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Beginning Jan. 1, 2012, providers must use the new HIPAA 5010 transaction standards to conduct certain administrative transactions such as claims, remittance, eligibility and others, but not all providers are ready for the transition to new standards, and that lack of preparedness could affect transition to ICD-10 as well.
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Leon Rodriguez, the new leader of the government's HIPAA privacy and security enforcer, last served as chief of staff and deputy assistant attorney general for the Department of Justice Civil Rights Division.
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When an interdisciplinary team including patient access, insurance verification, and radiology personnel was formed to reduce claims denials, "realizing where denials are coming from was definitely our first step," reports Brian A. Todd, CHAM, manager of patient access staff development and training at Lourdes Health System in Camden, NJ.
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As hospital compliance officers prepare for a proposed increase in patient access to medical records' information, another proposed rule increases access to laboratory results. Comments on the laboratory proposed rule must be received by Nov. 14.
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Has your access staff been wrongly blamed for mistakes, delays, or other problems related to clinical areas? To avoid this problem, patient access must "link themselves with clinical departments and establish a relationship a tight one," says Barbara Snodgrass, patient access manager at Legacy Mount Hood Medical Center in Gresham, OR. Snodgrass gives these recommendations:
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Payers are frequently requiring additional clinical information from the provider or medical staff as to the medical necessity for a procedure or surgery, says Nan Olivieri, a supervisor at the Financial Clearance Center at Hennepin County Medical Center in Minneapolis.
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Keeping up with all the new payer requirements "is getting overwhelming," reports Margie Mukite, director of patient access at Advocate Condell Medical Center in Libertyville, IL. Here are some trends the department is seeing:
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If an admitted patient is impatiently waiting for a bed to become available, and all he or she sees is access staff, it's easy to come to the wrong conclusion about who is really responsible for the delay.
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At St. Joseph East/St. Joseph Jessamine in Lexington, KY, collections in a newly opened women's hospital went from only about $100 in March 2010 to $15,000 a year later, and preadmissions collections, which were just $1,300 monthly, now range from $15,000 to $40,000. Stanford (CA) Hospitals and Clinics expects to collect $1 million more at point-of-service in 2012.
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After a registrar immediately blamed a clinic because she wasn't able to verify a patient's demographics, Nicole Marsoobian, supervisor of pre-registration at Tufts Medical Center in Boston, sent her to the clinic for an hour.
