Payer auth requirements grow — Keep up to date

Take a proactive approach

With payer requirements becoming more numerous, patient access departments face an ongoing battle to keep staff current.

"Keeping staff apprised is always a challenge," says Catherine M. Pallozzi, CHAM, CCS, director of patient access at Albany (NY) Medical Center Hospital. "We keep a matrix for radiology services requiring pre-authorization on our intranet site, for both patient access and radiology to view."

Other payer requirements are announced via staff meetings and e-mails, she says. "It is an area that we will continue to focus on. Every denial is an opportunity," she says.

Pallozzi says that while she has had a couple of HMOs relax their authorization requirements recently, others have increased the number of services requiring authorization. "Observation status is on the increase in our inpatient population," she notes.

The biggest challenge is keeping all ancillary departments and physicians apprised of the changes, she says. "Quite often, it is the physician's office that additional information is needed from," says Pallozzi. "We do not have a centralized scheduling process, so ensuring that ancillary departments are fulfilling all payer requirements is most critical."

To keep ancillary areas and practices apprised of updates, Pallozzi reaches out directly to the managers with "one-on-one communication." Staff members in patient billing services make a point of sharing any denial or provider fault information with patient access staff, says Pallozzi, "and we do try our best to be pro-active in education."

Training opportunities

Patient access services at University of Utah Health Care in Salt Lake City is seeing an increase in authorization requirements, says Adrienne Pinelle, CHAA, manager of the preauthorization team.

This increase includes procedures and services that previously did not require pre-authorization, as well as additional clinical documentation to demonstrate patients are meeting criteria for certain services, she says. "Our contracting department keeps us up to date when there are new authorization requirements being added during contract renewals," says Pinelle. "We make sure we communicate the new requirements to the authorization team."

Printed and electronic versions of the new requirements are shared via e-mail or discussions in staff meetings, says Pinelle, and she then monitors claims denials for any errors that might have slipped through. "From there, we can determine if it is a training opportunity with the team or if we need to make changes to our processes," says Pinelle.

Sources

For more information on keeping updated with payer requirements, contact:

• Catherine M. Pallozzi, CHAM, CCS, Patient Access, Albany (NY) Medical Center Hospital. Phone: (518) 262-3644. Fax: (518) 262-8206. E-mail: PallozC@mail.amc.edu.

• Adrienne Pinelle, CHAA, Preauthorization Team, Patient Access Services, University of Utah Health Care, Salt Lake City. Phone: (801) 587-6920. Fax: (801) 238-6644. E-mail: Adrienne.Pinelle@hsc.utah.edu.