HomeMy WebLinkAboutMINUTES - 10201987 - 1.36 _ IV 036
+ POSITION ADJUSTMENT REQUEST No. ISD
Date: 9Z241,S7
Dept. No./ Copers
Department Health Svcs/Finance Budget Unit No. 0540 .Org. No. 6577 Agency No. 54
Action Requested: Classify one (1) P. I . patient Financial Services Specialist position,
reduce Clerk - Experienced level position #54-1378 from 40/40 to 20/40 ana re esigna e o
Beginning level (non typing) .
Proposed Effective Date:
Explain why adjustment is needed: To augment staffin in the Financial Counseling Office to
deal with increase workload.
e}assfifireai;fon-Questionnaire attached: Yes ® No
DESCRIPTION OF DUTIES
Estimated cost of adjustment: S .(30/mo) savings
Cost is within department's budget: Yes ® No
If .not within budget, use reverse side to explain how costs are to be funded.
Department must initiate necessary appropriation adjustment. Web Beadle, `
Use additional sheets for further explanations or comments. Dept. Personnel()Offic'er
or Department lead
Personnel Department Recommendation
Date: /0 .4 -0 -
Classify one P.I. Patient Financial Services Specialist position, Salary Level
XB 1301 (1668-2130) ; reduce hours of Clerk - Experienced Level position #1378 from
40/40 to 20/40, Salary Level C5 1105 (1373-1669) and redesignate to Beginning Level
(non typing) , Salary Level Cl 0721 (1136F) .
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Amend Resolution 71/17 establishing positions and resolutions allocating classes to the
Basic/Exempt Salary Schedule, as described above. -
Effective: IX) day following Board action.
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Date or Director of Pe—r—s—on--n-e
County Administrator Recommendation
Date: 1
prove Recommendation of Director of Personnel
0 Disapprove Recommendation of Director of Personnel t
0 Other:
s
for) %1ou ministrator ;
Board of Supervisors Action i
Adjustment APPROVED/ on OCT 2 0 1987 Phi! Batchelor, Clerk of the Board of
OCT 2 0 1987 Supervisors and County Administrator
Date: By:
APPROVAL OF THIS ADJUSTMENT CONSTITUTES A PERSONNEL/SALARY RESOLUTION AMENDMENT.
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To: Harriette Fisher, Manager Date: August 25 , 1987 '�j`
Admissions/Financial Counseling
From: Kathy Rank Supervisor Subject: STAFFING
Financial Counseling a� our
I am requesting two new financial counselor positions ; one would
be a P. I. position, the other fulltime.
The P.I . position would be to cover for vacations and sick leave.
We currently have nine financial counselors. Each financial counselor
is allowed three weeks vacation and 3 days floating holiday time each
year, and accrues 12 days sick leave each year. In addition, we must
cover the in-patient hospital wards on Saturday. Based on a formula
utilized by the Nursing Office for staffing purposes , we need two P. I . 's
to cover. Since Mary Medina was hired as a P. I . in April , we need one
additional P. I . position. The new position would be used solely for
vacation/sick leave relief and to assist with the Basic Adult Care
reverifications , as needed.
As you' are aware, the in-patient census has increased dramatically over
the past year. Although I do not have the statistics for last year, I
recall the census staying between 100-120 patients per day. I have
attached the statistics I have kept since May of this year. As you can
see, the in-patient census now varies between 110-155 patients per day,
with an average 130 patients. This means that the in-patient financial
counselors average 43+ patients each. The increase in census equals
the workload of one fulltime financial counselor. The census has remained
consistently high (not even decreasing in July as anticipated) .
Additionally, the Social Security Department no longer has a field worker
that comes on-site to do SSI applications . •I am meeting with their
representatives to work on a permanent solution to this problem, however,
since March of this year, the financial counselors have been doing the
SSI applications , themselves. Needless to say, the in-patient financial
counselors are burning out.
This is also beginning to impact the revenue recovery. Incomplete folders
are increasing, however the counselors have less time to spend following
up on them. Hence, some cases are being denied and patients coded private
Pay (I haven't kept any stats on this ; I am basing it upon my review of
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Harriette Fisher -2- August 25, 1987
discharged folders) . It is only beginning but I want to nip it in the
bud.
If you or Pat need any additional information, please let me know.
Thanks .
F
PATIENT CENSUS BY DAYS
May-111 June-119 2) May-115 June-136 3) May-128 June-129 4) May-131 June-126
July-111 Aug.-138 July-114 Aug.-141 July-120 Aug.-133 July-130 Aug.-130
5) May-134 June-134 6) May-136 June-128 7) May-135 June-133 8) May-129 June-138
July-124 Aug.-141 July-119 Aug.-136 July-124 Aug .-139 July-110 Aug .-134
9) May- ? June-149 10) May-137 June-144 11) May-146 June-143 12) May-142 June-145
July-113 Aug .-132 July-115 Aug.-124 July-134 Aug.-129 July-145 Aug .-150
13) May-138 June-143 14) May-128 June-? 15) May-128 June-156 16) May-130 June-126
July-? Aug.-128 July-133 Aug.-121 July-122 Aug.-121 July-119 Aug.-131
17) May-123 June-134 18) May-126 June-142 19) May-133 June-141 20) May-121 June-130
July-109 Aug.-142 July-110 Aug.-136 July-121 .Aug.-136 July-121 Aug.-138
21) May-129 June-130 22) May-125 June-130 23) May-118 June-134 24) May-122 June-136 '
July-139 Aug.-129 July-155 Aug.-124 July-132 Aug.-138 July-122 Aug.-146
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25) May-129 June-149 26) May-115 June-133 27) May-112 June-129 28) May-113 June-124
July-125 July-121 July-125 July-125 .i
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29) May-112 June-122 30) May-132 June-119 31) May-120 June-?
July-126 July-137 July-136
Preliminary descriPei.on -_ r�_�1�onsit>ilities cif thc�_ rinancInI Counsel Inrs
The primary role of the financial counsellor .is to determine the optimum
source of payment on all inpatient accounts and on recurring outpatient
accounts and to obtain the nec:essnry simnatures, paperwork and billing
information to enable the patients' accounts to be billed and navment
received in a timely manner.
The financial Counsellor works with the patient., the family, government
agencies, insurance companies and other hospital personnel to ensure that
any possible payment source is explored and iduntifieri promptly.
Specific Task.-,
I . All patients who are admitted without. verified third party cojerame
are interviewed by the financial counsullor, preferably at the time of
admission.
(a) If a patient is admitted after normal working hours, he/she is
interviewed the following day in order to determine possible sources
of payment.
(b) If the patient has possible group or i>rivatu insurance coverage, '
Worker's Compensation, medical payment on automobile insurance
or other form of non program coverage, the insurance company or
the employer .is contacted and insurance is verified by both patient
name and admitting diagnosis. The amount: of the coverage is obtained
and the patient is notified of tate estimated personal balance that
will he owed on discharge.
(c) If the patient has no coverage, lle/tiN is asked for a cash deposit
based on the estimated length of stay. (A deposit schedule needs to
be developed. ) Although most patients will be unable to make the
requested deposit, making the p;itiunt ' s responsibility known in terms
of actual dollars and cents will provide some psychological impetus
to make the patient apply and complete a MediCal application.
(d) If the patient is unable to rake the renuested deposit , eligibility
is contactod to come to the hospHal and take an application for
MediCal .
(e) If a patient appears, either through ache or disability to be eligible
for Medicare, the Social Security office is contacted to obtain eligibill
information. 1f a phtient has never analled but appears to be eligible,
Social Security is requested to came to the hospital and take an
application.
2, hollow up each day with both patients and thv Social. Services oFfice to ensure
that patients (car family members) are foll.owinp through on MediCal application:
Counsel those patients who have not done so and remind them of the hospital's
deposit requirements.
3. On all patients with third party coverage, make sure that the following
have been obtained and have been placed in the patient `s file:
(a) MediCal : a lila: fpr the month of service, a Notice of Action letter
whPQ ""Plifluble ;trial n comnletcd Share of Cost form when
"'A should 1>e mr.C the e firsC eiav of hospi,CallZ:'1(;.ian :
Financial Counsellors (cont. ) Page Two
(b) Medicare; a cony of the Medicare card OF, Medicare number, A and B
coverage and effective date obtained from Social Security or the
nursing home from which the patient has been transferred.
(c) Insurance: verification and amount of coverage, assignment of
benefits and release of information and billing address.
(d) Pending coverage through MediCal or BAC: Authorization to receive
MediCal card, relense of information to query status of claim,
verification of address and phone number, alternate address and
phone number contact , promi:c:;c ry note for the bal.:ince duce, to be
cancelled rlpon rrcoipt of P ,-diCal 11017 for the month of service.
(e) Cash accounts, including Share of Cost - Deposit on accou'rit and/or
promissory note for the amount due. These notes should be set up
as a monthly payment agreement not to exceed six months, with a
balloon payment at the enol, if necessary. Provided that payments
have been made as agreed, the balloon pavment can be renegotiated
to another six months contract whoa it becomes due.
4 . Follow up on all problem ilationts or nendin}, MediCal for one week after
discharge.
(a) Call on those patients who h;ive 11c0t provided the information necessary
to complete a Medical apnlicntioll.
(b) DriVe tO IML iL'llt.;' 1101110s ti) hill( no 1)01-"s or eli!;ibil].ty information.
(c) At t111' 011d 01 011(2 Wk-Ck, CHIC thC nnCit,nl files accordins; to source
of payment and transfer to patient accounting. Files should contain
all the paperwork- necessary to hill the account as soon ,ns a claim
A. form is recoived.
5. Counsel all Emrrgoncy Room and outpatient patients who are chronic offenders
at not completing .`1edi.C11 applir.ations.
Mien reference is made above to colinselli.ns; patients, it must be remembered
that whenever possible, contact is m;i(1c with cher patient 's spouse or other family
member both to avoid upsetting the patient and to insure that immediate action
is taken to obtain the necessary documentation of third party coverage.
The above responsibilities should he exi)anded, :t!; thu program gots under way,
to include preadmission of all elective' stir'very patients and all 09 patients to
insure that MediCal ipp.lications are completed and approved prior to the patients'
admission to the hospital.. For those not elllri.bl.e for MediCal, all other possible
payment sources should be explored prior to a&imiss.ion. . Financial counselling
should also be expanded to the clinics to include at least one counsellor in East
County and one in West County.
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Nu-Med Medic;1.1. Inc,
Fehrua-v 29r 1.9$4
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