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Registrars might learn more information after asking patients with inactive coverage, “While reviewing your insurance, we are getting notification that you have another primary payer. Do you have any other insurance?
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We are now receiving denials for failing to obtain authorization for the medication in those injections. This is something we had not seen previously,” reports Jeanette Foulk, director of patient access at Methodist Charlton Medical Center in Dallas.
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Previously, it took some patient access employees over an hour to travel up to 40 miles to a training site for required education at St. Luke’s University Health Network in Allentown, PA. Now, employees can take some of the training right from home or at their current facility.
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While a small group of registrars at Legacy Health in Portland, OR, were effective collectors, and most were trying their hardest, about one-third weren’t making much of an effort to collect anything at all.
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At Harris Health System in Houston, patient access staff identify patients who fall into the category of self-pay or under insured, but the completion of the application and follow-up is outsourced, reports Veronica Rodriguez Patricio, audit, appeals, quality assurance, and training manager for eligibility and registration services.
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Recently, a large payer denied a claim for a CT scan of the abdomen due to no authorization, even though a registrar previously had been told none was required.
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The fact that payers almost never give a guarantee of payment prior to service and require registrars to confirm that there is no guarantee should set off warning bells when verifying coverage information, says John T. Porter Jr., access denial analyst for patient financial services at Scripps Health in San Diego, CA.
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When speaking with a payer representative, verify eligibility first, then move on to more specific details such as service category and codes, recommends John T. Porter Jr., access denial analyst for patient financial services at Scripps Health in San Diego.
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A third of patients seen at one Arizona emergency department (ED) were uninsured, but this percentage was cut in half after a checkout process was implemented, reports Todd B. Taylor, MD, FACEP, a Phoenix, AZ-based consultant specializing in Emergency Medical Treatment and Labor Act (EMTALA) compliance.
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When patients call and ask what a test costs, the information isnt always straightforward, says Robin Woodward, CHAM, patient access director at Riverside Regional Medical Center in Newport News, VA.
