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When you consider the newly eligible population coming onto your state's Medicaid program in 2014, remember that "those 32 million people out there are already being seen somewhere. They are being seen by a range of safety net providers," says Georges C. Benjamin, MD, FACP, FNAPA, FACEP(E), executive director of the American Public Health Association in Washington, DC.
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If a patient gives untruthful information to registrars to avoid paying for services, this fraud can result in dangerous clinical outcomes as well as lost revenue.
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Claims denials often occurred because the patient's disposition didn't match up with what the Centers for Medicare & Medicaid Services (CMS) required to authorize a procedure, reports Maura Corvino, MSOL, RN, CEN, assistant vice president for emergency services and patient access at Valley Health System in Ridgewood, NJ.
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When a new emergency department (ED) bedside co-pay collection process was implemented at Middlesex Hospital in Middletown, CT, access reps were "very, very nervous about what the reaction was going to be," recalls Margaret Trudel, patient access manager.
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After patient access staff at UNC Health Care in Chapel Hill, NC, began receiving bi-weekly reports on how much they collected, their performance began to improve.
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Martin Memorial Health Systems in Stuart, FL, reports an increase in authorization requirements for inpatient and outpatient accounts.
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Registrars at Cincinnati (OH) Children's Hospital Medical Center now have an added incentive to obtain co-pays: It could determine the amount of their pay increase.
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When patient access leaders at Cincinnati (OH) Children's Hospital Medical Center took a close look at multidisciplinary clinics, it was determined that many of them were collecting a single co-pay even when patients saw multiple providers, says Michelle Gray, MHA, director of patient access and outpatient registration.
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Patient access staff at Methodist Hospital in Kalamazoo, MI, are assessed for customer service as part of the criteria for the hospital's bonus program, says Patti Burchett, director of registration and central scheduling.