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Carmen Arroyo, clinic operations manager of cardiology, nephrology, and pulmonary medicine at Children's National Medical Center in Washington, DC, set a goal to increase her area's time-of-service collections by 9% over the previous fiscal year. She wound up tripling the amount collected. Here is how she did it:
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If registrars are more accurate when completing registrations, fewer claims denials will result. This clearly improves your hospital's fiscal situation, but remains a daunting challenge for many patient access departments. Here are some steps taken by the patient access department at St. Joseph's Hospital Health Center in Syracuse, NY:
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Here is a payment planÿ
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Here is a payment plan matrix for self-pay patients used by patient access staff at Skaggs Regional Medical Center in Branson, MO.
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By taking a proactive approach to patient status and instituting a series of checks and balances, Good Samaritan Hospital in Dayton, OH, keeps denials at a minimum.
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By redefining the roles of case managers and social workers and working with physicians on patient throughput and length of stay, Fauquier Hospital in Warrenton, VA, significantly reduced its Medicare length of stay by almost a day and decreased the revenue lost because of denials by medical necessity by 70%.
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If there are any doubts that improving patient flow also enhances patient safety, the recent experience of the ED at Enumclaw (WA) Regional Hospital should dispel them.
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As reimbursement shrinks and health care providers tighten their belts, hospitals need to take a proactive approach to denials to make sure they get paid appropriately for the care they provide, experts say.
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By conducing real-time concurrent denials management, Jewish Hospital and St. Mary's Healthcare, a not-for-profit health care system in Louisville, KY, keeps its average denials rate below 1%, consistently exceeding the hospital's goal of a denials rate of under 2% for commercial patient days, including Medicare managed care patients.
