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Just a couple of years ago, registrars in the emergency department (ED) at the University of Connecticut Health Center in Farmington collected only $100 to $1,000 a month in copays.
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Payers are asking for more authorizations for high-dollar radiology procedures, and claims denials are resulting, reports Stephen Hovan, executive director of patient fiscal services at The University of Tennessee Medical Center in Knoxville, who adds that his department is seeing a 75% increase in authorizations for radiology processes.
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Registrars at Carolinas HealthCare System in Charlotte, NC, benefit from "tricks of the trade" shared by specialists within the department, reports Christina Baugh, supervisor of PRN registrars and patient financial service specialists for corporate patient access.
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Would you consider one-year-old uncollected account with a large outstanding balance to be a lost cause that ultimately will need to be written off?
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A year after Saint Joseph-London Hospital in London, KY, began a heart failure readmissions program, 30-day readmissions dropped from 27.7% to 15.9%. A similar program for patients admitted for acute myocardial infarctions (AMI) reduced the readmissions rate from 23% to 10% in a short time.
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When the Inpatient Prospective Payment System (IPPS) final rule for 2012 was issued, the Centers for Medicare and Medicaid Services (CMS) stated that its goal is to encourage hospitals to provide higher quality of care at a lower cost and to promote greater efficiencies across all care settings and throughout the entire health system.
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Most of the items in in the box "Characteristics and Core Competencies of Potential Candidates" (below) are inherent and/or learned over time.
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Your job descriptions should clearly define the minimum amount of education that you require for the role of case manager or social worker.
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Orientation should be geared to the experiential level of the new staff. The novice case manager will require a different orientation than the experienced case manager. You will need to determine this based on an assessment of the new staff member.
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Healthcare reform mandates, new reimbursement requirements from the Centers for Medicare and Medicaid Services (CMS), and pressure from payers to keep patients out of the hospital and emergency department all mean that hospitals need to do a better job of transitioning patients to another level of care.
