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Revamped role to mean fewer denials
At Valley Health System in Ridgewood, NJ, two major goals are to obtain more authorizations and to do them in advance of the inpatient stay or procedure, says Maura Corvino, MSOL, RN, CEN, assistant vice president for emergency services and patient access.
A new Patient Access Center will help with both of these goals by centralizing Valley Health's registration, Corvino reports. "We have initiated some new software and reallocated resources," she says. "We expect to get a very low error rate and a very good return on investment."
While registration was decentralized almost two decades ago to make registration more convenient for patients, this decentralization no longer made sense as the patient access role expanded says Susan Sigler, supervisor of Valley Health System's patient access center. "The kind of work that was being added to the job of the business associates was quite varied and very unfocused," Sigler says. The business associates perform a wide variety of tasks, only one of which is registration, she explains.
"The business associates wear many hats," says Sigler. "Whenever there was a new responsibility that did not fit cleanly into another role, it was absorbed by the business associates on the individual units."
While that served all the individual units very well, says Sigler, it made it challenging for the individual business associates to maintain the quality of their registrations. Errors occurred that resulted in inaccurate billing, she explains. "This led to more back office work to correct and edit, and the need for re-billing," Sigler says. "It ultimately decreased patient satisfaction, as they dealt with both the insurance company and the hospital billing office to rectify the inaccurate bill."
While endoscopy, the emergency department, and diagnostic imaging were high in registrations per business associate, the volume of registrations per business associate was low in some units, says Sigler. Because those employees did registrations only rarely, they had trouble keeping up with all of the different payer requirements, she explains.
"It became a real challenge to provide that education in a manner that didn't disrupt the rest of their duties," she says.
Corvino says that by having patient access staff pre-register patients with scheduled procedures and obtain authorizations, "everybody there is an expert in these work activities. They are marching through a systematic process of validating and checking."
Now, members of the patient access staff "huddle" each day to talk about the next day's cases with staff from the patient care areas.
"We make sure that we are crystal clear that everybody's covered," says Corvino. "If we do all this work upfront, we won't be talking over the patient on the stretcher about the authorization that we didn't get. We'll be focused on their care."