Keep up-to-date portfolio that includes clinical skills

AM nurses have advantage

Access managers continually need to refine the contents of their career portfolios to rise to the challenges of today’s health care environment.

That’s the suggestion of Jack Duffy, FHFMA, director and founder of Integrated Revenue Management (IRM) in Carlsbad, CA. Access managers typically are better suited than their counterparts in the business office, for example, to play a pivotal role in addressing the clinical issues associated with denial management, Duffy says.

In many facilities, he notes, the chargemaster — the primary document for charging all the services, supplies and pharmaceuticals in a hospital — either is decentralized to ancillary departments where staff don’t have the necessary training or centralized in the business office. The person who oversees it in the business office, Duffy says, is likely to know something about billing, but little about clinical issues.

"The chargemaster turns out to be a clinical document," he says. "To keep these critical items up to date, you need individuals who have nomenclature and disease process experience. It’s more likely that an access manager rather than a business office manager would have this in his or her background."

The growing number of nurses who are access managers, Duffy suggests, "would make wonderful partners to central supply or in making improvements to the chargemaster, where the errors can reach 90%." Access managers can add to their professional stature, he says, if they can perform that role.

"Because of the nature of changing supplies, and the bombardment of ambulatory payment classifications (APCs), the average hospital has 100 changes a week," he adds. "If those are not done on a timely basis, and the contracts are not understood, the consequences of miscoding the chargemaster could be financially devastating.

"[The chargemaster] needs constant review. I’ve seen hospitals that have undercollected up to 40% because of errors in the chargemaster, inability to code, and lack of ability to present complex issues on a bill.

In organizations that moved to the central business office (CBO) model, most of those CBOs now are off-site and serve geographically diverse areas. Because the business office has left the [hospital] arena, Duffy says, the gap between those professionals has widened.

In such cases, the access manager may be "the No. 1 person on campus" when it comes to revenue management. "This is a risk as well as an opportunity for that on-campus access manager to take on the role of developing revenue," he says.

The real question, he suggests, is whether the access manager portfolio represents success from point-of-service inception to bill drop. If the answer is yes, Duffy says, then you need to examine all of the skills necessary to do that successfully.

For the access portfolio to really be comprehensive, those skills should include:

  • working knowledge of call center operations;
  • understanding of charge capture;
  • eligibility and authorization expertise;
  • innovative ideas about point-of-service collection;
  • successful management of the chargemaster.

"The gap between what happens at registration and the bill drop is huge," Duffy says. "What happens before billing is a whole management area that is a no-man’s land. I don’t see a named executive who really understands the consequences of doing this right."

Much of the gap, he suggests, is because registration departments still have the habit of being shift-oriented. "Some [hospitals] don’t return anything to registration for rework, and some return a lot, but build huge inventories, and send incomplete [bills]. The access department has to delete the thought process that completing the shift is the end of its responsibility."

Access managers should become familiar, Duffy says, with initiatives such as the Patient-Friendly Billing Project of the Healthcare Financial Management Association and the American Hospital Association. This effort, he says, is centered on revamping the entire format for communication with patients.

"It’s important for access to know what’s happening, because that’s where patients will bring their bills," Duffy advises. "[Access managers] need to be influential and cognizant. This is a major national initiative, and a good thing for them to know in advance."

Up-and-coming job titles ambitious access managers should be aware of include vice president of revenue cycle management and director of revenue cycle management.

"That job is now paying a premium," he says.

Number of CAH hospitals sees big jump in past year

The number of critical-access hospitals (CAHs) increased 69% in 2001, as struggling rural hospitals identify the program as a means toward financial viability.

The number of CAHs jumped by 211 in 2001 to a total of 526, according to information from the Centers for Medicare and Medicaid Services database. Another 10 hospitals had been designated CAHs by late January 2002.

Nebraska and other Great Plains states continue to lead the nation in number of facilities. Nebraska has 54, followed by Kansas (40), Iowa (32), North Dakota (24), and South Dakota (23). Iowa saw the biggest increase in the number of CAHs in 2001, adding 20. Minnesota and North Dakota each added 14.