Sometimes, clinical areas disregard patient access when making changes to policies, procedures, or protocols — until trouble starts.
Peter Kraus, CHAM, CPAR, FHAM, a business analyst for revenue cycle operations at Emory Healthcare in Atlanta, collaborates with clinical areas on projects involving new locations, billing protocols, and report generation. “As with many departments, clinical areas sometimes are unaware of the impact of their operations, policies, and procedures on downstream,” Kraus notes, offering two recent examples:
- Clinical areas tested changes to their automated systems without informing patient access.
Clinical systems are updated routinely, which may include new locations or internal fixes that require the registration of test patients.
“Clinical staff may neglect to tell ancillary systems, including those used by patient access and patient accounting, that they’ve been testing,” Kraus says. Clinicians also may fail to use test naming conventions that help identify test patients. This populates not only the clinical systems but also the Admission/Discharge/Transfer and financial systems with bogus patients.
“These become identifiable only after they cause much confusion and extra investigation, not to mention skewing statistics,” Kraus notes. These skewed statistics can include census figures, posted charges, or even billed charges if the account slips by the medical records department and is coded. Bogus test patients can affect productivity reporting.
“In fact, test accounts can qualify for all sorts of internal reporting, depending on the nature of testing,” Kraus adds.
- When patient-accessible units are renovated or expanded, departments submit their requirements to a central, information services-led team, leaving patient access uninformed.
The team evaluates and updates all the various interfaced online systems that potentially are affected by test accounts in production. This includes clinical systems, registration, billing, collecting, medical records, and financial systems.
“Much later in the project, they will announce big changes, often already implemented, that inconvenience everyone,” Kraus says.
This has been especially challenging when nursing units are added or expanded. Typically, these teams submit a list of new locations and room numbers to be built into hospital systems for ordering and reporting purposes.
“They then change everything physically before letting everyone know that systems must be rebuilt,” Kraus says. When locations or room numbers change at the last minute, the original additions can be inactivated. “But the extra time and work involved can be significant,” Kraus adds.
At Emory, the revenue cycle operations department holds a biweekly meeting to discuss the status of outstanding issues, projects, and system updates. In recent months, nursing and department system managers have been included. “We have become acutely aware of how interdependent we are,” Kraus says.
Familiarity with work processes is necessary, but so is camaraderie. “Equally or perhaps more important is friendship and familiarity,” Kraus offers. Staff who know and respect each other tend to be more considerate about how planned changes will affect other departments. It turns out that friendship is a satisfaction-booster for patients, too. “Patients pick up on the positive vibes, which enhances their experience,” Kraus adds.
Tension fades quickly if patient access “come up with the goods” in terms of must-have information. “I enjoy cordial relations with a number of departments because I supply them with reports containing data they struggle to obtain from other sources,” Kraus explains. Some particularly coveted data include information on missing precertification numbers and other prerequisites for admission, patients who qualify for the Two-Midnight Rule, statistics on observation patients, the number and cost of avoidable denials, and statistics on patients treated by specific physicians or groups of physicians (such as insurance coverage information).
Obviously, there can be a fine line between helpful collaboration and taking advantage of someone. “But, generally, the benefits outweigh the extra effort expended,” Kraus says. Surprisingly often, patient access responsibilities still are viewed as unimportant clerical work that requires little to no skill. “It’s seen as annoying to patients and time-consuming,” says Carol Venson, financial counseling manager for Novant Health. This is painfully evident when clinicians sometimes remark, “Is all of this really necessary?”
To build mutually beneficial relationships, Venson says clinical leaders observe patient access by shadowing them for a short period. During this time, patient access employees tell clinicians about particularly difficult (and even dangerous) registrations. Examples include duplicate medical record numbers, unconscious patients, and patients trying to use false identities to claim someone else’s medical coverage.
Patient access employees explain the “how and why” of insurance verification. They show clinicians how complex benefits are explained to patients. Clinicians can see collection totals and how those affect the hospital’s operations. Also, patient access shares statistical data on noncompliance after the fact. After these sessions, clinicians often are shocked by how often registrars are unable to obtain basic insurance or demographic information at a later date.
“We share nightmares associated with patient access not being present or obtaining incorrect information,” Venson says. These worst-case scenarios include the inability to bill for services.
But patient safety is a very real concern. Without registration, clinicians are unable to chart on a patient or dispense medication.
“If information is not accurate, there is a risk of misdiagnosis or dispensing medication patients may be allergic to,” Venson says.