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It must seem as though the number of important things to read and digest that come across a quality manager's desk is never-ending. But the 2013 Office of Inspector General (OIG) Work Plan should be at the top of your to-do list.
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We listened in on the calls where we had heard a little more impatience in responses and found out the caller was over 70,” says Cynthia Norman-Bey, the hospitals’ director of patient access services and the PBX (private branch exchange) Call Center.
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If a patient is admitted on a holiday or after normal business hours and registrars are unable to notify the payer until the next business day, the claim could be denied for late notification, warns Jeanette Foulk, director of patient access at Methodist Charlton Medical Center in Dallas.
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Is this patient in a Medicare A bed? Does the patient have Medicare coverage, and if so, what type? Is this patient End Stage Renal Disease (ESRD) or disability entitled? What is the patient’s entitlement date? How many lifetime reserve days does this patient have left? Is the patient in their 30-month coordination period for ESRD entitlement?
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When Cynthia Norman-Bey, director of patient access services and the PBX (private branch exchange) Call Center at Glendale Adventist Medical Center, notices an employee’s customer service skills are lacking, she pairs him or her with a high performer.
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If a patient is admitted on a holiday or after normal business hours and registrars are unable to notify the payer until the next business day, the claim could be denied for late notification, warns Jeanette Foulk, director of patient access at Methodist Charlton Medical Center in Dallas.
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Patients might tell a registrar that they still have a Medicare Advantage plan when they no longer do, that they do not have supplement A & B coverage when they actually do, or that they have Medicare for disability coverage when it is really for end stage renal disease.
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Registrars might learn more information after asking patients with inactive coverage, “While reviewing your insurance, we are getting notification that you have another primary payer. Do you have any other insurance?
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We are now receiving denials for failing to obtain authorization for the medication in those injections. This is something we had not seen previously,” reports Jeanette Foulk, director of patient access at Methodist Charlton Medical Center in Dallas.
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Previously, it took some patient access employees over an hour to travel up to 40 miles to a training site for required education at St. Luke’s University Health Network in Allentown, PA. Now, employees can take some of the training right from home or at their current facility.
