New skill sets that patient access needs — right now

Focus is shifting to the front end

Right now, patient access managers are in a difficult situation — their roles and responsibilities, already very broad, are "changing on a regular basis," says Ed Erway, chief revenue officer at University of Kentucky (UK) HealthCare in Lexington.

Providers are being forced to deal with increasing co-pays and deductibles, health plan complexity, and more uninsured patients. This means that the focus of accountability for payment and collection of valid data must switch from back-end billing to the front end — in other words, to patient access staff, says Erway.

"This change will require patient access personnel to possess the technical skills of communication, attention to detail, and basic health science," says Erway. "They must also have the ability to multi-task with many new technologies."

Erway adds that higher-level degrees or certification in patient access will be helpful to promote these skills.

According to Jodie Martin, the organization's director of hospital admitting, "As the diversity of our population increases, there is also a need for bilingual and multilingual patient access personnel." Martin says that the organization's learning center offers classes on basic Spanish, and patient access staff are encouraged to participate.

Make new roles work for you

There is no question that the financial focus at many hospitals is shifting — from receivable collections to front-end collections. Very likely, this means that your patient access personnel need both new technology and new skills — to help them verify insurance benefits, addresses, employers, referring physicians — and the need for health care services.

It's true that this trend means extra workload for patient access. However, it also could be an opportunity to obtain more resources for your department. "The work is shifting to patient access," says Erway. "However, forward-thinking providers will also shift the resources to go with the workload."

The goal, says Erway, is to achieve the "best possible efficiency" in getting pertinent information verified correctly in the beginning of the patient's stay, instead of applying resources after the patient has already received their services.

UK HealthCare is going through a new system selection process for patient scheduling and registration. "One of the critical components of the evaluation will be insurance benefit verification, address verification, and credit history," says Erway.

In the meantime, the department plans to install an insurance verification module with its current system. "This will not meet all the business requirements we have. However, it will allow for a more comprehensive approach than we have today," says Erway.

Accuracy, but with less interaction

Martin says it's important for patient access managers to take note of two other health care business priorities: customer service and patient convenience.

"Institutions must come up with processes and technical solutions that allow patients to register remotely or via kiosks, so they can report directly to their procedure areas without having to stop at patient access stations," says Martin.

A hospital committee is currently exploring the use of kiosks for registration at UK HealthCare. "We are at the stage of defining the functionality," says Martin.

She says that she hopes to end up with a product that interfaces with the existing registration system, allows patients to enter or scan their basic demographic and insurance information, accepts co-payments, provides copies of standard notices, activates pre-registered accounts, and if necessary, activates interpreter services.

You'll need to ensure the accuracy of demographic and payment insurance at a time when there will be less face-to-face interaction with the patients themselves.

Both technology implementations and process changes are necessary to meet this challenge. For example, technology may provide patients with the ability to scan demographic and insurance information through the use of a health care ID card, says Martin. Likewise, enhanced pre-registration processes will allow for more complete data-gathering processes, with a comprehensive eligibility and address verification system as a necessary component.

Another big challenge: the need for a much speedier process. This is becoming more important as more and more clinical information systems are implemented and integrated with patient access registration systems.

"Delays in registration can mean delays in the start of patient care," says Martin. "All patient access managers must creatively design their departmental processes to address this issue," she says.

Martin says that the organization's planned upgrade of its registration system is going to enhance its "quick reg" process for emergency department patients. The new function decreases the number of screens that the registrar has to go through to do a basic quick registration.

"The improvement will decrease registration time by several minutes," says Martin. "There is a commitment at the enterprise level to improve our pre-registration processes. The focus is on pre-clearance and pre-registration for all scheduled patients."

Martin estimates that about 60% of scheduled patients are currently pre-registered, with very basic demographic and insurance information.

"Our goal is to both increase the number and the comprehensiveness of pre-registrations through the use of better systems, staff programs and requirements, and standardized processes," says Martin. "Ultimately, we hope to be in the 95% to 98% range of scheduled patients being pre-registered."

For more information, contact:

  • Ed Erway, Chief Revenue Officer, University of Kentucky HealthCare, Lexington. Phone: (859) 323-5502. E-mail:
  • Jodie Martin, Director of Admitting and Registration, Department of Revenue Management, University of Kentucky Healthcare, Lexington. Phone: (859) 323-5808. Fax: (859) 257-2184. E-mail:]