APCs, customer service may be tricky combination
APCs, customer service may be tricky combination
The advent of Medicare’s outpatient prospective payment system this month may signal more than a logistical and financial challenge for the nation’s hospitals. It could require a major customer service initiative for access departments.
In many cases, the new ambulatory payment classifications (APCs) mean that the patient’s portion of the Medicare payment has increased and is actually greater than the share paid by the government, points out Joseph Denney, CHAM, lead, patient management system implementation, The Ohio State University (OSU) Medical Center in Columbus.
"This could be a customer service nightmare for hospitals, depending on how well Medicare has informed [its beneficiaries]," he adds. Denney is interested in hearing about how other hospitals plan to address the issue.
When diagnosis-related groups were introduced to the inpatient arena in the 1980s, he says, "it took a while to get everybody on the same page." Denney says he anticipates a similar transition for APCs. "My understanding is that we will eventually get to a point where things will even out and the [payment breakdown] between Medicare and the patient will be more in line," he adds. "But in the interim, on many of the charges, the patient will pay more."
One thing seems clear, Denney says. "We will have to have some good scripts down for our registration people. Hospitals will have to take a much more assertive approach relative to upfront payments. If patients come in and have Medicare but no supplemental insurance, they will have more out-of-pocket expense."
Access departments need to decide if they will bill patients or focus on getting the money at the point of service, to make sure they get paid, he adds.
Staff at OSU Medical Center are beginning to talk about the collection/customer service issue at APC implementation meetings, Denney says. "We want to make sure we are sending a clear message as an institution. We will tell patients that this is something from the Health Care Financing Administration [HCFA], that they should have received information from them, and that there is nothing we as an institution can do to change it."
Denney would like to receive feedback from his access peers on these concerns:
1. "How are you prepared to address the Medicare public when they well may be paying a greater share out of pocket for outpatient services?"
2. "HCFA has stated that institutions can choose to discount the patient’s share of the payment as a marketing tool. They’re leaving it up to the hospital, but whatever the difference is, you eat it. Medicare will stay pay only its portion. Is your hospital going to discount?"
From what he has heard so far, Denney says, most are saying no. "They can’t afford to give up any dollars."
[If you have feedback on this issue, call editor Lila Moore at (520) 299-8730 or e-mail her at lilamoore @mindspring.com. Joseph Denney may be reached by calling (614) 293-2132. E-mail: denney-1@medctr. osu.edu.]
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