Rounding means payer requirements are met

Staff get their questions answered

Patient access staff often overlook or misinterpret payer requirements, which can cost the hospital thousands of dollars. Yet keeping staff current with all the various rules is a full-time job in itself.

"Keeping up with payer requirements is a daily challenge," says Gayle Dickerson, patient access director at Baptist Hospital East.

Part of the problem is that many companies change precertification and notification procedures within a contract period. "They also write contracts to be employer-specific, so even with the same payer, the rules may be different depending on the employer's wishes," says Dickerson.

To address this problem, patient access managers now do regular rounds to answer the questions of employees in the emergency department, ambulatory surgery, outpatient surgery, radiology, and endoscopy. "We visit each work area where we have registration staff and talk about the issues of the day," says Vicki Lyons, the hospital's patient access manager.

For example, staff might have process questions related to a particular insurance or need answers to questions raised by patients. "One question related to signatures in Medicare's Important Message and how to obtain acknowledgement of receipt if the patient was unable to sign," says Lyons.

Rounding also is a chance to give staff tips on customer service and patient interactions. "Many patients are in highly stressful physical conditions on entry into the hospital. Remaining calm while acquiring all the necessary information for care, treatment, and billing is important," says Lyons.

Here is what a patient access trainer does

Below is a description of the responsibilities of a full-time patient access trainer position at Baptist Hospital East:

Job Summary: Provides registration training specific to each staff member's duties in all registration areas and responsible for auditing all staff performance to ensure competency in the registration process. Will share feedback with appropriate managers regarding additional training needs as well as conduct the additional training.

Principal duties and responsibilities:

  • Demonstrates working knowledge of daily/weekly/monthly reports.
  • Develops and reinforces ongoing competency with staff, utilizing results of tracking.
  • MSP.
  • Insurance.
  • COB issues.
  • Guarantor.
  • Maintains database for tracking staff competency.
  • Presents at least one in-service quarterly related to areas of high financial impact or high error volume causing patient dissatisfaction or billing errors/rework.
  • Develops training manual and keep updated with system upgrades.
  • Develops orientation schedules and precept new employees for all registration areas in hospital.
  • Assists with data collection for registration function.
  • Assists with project development as directed by management.
  • Ongoing auditing of registration outcomes to develop process improvement recommenda- tions (monthly – rotate schedule by department).
  • Flexibility in shift worked to accomplish training.

In addition to rounding, patient access at Baptist has made these changes:

  • A formal trainer was hired.

This is a full-time position responsible for both the initial training process and ongoing updates given to patient access staff.

"The trainer is an experienced full-time staff member who also has good interactive skills," says Dickerson. Staff are taught using scenarios with fictitious patients, such as labor and delivery patients and Medicare patients who require additional completion of the MSP form.

Staff are taught how to use the computer system for registration, and how to use other resources built into the system, the differences in inpatient vs. outpatient registration, understanding insurance plans and codes, and how to read insurance cards.

"Updates are given whenever there are changes to any of the above, new plans added by managed care in contracting or plans termed," says Dickerson. "Our goal is for claims to be clean, so electronic submission is fast and accurate."

Since patient access staff also are responsible for up-front collections, the staff are taught how to explain co-pays and deductibles, and how to take payments by phone through the automated payment processing system.

  • Payer-specific requirements are kept online through the hospital's intranet, so they are always available for staff reference.

"We have a staff member who is responsible for keeping the intranet resource up to date," says Dickerson. "Payers have newsletters and regular transmittals to the hospital, which are reviewed and updated on the intranet."

  • Edits are placed within the hospital's information systems.

These flag cases that may represent errors in staff interpretation of guidelines to allow both correction prior to billing and ongoing staff education. For example, a policy number might be missing or incorrect, or an out-of-state Blue Cross plan might have been entered incorrectly. "Sometimes if it is a miscellaneous insurance, the insurance address will be left off. These are all opportunities to correct billing," says Lyons.

[For more information, contact:

  • Gayle Dickerson, patient access director, Baptist Hospital East, 4000 Kresge Way, Louisville, KY 40207. E-mail: Gdickerson@BHSI.com.
  • Vicki Lyons, patient access manager, Baptist Hospital East, 4000 Kresge Way, Louisville, KY 40207. Phone: (502) 897-8159. E-mail: Vlyons@BHSI.com.]