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The Centers for Medicare and Medicaid Services (CMS) has announced that the final deadline to comply with the ICD-10 implementation requirement is Oct. 1, 2015, according to the National Association of Healthcare Access Management (NAHAM). The 10th edition of the International Classification of Diseases (ICD) is widely viewed as a significant change in the way claims that are submitted to Medicare and private insurance payers are classified.
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One of the biggest challenges in staffing patient access areas is incorporating volume flexing into the staffing model, says Jen Nichols, senior director of revenue cycle operations at Kaleida Health in Buffalo, NY. At many organizations historically, patient access was staffed in a fixed model, she explains.
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Staffing models dont always factor in additional tasks performed by patient access, warns Stacy Calvaruso, CHAM, assistant vice president of patient access services at Ochsner Health System in New Orleans.
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Incorrectly labeling Medicare as the primary insurance, or missing payers that are primary to Medicare, often costs facilities greater reimbursement and puts hospitals at risk for audits/fines.
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Clear and open lines of communication between the clinical team and patient access is the single best way to prevent claims denials due to no authorization, according to Aaron Robison, CHAA, a patient financial advocate at University of Utah Health Care in Salt Lake City. However, this step remains a significant challenge for the department.
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Payers are requiring authorizations for many additional procedures, which results in increased claims denials and dissatisfied patients.
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