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Patients might tell a registrar that they still have a Medicare Advantage plan when they no longer do, that they do not have supplement A & B coverage when they actually do, or that they have Medicare for disability coverage when it is really for end stage renal disease.
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If a patient is admitted on a holiday or after normal business hours and registrars are unable to notify the payer until the next business day, the claim could be denied for late notification, warns Jeanette Foulk, director of patient access at Methodist Charlton Medical Center in Dallas.
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When Cynthia Norman-Bey, director of patient access services and the PBX (private branch exchange) Call Center at Glendale Adventist Medical Center, notices an employee’s customer service skills are lacking, she pairs him or her with a high performer.
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Is this patient in a Medicare A bed? Does the patient have Medicare coverage, and if so, what type? Is this patient End Stage Renal Disease (ESRD) or disability entitled? What is the patient’s entitlement date? How many lifetime reserve days does this patient have left? Is the patient in their 30-month coordination period for ESRD entitlement?
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If a patient is admitted on a holiday or after normal business hours and registrars are unable to notify the payer until the next business day, the claim could be denied for late notification, warns Jeanette Foulk, director of patient access at Methodist Charlton Medical Center in Dallas.
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We listened in on the calls where we had heard a little more impatience in responses and found out the caller was over 70,” says Cynthia Norman-Bey, the hospitals’ director of patient access services and the PBX (private branch exchange) Call Center.
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It must seem as though the number of important things to read and digest that come across a quality manager's desk is never-ending. But the 2013 Office of Inspector General (OIG) Work Plan should be at the top of your to-do list.
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At the 100-bed Morehead Memorial Hospital in Eden, NC, the journey from TJC to DNV took two years, says Susan Netherland, RN, MBA, director of quality management and compliance officer at the facility.
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The 5th annual Joint Commission (TJC) report on patient safety, "Improving America's Hospitals: The Joint Commission Annual Report on Quality and Safety 2012," presents proof positive that hospitals are getting the quality message that TJC wants them to learn.
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In the few years since DNV Healthcare became the first new company in 40 years to win deeming status from the Centers for Medicare & Medicaid Services (CMS), some 320 of the 5,800 registered facilities have opted to use the OH-based company rather than The Joint Commission (TJC).
