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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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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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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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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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It is expected that metrics will be available so that the contributions of case management are quantified, as outlined by Toni Cesta, PhD, RN, FAAN, senior vice president, Lutheran Medical Center, Brooklyn, NY, in her April 2011 Case Management Insider article "You're only as good as yesterday's discharges Strategies to demonstrate case management's value."
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The devil is in the details when it comes to convening a successful interdisciplinary meeting.
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To maintain stability and effectiveness in meetings, the following steps should be considered.
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It's a new era for hospitals and for case managers as a multitude of auditors from the Centers for Medicare and Medicaid Services (CMS) and commercial payers scrutinize patient records looking for errors.
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Some states have highly developed quality improvement organizations (QIOs) that have for years worked with healthcare organizations to improve quality, share information, and tackle problems.
