They say collaboration is the key to managing claims quickly
Members of the Reimbursement and Payer Management Department have a reputation for working well together and nurturing relationships throughout the practice to make sure YMG is paid for claims.
Like any good team of private detectives, the 30 investigators in Reimbursement and Payer Management (RPM), which is part of Yale Medical Group (YMG)’s Patient Financial Services, keep a low profile. But now they are in the spotlight as the clinical practice’s Outstanding Employee Team.
We put out a call for nominations in March and received some impressive entries. A special committee including senior administrators, physicians and YMG staff helped choose the RPM group.
Chief Revenue Officer Marianne Dess-Santoro was not surprised by the honor. “They are a special and superb group,” she said. “One of the reasons they are so successful is that they have developed close working relationships with physicians, administrators, practice managers, billing managers, coding specialists and the like in their clinical departments, and are seen as invaluable resources for them.”
Lisa Hines (left) and Sally Chesney say members of their team are “experts in rejections and denial management.”
RPM investigators work collaboratively with every clinical department to “make sure we get paid for claims,” said RPM Associate Director Lisa Hines, who works closely with Director Sally Chesney. “Our staffers dig deep to figure out how to maximize revenue potential and find missed revenue opportunities. We’re the experts in rejections and denial management,” Hines said.
Each YMG practice has at least one RPM analyst assigned to it to help determine the root causes of claims reimbursement problems, and to design workflows and other solutions that minimize such headaches. The analysts keep in close contact with insurance companies so they can understand what they need to quickly and efficiently settle claims.
For example, an RPM analyst was monitoring rejection trends for their department and identified an increase in claims rejected for no authorization. The analyst worked very closely with the clinical department, reviewed the workflow, identified the process breakdown, and provided training and education to resolve the issue,” said Hines. “Everything involves collaboration.”
While Hines is reluctant to take credit for RPM’s success, reimbursement analyst and team co-leader Lisa J. Sarris offered insight into a critical aspect of creating such a committed group. “Lisa stays in the trenches with us,” said Sarris. “She always supports us, encouraging us to think outside the box and to look at the whole picture to find the correct solution. She’s right beside us working with us until we are finished.”
Dess-Santoro and Hines both commented on the fact that the RPM analysts are a diverse group of people with a variety of strengths. “We all think differently, and we all have different approaches,” Hines said. “But we’re all in the same boat and no one is rowing alone. Sharing is the key. Every week we have meetings, workshops and informal group discussions to share knowledge and successful solutions to problems so that everyone can learn from each other and add value to this team.”
Reimbursement and Payer Management team:
|Howard Bibbins||Dawn Gilbert||Jennifer Lacerda||Jeannette Repollet|
|Andrea Cable||Krishna Gopal||Judith Mahony||Lisa Sarris|
|Jennifer Canepari||Judy Gottlieb||Steven Mancini||Martha Schwartz|
|Teresa Carty||Mary Ellen Grom||Melissa Maniscalco||Gary Strysko|
|Anita DeGoosh||Lisa Hines||Sharon McGrath||Dawn Tuttle|
|Pat Francis||Christine Hoyt||Karn McKane||Kathy Woods|
|Linda Ehrler||Nancy Hughes||Carolyn McNamara|
|Anita Fraser||Patricia Kaminsky||John Morettini|
The RPM team celebrated their award in July over a continental breakfast.
More than 30 team members and guests lined up for food. COO Fred Borrelli chats with RPM staff.
Members of the team gather round the table for a welcome break from work.
Marianne Dess-Santoro recognizes a “special and superb" group of people.
Yale Medical Group CEO Paul Taheri, with Lisa Hines, left, and Sally Chesney, presented the group with a plaque.