Access Management
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Observation Status Is Issue in Claims Denials
Patient access should be documenting the true severity of a patient’s illness on day two or three of hospitalization. By that time, there is an actual diagnosis to support the need for admission.
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Physicians, Patients Rarely Discuss Cost: Registrars Can Help
A lack of knowledge and a discomfort discussing money leads everyone to steer conversations in other directions.
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Lawmakers Broker Agreement to End Surprise Billing
Bipartisan compromise was included in latest COVID-19 relief package.
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Analysis Details the Burdens
of Prior AuthorizationAdministrative hassles and confusion, along with delays and denials, push providers and patients alike to the brink.
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CMS Finalizes 2021 Physician Fee Schedule, Tinged with a Bit of Controversy
A budget neutrality provision leads industry groups to cry foul over Medicare cuts.
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Scripting Keeps Financial Message Consistent
Giving families a point of contact for each area of the revenue cycle is the best way to provide uniformity. For example, when patients call in for an explanation of their bills, connect them with customer relations. If they need to set up a payment plan, bring in financial counselors.
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Incomplete ED Registrations Disastrous for Copay Collections
Hospitals are trying to shorten door-to-provider times. Lower-acuity patients are treated as “fast-track,” and discharged quickly. Registration teams might struggle to keep up, to the point that some patients may miss the official registration process. Without proper contact information, collection becomes exponentially more difficult.
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Revenue Cycle Needs Prep Work for Tough Financial Conversations
The most challenging situation can be when patients ask why the cost is so high. Scripting can help registrars answer this difficult question. This training includes teaching patient access staff how to show the patient detailed benefits and explain the out-of-pocket expense is based on their insurance carrier.
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Health Plans Want Proof It Was Necessary to Admit Patient
Work with utilization managers to understand why these denials are happening. Ensure clinical documentation is detailed enough to support inpatient level of care, and be sure to submit such evidence to the health plan while patients still are in house.
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Revenue Cycle Staff Keeps ‘Financial Toxicity’ from Harming Patients
Patients often are left alone to navigate the complex healthcare system, which can cause problems. The most successful financial navigation programs direct healthcare providers and staff to work together to address patients’ needs from the time they enter the system to after discharge.