Managed Care Plan Performance Model
Weill Cornell Physician Organization
The Capstone team developed a decision-making model for the Weill Cornell IPA and Physician Organization to assess the value of contracted managed care plans based on a variety of selected performance measures. The model is intended to benchmark plan performance, identify preferred plans, aid in decision making regarding physician participation, and serve as leverage during contract re-negotiations with managed care organizations. The team developed and administered surveys to obtain physician and staff judgments on plan performance.
Revenue Cycle Process Analysis at Montefiore Medical Center
Montefiore Medical Center
Montefiore Medical Center is an integrated healthcare delivery system serving patients in the Bronx and southern Westchester counties. The facility treats a significant number of patients through its Emergency Room Department (ED). Montefiores ED is experiencing a significant number of denials and reduction of payment for care rendered by insurance companies including Medicaid and Medicare. The Capstone team was asked to identify the root cause of this problem and provide recommendations on how to rectify the situation. The team undertook a comprehensive review of the registration process, as well as the interface between the registration and billing systems. The team then proposed ways to improve the front-end eligibility verification process and suggested enhancements to the interface. The expected result is a decrease in overall payment denials and greater accuracy of up-to-date insurance verification.
Evaluation of Emergency Department Patient Admission Time at Bellevue Hospital Center
The Capstone team evaluated the Emergency Department (ED) patient admission time from the time a general medicine patient arrives in the ED to the time s/he is transported to an inpatient floor. The primary goals of the project were to increase patient satisfaction, decrease emergency room congestion, and possibly reduce the average length of stay per patient. The Capstone team assessed and quantified the current admission process by tracking adult medicine patients and evaluating the major delays. These major delays or bottlenecks were further analyzed during the second phase of the project, and the Capstone team formulated reasons why these problems exist. During the final phase of the project, the Capstone team developed feasible options that could decrease the length of time required for patients to be admitted to the medicine floors. The proposed options were evaluated in terms of costs, available resources, and long-term benefits.
Lutheran Medical Center Medicaid Reimbursement Case Study
Lutheran Medical Center is a community-based hospital in Brooklyn, New York that serves a large underprivileged population. Because Medicaid comprises approximately 20% of the Medical Centers revenue, it is important to collect these payments in a timely manner. The Capstone team assessed the Medicaid reimbursement cycle of the Medical Center to determine if it would be possible to improve the rate of collection. The team reviewed delayed and denied Medicaid claims to identify any bottlenecks. As a result, the team identified three areas that contributed to the delay or denial of payment from Medicaid: 1) delays in the Medicaid application process, 2) delays in coding by Medical Records, and 3) improper patient account/billing procedures.