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About half of the self-pay patients presenting for services at Vanderbilt University Hospital in Nashville ultimately obtain Medicaid coverage, reports Marsha Kedigh, RN, MSM, director of admitting/emergency department registration/discharge station/insurance management.
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Claims denials at The University of Tennessee Medical Center in Knoxville have increased 20% to 30%, particularly from major payers including The Blue Cross and Blue Shield Association, United Healthcare, and Humana, according to Stephen Hovan, executive director of patient fiscal services.
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A team of patient access specialists consisting of top performers, role models within the division, and lead personnel offer a wide range of expertise and experience to registrars at Carolinas HealthCare System in Charlotte, NC, reports Christina Baugh, supervisor of PRN registrars and Patient Financial Service Specialists for corporate patient access.
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If a patient complains that a registrar seemed to care only about money, or insists he or she waited way too long to be registered, Jan Fowler, director of patient accounting at Saint Vincent Health Center in Erie, PA, makes a point of meeting with the staff person involved to hear their side of it.
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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.
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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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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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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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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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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.
