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Did payer deny claim? Look closely to see if contract allows it

Many patient access leaders are seeing a sharp increase in claims denials, primarily due to more numerous and stringent payer requirements.

Payers claim procedures weren’t medically necessary

With medical necessity denials, “prior authorization is ‘job-one,’” says John Holyoak, director of product management at RelayHealth Financial, which is based in Alpharetta, GA.

Prevent denials in the first place — Training is ‘paramount’

Errors or typos made by registrars during the collection of information or during the data entry process are “extremely prevalent” in claims denials, according to Brinn Leach-Wilson, a Merritt Island, FL-based consultant with BHM Healthcare Solutions.

Common registration practices cause big problems with HIPAA

“Mr. Bob Jones? Your colonoscopy will take place in 15 minutes.”

Create ‘culture of privacy’ in patient access areas

To prevent potential violations of the Health Insurance Portability and Accountability Act, “we need to, first, cultivate a culture of privacy within the patient access staff,” says Julie Johnson, CHAM, FHAM, director of patient access and Health Information Management and HIPAA privacy officer at Mount Graham Regional Medical Center in Safford, AZ.

Record high turnover: Senior registrar role ‘slows the flow’ out of patient access

In 2014, the patient access department at William Beaumont Hospital Royal Oak (MI) had a record high turnover rate.

Can members of patient access department answer toughest questions about coverage?

Many overwhelmed, confused patients turn to patient access employees to help them make decisions about healthcare coverage and even to obtain coverage. A recent Health Affairs policy brief discusses some difficult questions that often come up.

Emergency department registrars work with clinicians to identify “superusers”

Do you assume that “superusers” of the emergency department, or individuals who present very frequently with the same vague complaints, are just a nuisance?

Small changes add up to big benefits for access

Whenever Sarah Thomas, senior director of access systems at Seattle Children’s Hospital, hears a registrar sigh in frustration, she makes a beeline to that employee and asks what’s wrong.

Shorter surgery check-in saves $11,500 plus a minute per case

Patient access employees, supervisors, and managers at Seattle Children’s Hospital are constantly on the lookout for work that is no longer useful.

Hospital Access Management – March 1, 2016

March 1, 2016