Hospital Access Management – August 1, 2015
August 1, 2015
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Pending coverage, no authorization, or high out-of-pocket?
A patient is scheduled for an MRI in three days, but the payer says it could take five business days to obtain the required authorization.
Avoidable no-authorization denials cut by 60% — Avoid postponing procedure at your hospital
Is there a problem with an authorization that will result in a denied claim? Good communication with providers and office staff about this issue has reduced avoidable authorization denials by 60% at LCMC Health in New Orleans, according to Stacy Calvaruso, CHAM, system assistant vice president of patient access services.
Applicant looks great on paper? He or she might be a terrible fit for access
During an interview for a patient access position, one applicant confided that she had difficulty working the second shift on her last job. “And she was applying for a second shift position! That was a red flag waving in the wind,” says Lolita M. Tyree, CHAM, MSW, patient access manager in the ED at Riverside Regional Medical Center in Newport News, VA.
Is registrar able to handle the ED setting?
An employee might be detail-oriented, friendly, with an encyclopedic knowledge of payer requirements. An emergency department ED registrar, however, also has to be comfortable working in a setting where they’ll encounter tragedies, suicidal patients, and gunshot wounds.
Don’t allow patients’ privacy to be violated during registration
Nina Pham, the ICU nurse who contracted Ebola at Texas Health Presbyterian Dallas Hospital while treating the first patient diagnosed with Ebola, sued the hospital’s parent company, Texas Health Resources, and said it failed to train and protect nursing staff.
Do you want to know how an employee is really doing? Colleagues can tell you
“Does your work unit work well together?” “Does your work unit have a climate of trust?”
Here are best role-playing scenarios to increase your department’s collections
Every patient access department has its struggling collectors: employees who just can’t seem to collect, despite it being part of their job description. For some, the problem could be as simple as a lack of practice.
Use these responses when collecting
Here are some patient comments and suggested responses for role-playing exercises by patient access leaders at Adreima in Jacksonville, FL.
AMA adopts policies to improve data and price transparency
At its recent annual meeting, the American Medical Association passed two new policies addressing the growing interest in healthcare data and price transparency.
8.8 million fewer U.S. residents uninsured in 2014
An estimated 36 million U.S. residents lacked health insurance at some time during 2014, 8.8 million fewer than in 2013, according to a report released by the Centers for Disease Control and Prevention.
Vendors can be the weak point in your HIPAA compliance efforts
Business associates can frustrate compliance officers because they cannot be completely controlled, yet their performance can lead to a HIPAA breach for which the hospital or healthcare system is liable. Some providers are trying to use indemnification to escape that trap, but there are limitations to that strategy too.
CareFirst breach tied to Chinese attacks, limited by segmentation
Soon after CareFirst BlueCross BlueShield announced that the company had been the target of a sophisticated cyberattack, clues started arising to suggest that the same attack methods might have been used in this intrusion as with breaches at Anthem and Premera. Those incidents collectively involved data on more than 90 million Americans.
HIPAA breach attributed to stolen laptops
The latest HIPAA breaches across the country continue to reinforce the importance of basic security measures, with stolen laptops causing trouble for one hospital.