits are the sequential visits to that site for the day.  This is the first visit.  WE is the location identifier.  I’m not sure what the full name of the location is for this demo.  A indicates the service type.  In this instance it is ambulatory.  

##     PAMS Claim Edit Toolbar 

-  Claim Editor Create Claims Window

## Work Queue Parameter Selection box

##  The Create Claims toolbar

## Create Claims General Tab Screen

## Provider Search tool window

## The Create Claims Insurance Tab Screen

## Order of Billing Screen

## Payments and Adjustments Tab (Only used to apply Payments and Co-pays taken prior to billing.)

## Adjustment Reason Selection box

## HCFA 1500 Tab Screen

## Diagnosis Order Edit Box

## Procedure Edit Screen

## Procedure Search box Screen

## ADA Tab Screen

## ADA Procedure Edit Screen

## ADA Procedure Search Tool Screen

## UB92 Tab Screen

## NCPDP/ Universal Claim Tab Screen

## Statement Tab Screen

## Account Inquiry Tab Screen

## Refund Unallocated Cash Screen

## Refund Prepayment Screen

## Apply Unallocated Cash Screen

## Claim Output Selection Screen

## Enter/Edit Referring Provider Screen

## Referral/Authorization Edit Screen

## Account Inquiry

## Itemized Charges in Account Inquiry and Payment Batches

## Account Inquiry Filters

## Collection Batch and Payment Center 

- Collection Batch and Payment Center

## Collection Batch Header

## Collection Batch Check/Cash Entry

## Payment Screen

## Messaging

## Preparing for PAMS....

- Change Management Strategy (First Step)
- Educating Facility Staff and Management on steps to consider, plan for and implement...

## Three Major Pre-Requisites before PAMS can be installed:

**Business Process Change Management**
**Patient Registration V7.0 Patch 5 and V7.1**
**Patient Account Management System ****	****(PAMS) software installation**

## Importance of Business Process Changes

## Business Process Change Management

*It has been stated:*
**“****80% of software implementation problems relate to people and processes.   **
**20% account for technology issues.” **
**- Gordon Moreshead, Director, ILC**

## “Change Management” Strategy – Business Process

- Sites should utilize checklist process
- PAMS Business Process Checklist
- Sites need to allocate enough time for process changes
- Business Process Grid
- Sites will be required to complete survey prior to PAMS scheduled installation
- PAMS Business Assessment Survey

## Importance of Patient Registration software requirements

## Patient Registration (AG) 7.1 - New Functionality

- PAMS Requires Front End Edits (>100 items based on PAMS requirements)
- Pt Registration V7.1 Front End Edits – Errors by Required Fields.
- Training on Sequencing/Order of Billing by Payer Coverage types
- Utilizing new Benefits Coordinator page
- Utilizing on-line Medicare Secondary Payer questionnaire

## Patient Registration Front End Edits

- Front End Edits defined based on Denied Claims
- Error/Report Functionality added to AG V7.1
- Examples include:
- Assignment of Benefits Date Missing
- Patient Date of Birth Incomplete
- Patient Address Incomplete
- Medicare Secondary Payer Not on File
- Coverage Type Not Defined
- Total of 35 errors identified

## Patient Registration Error/Warning Functionality

- Errors:  User will not be able to bypass screens if data is missing
- Site can set up by Parameters to determine if data element is error or warning
- Issues:
- End Users will have to be trained on how to interview for missing data elements
- Ongoing monitoring of actual data entry must be monitored
- If sites do not clean up database prior to installing AG V7.1, process of interviewing patients will be hindered

## Patient Registration V7.0 P 5 – Error Report Utility

- Ability to take a “snapshot” of database on Errors (missing critical data elements)
- Report can be generated by location, date range (not to exceed three years) and for third party patients only
- Sites will have to allocate resources to clean up database prior to installation AG V7.1
- This is an ongoing process!

## Patient Registration V7.0 Patch 5 and V7.1 Timeline

- _Patient Registration V7.0 Patch 5_
- Alpha Testing in progress
- Final Testing to be completed
- Deployment:  February 2005
- _Patient Registration V7.1_
**Alpha Testing**:   	Feb  – April 2005
**Beta Testing**:   		April – May  2005
**Deployment: ****	****	**June 2005

## Patient Registration 7.1 - New Functionality – Other Major Items

- Training on Sequencing
- Available in Pt Registration 7.0
- Order of Billing by Payer Coverage types
- Training with Check-In staff
- PAMS will use data to determine payer for each visit encounter

## Patient Registration 7.1 - New Functionality – Other Major Items

- Utilizing Benefits Coordinator page.
- Ability to track status of incomplete applications
- Ability to track productivity
- Utilizing on-line Medicare Secondary Payer questionnaire
- On line, paper
- Key questions for secondary payers for Medicare Patients

## 3)  PAMS Software Installation

- Completing the PAMS Business Assessment Survey
- Scheduling training for End Users
- Defining PAMS system setup (Table Maintenance)
- Defining Data Conversion dates
- On site review, installation and support until “go live” date

## Preparing for PAMS Installation

## PAMS Business Assessment Survey

- Survey to be completed before scheduling can be finalized
- Focuses on five processes:  Management, Registration, Check-In, Coding/Data Entry and Billing
- Responses to be discussed with Site for clarification

## PAMS Business Assessment Survey

- Software:   POS, PIMS, Reg 7.1, EHR, all current RPMS patches.
- Not all required but Survey needs to reflect which are in operation
- Process changes for Business Office Operations Required Before PAMS installation

## PAMS Business Assessment Survey

- Checklist prior to implementation
- Other questions include:
- Define Financial Classes, IHS Clinic Types, IHS Service Types
- Define a date to switch over to PAMS for production
- What Service date do you want the unbilled claims list to start with?
- List the top 10 Insurers in addition to Medicare and Medicaid

## PAMS Business Assessment Survey

- List flat rates contracted by your site including rate and clinic
- List and describe any contracted or capitation arrangements for your site
- What forms would you like printed upon check-in?
- Visit sheet
- Patient Statement
- Outguide
- Encounter Form
- Other...

## PAMS Business Assessment Survey

- Other Questions:
- What kind of transmission schedule do you plan?
- What is your current billing backlog?
- Define security levels by billing staff
- Define listing of reports
- Define process for outpatient and inpatient check-in

## PAMS Business Assessment Survey

- Do you have any Coding Compliance software in place at your site?
- List all sites for which you submit claims.
- Are the servers at each site located separately or is one server used for data entry?
- Will you be billing for Non-beneficiaries?
- What fee schedule (s) or charge master do you intend to bill with?

## PAMS Business Assessment Survey

- List submitter identification numbers and indicate when they are to be used.
- Defining Table Maintenance setup and providing guidance on setting up the system
- More....

## PAMS Data Conversion

- 3PB / AR

- PAMS

## PAMS Data Conversion

- Defining a cutover strategy
- Conversion will affect:
- Open accounts and all data associated with that open status
- RPMS reports that use existing 3PB/AR files
- Defining an open account:
- An account is open when a claim exists for an account with a non-zero balance and it is flagged as billable and not “completed.”

## PAMS Data Conversion

- Additionally, all information associated with an “open” claim including payments, adjustments and outstanding balances.
- Support tables such as fee schedules will also have to be brought over.

## PAMS Data Conversion

- Two approaches proposed:
- To convert accounts as activity occurs against them.
- Risk:  Some accounts will not be closed in a timely manner and there will be overhead in maintaining two systems.

## PAMS Data Conversion

- To convert all open accounts at once and begin using PAMS for all these accounts.
- Selection Criteria would be for open accounts with DOS within a site-specified time frame prior to conversion date
- Not to exceed two calendar years.

## PAMS Data Conversion # 2 Continued

- Backlog of open claims should be reduced to minimize amount of manual review or intervention
- Mandates that orphan and straggler accounts will be to be reviewed manually
- Patient Registration and PCC Data Entry backlogs need to be as current as possible.

## When should Data Conversion be scheduled?

- On a weekend
- Close to the first day of the calendar month after the month end closing process as occurred.
- System needs to be “frozen” until all data is converted.

## Data Conversion Steps Review

- Pre-Conversion Preparation
- Identification of data to be converted
- Clean up of receivables
- New system user training
- Conduct mock conversion on test database
- Conversion
- Freeze system changes
- Convert data
- Test converted data
- Catch-up from freeze date
- Reporting
- Generate historical reports as needed

## Data Conversion “Issues”

- PAMS tables and data elements must match RPMS 3PB/AR to fully assess scope of conversion
- Site will need ability to access old accounts and do historical reports out of PAMS.  Ex.  Ability to retrieve data back to 10-1-04
- System should be able to upload single accounts or by Insurer, Date Range and by Visit Type.

## Data Conversion “Issues”

- Approach must be developed to handle secondary/tertiary claims.

## PAMS Strategic Planning:  Local and National

## Local Strategic Planning for PAMS

- Preparation is time consuming and different for each site
- Provide opportunity for Site to do a self-assessment of billing processes and make necessary changes for Revenue Enhancement

##  IHS Support Role & Planning

- Coordinating Train the Trainer sessions
- Software support from Beta testing
- to Release
- to Deployment nationally
- Post PAMS National Release Planning
- Continued Tribal Consortium/IHS collaboration
- Defining an Infrastructure for Ongoing Support/Development
- Training on Business Process

## Strategic Planning for PAMS  

- Training of new application will require additional resources
- Two Week Course and On Site hands on experience
- HIPAA transaction testing
- OIT role:  Contracting of development and support infrastructure
- Scheduling by Area or Tribal sites

## PAMS Project Status - Timeline

- Installation of software at Chickasaw Tribal Health Facility 1-10-05
- Training for staff planned for week of Jan 31, 2005 to begin Alpha testing
- Install additional alpha sites Gila River, Choctaw and GIMC – February/March 2005
- Beta site testing in April 2005
- Projected release August 2005

## PAMS Alpha/Beta Testing

**Alpha Sites:  **
- Chickasaw Nation
- Gila River Tribal Healthcare Corporation
- Choctaw Nation
- Gallup Indian Medical Center
**Beta Sites:   **
- Maniilaq Tribal Facility
- Sacramento Urban Tribal Facility
- Wind River Service Unit
- SEARHC
- White River Indian Hospital

## Deployment Schedule for PAMS Software

- PAMS ready for release/distribution:   						**August 2005**
- Date for completing I/T/U deployment:    						**August 2006 **
- Target Date for ITSC to not support existing 3P AR RPMS software							**October 2006**

##  PAMS - For more Information...

**Documentation can be found on the PAMS Web board:**
-  _[http://www.forum.ihs.gov](http://www.forum.ihs.gov/~PAMS)__[/~PAMS](http://www.forum.ihs.gov/~PAMS)_
**Other information to be provided on **
**www.ihs.gov Business Office Website**

## Questions/Discussion