Business team fast-tracks Medi-Cal reimbursement

Department: Business Office, Redwood City Medical Center

Value Compass: Affordability

Problem: Lag in filing treatment authorization requests to a Medi-Cal field office for reimbursement 

Metric: Number of days from discharge of a Medi-Cal patient to filing treatment request

Union co-lead: Jessica Garcia, business representative 

Management co-lead: Pattie Murphy-Kracht, director of admitting and business office 

Small tests of change:

• Daily monitoring of the electronic work queue that tracks patient billing to look for Medi-Cal patients
• Monitoring the electronic list of Medi-Cal hospital patients, so the team can anticipate their discharge 

Result: The number of days to file a treatment authorization request dropped from 21 to two days between mid-February and April 2011. The turnaround rate continues to remain two days as of early November 2011. 

Advice to other teams: Develop cohesion among the members of your team. “We have a really strong bond,” patient financial adviser Sanita Mathura says. “So if you get stuck, you don’t feel uncomfortable about asking for help.” 

Also, be open to change. “We’re good at trying different ways of doing things,” union co-lead Jessica Garcia says. “Change isn’t always easy, but we’re not stuck on one way.”