Revamp patient access now: Reform in 2014
Revamp patient access now: Reform in 2014
Role will expand even more
When the Patient Protection and Affordable Care Act (PPACA) is implemented in 2014, "not only is our patient volume going to expand, but our role in patient access is also going to expand," predicts Michael F. Sciarabba, MPH, CHAM, director of patient access services at Advocate Illinois Masonic Medical Center in Chicago.
"Right now, we are very transactional and very volume-oriented. We register you, and you are in and out of the system very quickly," he says. "I see that process changing, because there will be more to do." Here are some ways patient access is changing:
Insurance verification will become more difficult.
"We have maximized the use of technology in determining eligibility and benefits," reports Sciarabba. "We have also expanded hours of operation for insurance verification to evenings and weekends."
Sciarabba says that patient access areas will need better processes to verify benefits, due to the myriad of different plans that will be offered through the health insurance exchanges to be created by the states. "All of the states will be required to have a tool for consumers to make decisions on what kind of healthcare insurance they want," he says. "That will provide a lot more transparency to the patient. But it will make things more difficult for us in patient access."
The reason? Patients will have more options and more flexibility in changing their plans, Sciarabba says. "Patients will be more educated, but insurance will be more portable and flexible," he says. "There will be a lot more plan specifications than they have right now."
Patient access will need to work with the hospital's information technology department to integrate physician and hospital databases.
Information on patients will need to flow more easily between physician groups and hospitals, says Sciarabba.
"There will be an expectation that we will have those structures in place, to improve the quality and transparency of care," he says. "That is a good thing for patient access, because we depend on the physicians for a lot of things."
Many patient access departments struggle to obtain basic information such as physician orders or other information on the patient, Sciarabba says. "In the system we are currently in, you have to start from scratch to find all of that," he says. "Someone should have that information already, or if not, the insurance company should be able to provide it electronically for you."
The PPACA puts the onus on providers and physicians to make it easier for the patient to navigate through the system, he says. "They will have quality measures around that, not to mention it's the right thing to do for the patient," says Sciarabba.
Healthcare fraud prevention will continue to be an issue.
Advocate Illinois Masonic Medical Center is conducting audits to be sure no unintentional fraud is being committed such as patient access staff obtaining inaccurate information on Medicare as secondary payer, failing to give inpatients the "Important Message from Medicare," or failing to follow guidelines on medical necessity, Sciarabba says.
"There will be more scrutiny on identifying fraud in healthcare," he says. "The government is going to be looking for it because they need the money to fund healthcare reform. We need to be proactive in following the regulations."
Source
For more information on changes in the patient access role, contact:
Michael F. Sciarabba, MPH, CHAM, Director, Patient Access and Support Services, Advocate Illinois Masonic Medical Center, Chicago. Phone: (773) 296-5071. Fax: (773) 296-5101. E-mail: [email protected].
When the Patient Protection and Affordable Care Act (PPACA) is implemented in 2014, "not only is our patient volume going to expand, but our role in patient access is also going to expand," predicts Michael F. Sciarabba, MPH, CHAM, director of patient access services at Advocate Illinois Masonic Medical Center in Chicago.Subscribe Now for Access
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