Did Payer Coverage Change? Communicate to Patient Access Quickly
EXECUTIVE SUMMARY
Updating patient access employees on payer coverage changes is a top challenge for patient access leaders. Below are some strategies to try.
- Make topics covered during “lunch and learn” sessions available for registrars unable to attend in person.
- Meet with individual employees for 15 minutes to answer questions.
- Use “hard stops” to clear up confusion.
Keeping the entire department apprised of payer coverage changes has become overwhelming for many patient access leaders.
“It is always challenging to stay ahead of these changes in time to get proper notification out to the end users,” says Kaniesha Mason, CHAM, associate director of patient access services at Syracuse, NY-based Upstate University Hospital.
It is not always possible to pull all employees from their registration locations for classroom setting training. The department also struggles to train both centralized and decentralized registration staff.
“Since not all registrars work for patient access services, it can be challenging to hold all staff equally accountable for thorough registrations,” Mason explains. The department uses the following strategies described below.
- A registration-related article is included in the monthly departmental newsletter.
“This is reviewed at staff meetings,” says Mason.
- Employees regularly meet for 15 minutes with a supervisor.
“This provides an opportunity for staff to ask questions or demonstrate proficiency on any topic,” says Mason.
- The department hires cross-trained staff to cover both emergency departments and central registration sites.
“We are able to share staff during peak times and schedule more end users for face-to-face training,” says Mason.
- “Lunch and learn” sessions explain new processes or clarify existing processes.
Even if registrars can’t attend in-person, they can still get the information. “The sessions are posted as mandatory training, with a short proficiency exam to test their knowledge,” says Mason.
Performance improvement manager Brenda Passardi, CHAM, hosts the monthly lunch and learns. The sessions are held at different times and at different facilities to accommodate all staff regardless of shift or location. “We select topics that serve as a mini-training session for work flows that need additional attention,” says Passardi.
Recent sessions have covered verbal consents, sexual assault work flows, insurance review, assigning no-fault insurance, registering a foster child, and insurance websites. Another session used a role-playing scenario to show staff how to conduct a patient interview properly. “We went through a demo of a bad interview session, and then covered a proper one explaining why we need to ask for certain items and what could happen if we miss capturing these items,” says Passardi.
This particular lunch and learn targeted a common mistake in the department. Registrars don’t always ask for all insurance, when a patient presents. “We can never assume anything. We should always ask,” says Passardi. “These errors can hold up a bill from going out, or can generate a denial.”
Avoid Future Denials
Often, a change in payer coverage is discovered too late — only after a denial is received. “Once identified, quick communication is needed to avoid future denials, which can be costly,” says Susan O’Brien, director of patient access at Advocate Good Samaritan Hospital in Downers Grove, IL.
The department is seeing more frequent changes from payers. No coverage can be taken for granted. “You can no longer predict what services will be covered and which will be denied,” says O’Brien.
O’Brien uses a wide variety of communication tools to “ensure the change being communicated is hardwired.”
These include email, rounding during shift changes, departmental newsletters, and online training tutorials. “We also create ‘hard stops’ throughout the day, to answer any questions the associates may have,” says O’Brien.
Patient access employees are encouraged to ask questions. “Having a questioning attitude allows them to be confident they understand the change,” says O’Brien.
Ensuring that all registration areas, both centralized and decentralized, receive a consistent message can be difficult. “Knowing the most effective communication tool for your audience is critical to ensuring the change is understood effectively,” says O’Brien.
SOURCES
- Kaniesha Mason, CHAM, Associate Director, Patient Access Services, Upstate University Hospital, Syracuse, NY. Phone: (315) 464-9367. Fax: fax: 315-464-4005 Email: [email protected].
- Brenda Passardi, CHAM, Performance Improvement Manager, Upstate University Hospital, Syracuse, NY. Phone: (315) 464-5043. Fax: (315) 464-5115. Email: [email protected].
Updating patient access employees on payer coverage changes is a top challenge for patient access leaders.
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