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Five years after the H1N1 flu pandemic, hospitals and public health authorities are dealing with a difficult aftermath: Stockpiles of N95 respirators are expiring. Rebuilding pandemic stockpiles could cost many millions of dollars and still might not provide enough protective devices.
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Most errors involving Medicare as a Secondary Payer Questionnaire (MSPQ) can be attributed to two things, according to Kevin Willis, director of Medicare Services in the Harrison, OH, office of Claim Services, a document retrieval company. Willis is a former Medicare Secondary Payer auditor.
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Sending the correct information to the insurance companies to show the medical need for services has become quite a task for patient access, says Aaron Robison, CHAA, a patient financial advocate at University of Utah Health Care in Salt Lake City.
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Patients are increasingly presenting with out-of-network coverage, due to more narrow networks in health plans. Patient access needs revamped processes to confirm eligibility, inform patients, and apply for patient-specific agreements.
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Although it is possible to keep training on Medicare as Secondary Payer (MSP) fairly simple, there are times when you need to stop, think, and ask a lot of questions, says Elizabeth Reason, MSA, CHAM, director of patient access for Cleveland County HealthCare System in Shelby, NC.
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In the past, the only way for patient access managers to develop productivity standards was through time studies, says Mark Sammartano, interim director of revenue cycle and managed care at Waterbury (CT) Hospital.
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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.
