Top revenue cycle position is a realistic goal for access directors

'It doesn't have to be someone on the back end'

Raising the value of patient access professionals throughout the health care industry continues to be a major focus of the National Association for Healthcare Access Management (NAHAM), says new President Julie Johnson, CHAM, director of health information management for Mt. Graham Regional Medical Center in Safford, AZ.

Johnson assumed her position at the organization's annual conference in May.

Related priorities are enhancing patient access educational opportunities and promoting access professionals as viable candidates for top revenue cycle positions, Johnson adds. Along that line, she notes, NAHAM is finalizing an improved certification process that includes new examinations for its certified healthcare access manager (CHAM) and certified healthcare access associate (CHAA) designations.

Despite much lip service throughout the industry regarding the importance of patient access, Johnson continues, access employees typically are still paid less than their business office counterparts, even though they are expected to perform a wider range of duties.

"They really have to do more upfront, because in addition to being pre-billers and collectors and a huge part of the revenue cycle, they also have to have customer service skills," she adds.

While Johnson is now director of health information management, she previously has held the positions of director of revenue management and vice president of revenue management.

Those career advancements, she says, "came from promoting a can-do attitude" and emphasizing that "it doesn't have to be someone on the back end" overseeing the revenue cycle.

She recently scaled back her work commitment to allow more travel time to be supportive of sons who are professional baseball players.

As NAHAM vice president, Johnson says, she was charged with recruiting vendors to serve as "business partners" with the organization. During those conversations, she notes, she took the opportunity to encourage them to consider patient access when developing and marketing revenue cycle products.

In many cases, she notes, vendors are coming forward with software that benefits the front end — such as automated guidance built into the registration process — and marketing it to back-end directors who don't always recognize the need.

"I feel like they need to promote [these innovations] in patient access," Johnson says. "There are a lot of [facilities] where they know that patient access is important, but many processes are still manual. [Vendors] need to be sending information to patient access directors."

Training programs offered by these companies, she adds, are "almost always" designed from the back-end perspective and don't fully encompass patient access processes.

To promote access education in her own arena, Johnson says, she is talking with the president of a local two-year college about developing some sort of access-related curriculum "so we can grow our own" qualified patient access staff members.

The idea is to create an associate's degree in the field, she adds, noting that there is growing interest in the CHAA and CHAM process among such colleges.

Transition to MACs under way

A recent regulatory event that affects patient access is the change from fiscal intermediaries (FI) to Medicare administrative contractors (MACs). Johnson points out.

It is the result of a Medicare contracting reform that was established as part of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

Johnson's hospital happens to be in the first jurisdiction — which includes Arizona, North Dakota, South Dakota, Montana, Utah, and Wyoming — where the FI was taken away and the MAC took over, she says.

"That's been a nightmare for all of us," Johnson says. The transition will be done in phases, she notes, and is to be completed by October 2009.

Keeping in mind the need to embrace technology and strengthen the revenue cycle through improving front-end quality, she says, the agenda for the 2008 NAHAM conference included sessions covering the following topics:

  • pre-service or pre-processing departments, with an eye on improving data entry;
  • why employees must be part of the technology selection process;
  • tablet-based electronic consent and charting;
  • keeping a balanced scorecard (evaluating work performance);
  • going from mediocre to synergetic;
  • automated registration QA: What's next?;
  • denial management technology;
  • using work lists on the web.

[Editor's note: Julie Johnson may be reached at]