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Don't expect a bouquet of flowers if patients gets their appointment reminder, they show up on time, the right payer gets billed, and the hospital is reimbursed.
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A patients may present for services without a referral required from his or her insurance company, or lacking a supporting diagnosis or procedure codes. These resulting claims denials are linked to the provider's office, along with prescriptions without diagnosis codes.
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Kettering Health Network in Dayton, OH, looks at both good and bad comments pertaining to access on Press-Ganey surveys. "We want to reward and recognize our people who are doing things right every time, but coach and mentor those having trouble with the processes," says Jana R. Mixon, director of patient access and central scheduling. "We make sure we are addressing both sides of the issue."
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If you sometimes feel as though every complaint in the hospital is directed at your department, you may not be that far off. "I believe that because patient access is the starting point for patients, we tend to receive complaints for the whole organization," says Maureen Moreno, manager of the patient access financial services contact center at Danbury (CT) Hospital.
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How many claims denials have occurred at your hospital because of mistakes that could have been easily corrected? Unless this information is put into the hands of registration staff in a timely way, errors will at best, get further along in the process. At worst, this will result in a denied claim.
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Many reimbursement dollars may be lost if patient access fails to obtain accurate information on whether a patient has another form of insurance that will supersede Medicare during the registration process. Medicare Secondary Payer (MSP) requirements are one of many ever-increasing demands put on front-end staff, says Jennifer Nichols, director of patient access at Spectrum Health System in Grand Rapids, MI.
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You're probably being asked to do more with less in your department, while rewarding staff for the good work they do. Roxanna DeMoss, director of hospital patient access at Ohio State University Medical Center in Columbus, says that a "Bravo" reward system has worked very well to provide registration staff with recognition.
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"How hard can it be to get the right address and phone number?" is a question you might hear too often. In reality, of course, it's not as simple as it sounds.
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If a patient requests financial assistance at University of Mississippi Medical Center in Jackson, he or she can expect to be asked for some very specific information about finances more specific than that previously requested. This makes it harder for patients to "game the system."
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Even though the number of self-pay and underinsured patients continues to grow at Northwest Community Hospital in Arlington Heights, IL, the patient access department set a goal of increasing emergency department (ED) collections by 50%.
