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Your current systems will need to be remediated if they will be used to check medical necessity for ICD-10 standards when they are implemented in October 2013, says Jeffrey Smith, RN, MBA, CPC, a New York City-based manager at Accenture Insight Driven Health, a management and technology consulting company.
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Because the prior authorization process occurs well in advance of a service, your Patient access staff will need to be prepared for ICD-10 well before the Oct. 1, 2013, implementation date, warns Rennae J. Glidden, RHIT, director of data services at HealthEast Care System Midway Campus in St. Paul, MN. Use these strategies:
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With payer requirements becoming more numerous, patient access departments face an ongoing battle to keep staff current.
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It's taken a collaborative effort between patient access and provider offices to navigate the challenges of prior authorization and payer requirements, while continuing to give patients an excellent experience, says Adrienne Pinelle, CHAA, manager of the preauthorization team for patient access services at University of Utah Health Care in Salt Lake City.
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Sick, upset, and distracted patients often gave inaccurate or incomplete information to registration staff in the ED at Bronson Methodist Hospital in Kalamazoo, MI, notes Tina Nadrasik, the department's Patient Access manager. This problem sometimes resulted in claims denials, she adds.
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The ED verification staff, registration staff, case managers, emergency nurses, and a group of patients joined together and brainstormed ideas at Bronson Methodist Hospital in Kalamazoo, MI, with the goals of reducing denials, obtaining a better understanding of each other's roles, and obtaining accurate demographics, says Tina Nadrasik, patient access manager over the ED. Here are three areas that were identified:
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When Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare (TMH), started point-of-service collections in her department about five years ago, she encountered a lot of resistance.
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Patients might have bought an insurance policy with lower premiums and higher deductibles, but lack understanding of what those mean. This part of the job is one of the hardest for patient access staff, according to Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare.
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Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare, says that her department has put a "very liberal, but very fair, uninsured payment policy in place."
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If some particularly dismal copay collection data came to your attention, chances are you'd want to scrutinize it carefully before presenting this to senior leaders.
