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The Centers for Medicare & Medicaid Services will use a complaint-driven process to enforce the transactions and code sets provisions of the Health Insurance Portability and Accountability Act after the Oct. 16 implementation deadline, and will focus on using voluntary compliance.
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Physician practices considering going back to paper claims as a way of coping with the Oct. 16 Centers for Medicare & Medicaid Services deadline for transactions and code sets should resist the temptation, according to John Thomas, CEO of Dallas-based MedSynergies.
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The Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance have started a new Privacy Certification Program for Business Associates to assess whether organizations designated as business associates under HIPAA are meeting essential requirements for safeguarding personally identifiable health information.
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Confusion in research circles over privacy requirements under HIPAA is seen in a flap at the Johns Hopkins Medical School, which sent a letter to the Department of Health and Human Services asking whether it could request patients permission to use their medical records for research.
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There will be dramatic changes in the works for patient access departments as a result of health care reform legislation. That is for certain. But many important details are still unclear.
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Does a system claim to be the "be all, do all" for your patient access department's issues, such as an eligibility system verifying benefits for all payers? If so, be skeptical.
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Reasons for claims denials often can be traced back to factors beyond patient access, such lack of medical necessity, lack of clinical documentation, or a physician not participating with a plan. This is why "patient access cannot work as a silo in reviewing claim denials," says Carol Triggs, MS, director of patient access at St. Joseph's Hospital Health Center in Syracuse, NY.
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To reduce administrative claims denials, Virtua Healthcare System in Marlton, NJ, did two Six Sigma projects. "Our major mission for the first project was to identify root causes that resulted in administrative denials at all campuses and all registration types," says Diane E. Mastalski, CHAA, CHAM, director of patient access.
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Next time you get a complaint, don't let it ruin your day. Instead, find a way to make a customer's dissatisfaction work to your advantage.
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Some patient access leaders are realizing that exemplary staff members can be a major resource for training and education. This could be because staff are more comfortable learning from their colleagues, or because the department is being charged to do "more with less" and more formal training resources are cut. Either way, it can be a successful strategy.
