Use training to stop costly payer pitfalls

Payer requirements are the single most challenging area in training of patient access staff, according to Colette Lasack, MBA, executive director of revenue cycle at Gundersen Lutheran Health System in La Crosse, WI.

"As this industry gets more complex, rules are changing daily," Lasack says. "You go on vacation for a week and everything changes." Here are some approaches used by the department:

• An internal web site is made available to front- and back-end staff, and it is updated continually.

"This becomes one source of truth and keeps people connected across the revenue cycle," says Lasack. "We have committed to this as a team. If we are going to distribute something, we use that web site."

Likewise, says Lasack, staff members commit to checking it every day for updates. "It is definitely our expectation that if you work in this department, you go to this web site routinely," she says.

• Staff meetings are taped and streamed online so all staff members can attend virtually.

Penny Schubert, a manager in patient business services at Gundersen Lutheran, says, "This is a huge cost-saving tool. You are not having to pay them extra hours to come in and attend those meetings." This process saves about $7220 annually, Schubert says.

At Augusta Health in Fishersville, VA, members of the registration staff are instructed to perform daily checks of the patient access page on the hospital's web portal, which includes all policies and procedures, updates, and announcements, says Beth Hall Wiseman, CHAM, director of patient access.

Wiseman says her biggest training challenges are insurance plan contracts and their medical management policies, and which insurance mnemonic to choose. "We are currently overhauling our insurance dictionary, to make it more user-friendly," she adds. "We are building rules to help the registrar choose the correct mnemonic."

At BayCare Health System in Clearwater, FL, when automation isn't an option, payer updates are communicated via e-mails, the Intranet, and team meetings, says Kandy Swanson, CHAM, manager of patient access services.

Patient access managers have worked hard to develop a relationship with the hospital managed care department, with monthly meetings. "Our suggestions to managed care have been put to good use," says Swanson. For example, letters from payers are obtained with information regarding the patient's estimated financial responsibility. "If a patient has questions relating to their responsibility, we can provide them with a copy of the letter from their insurance company," Swanson says.

Also, new denial codes were added to the database for local and national coverage determination and line-item denials for when an insurance company pays for an ED visit, but denies other services provided during the ED visit. "We also added a denial code for no authorization when the insurance company was closed, on a holiday, for example," says Swanson.

Sources

For more information on updating staff on payer requirements, contact:

• Colette Lasack, MBA, Executive Director, Revenue Cycle, Gundersen Lutheran Health System, La Crosse, WI. Phone (608) 775-4370. Fax (608) 775-1033. E-mail: CMLasack@gundluth.org.

• Kandy Swanson, CHAM, Manager, Patient Access Services, BayCare Health System, Clearwater, FL. Phone: (727) 461-8030. Fax: (813) 635-2590. E-mail: kandy.swanson@baycare.org.

• Beth Hall Wiseman, CHAM, Director, Patient Access, Augusta Health, Fishersville, VA. Phone: (540) 332-4626. Fax: (540) 332-4665. E-mail: BWiseman@AugustaHealth.com.