Has the time come for certification of access representatives?

Other professional organizations already offer certification alternatives

With an increasingly complex skill set required of front-line admitting and registration staff and the heightened pressures of aggressive federal fraud and abuse prevention programs, some leaders in the access field are debating the merits of a certification program for access representatives.

Meanwhile, other health care professional organizations, including the Healthcare Financial Management Association (HFMA) in Washington, DC, and the Chicago-based American Health Information Management Association (AHIMA), offer some role models for front-line worker certification programs. HFMA, in particular, covers several access-related areas in the requirements for its certified health care financial professional (CHFP) credential.

"The issue is how much longer [access employees] will go on as a specialty group without the benefits of certification — not at the manager level but at the worker level," says Jack Duffy, FHFMA, corporate director of patient financial services for ScrippsHealth in San Diego.

The skill set for such a certification could look like that of an accredited records technician (ART), Duffy says, requiring two years of post-high-school training and a similar curriculum. "That would be a very interesting model to look at."

The National Association for Health-care Access Management (NAHAM) in Washington, DC, meanwhile, is exploring certification of front-line workers based on a test of skills acquired on the job or through in-house training programs, says Nancy Farrington, MBA, CHAM, chairwoman of NAHAM’s education committee. NAHAM now offers the certified health care access manager (CHAM) examination for management-level access personnel.

"We have begun exploring. We’re in the rudimentary stages" of certification for front-line workers, says Farrington, who is MPI/CDR administrator for Main Line Health, a health care system based in Wynnewood, PA. "The bottom line is what keeps us from doing anything about it: the time and financial resources needed."

Farrington says she hopes a presentation by a NAHAM member at the organization’s upcoming educational conference will form the basis for a national training program. The session, tentatively titled "An Access Management Associate Training Program," will be presented in May in Phoenix by Mary Rita Jones, MSA, operations manager for patient financial serv-ices at St. Joseph Mercy Health System in Ann Arbor, MI.

The session will describe a training program developed at St. Joseph that has been effective in establishing consistent work processes for associates, according to NAHAM. (See related story, p. 27.)

Enough in common for national standards?

John Woerly, RRA, MSA, CHAM, director of patient intake at St. Vincent Hospitals and Health Services in Indianapolis and a former chairman of NAHAM’s education committee, says previous discussions of a certification process for front-line access employees brought out such concerns as whether certification would add value and lead to an increase in salaries.

And, he adds, "We never could strongly clarify how much interest there truly was out there. Looking at the staff here, they’re extremely committed, but I can’t see any of them going forward with [a certification program]. I think they might be better served with an associate or bachelor degree — that would get them further."

He also questions whether there is enough consistency among the access work processes and requirements at various institutions to make national standards viable. "Each organization is so different," he points out. "There is some common ground, such as medical terms and basic statistics, but [hospitals] all use dif- ferent computer systems, so the training is different."

Depending on the organization, access workers may be cross-trained in many functions, as in one of St. Vincent’s smaller facilities; or more specialized, as in the health system’s larger hospital, Woerly notes.

Customer service above all

Ruth Finkelstein, hospital project manager at the University of Texas Medical Branch in Galveston and a longtime admissions director, says certification is important, but competency can be obtained without it.

"Certification certainly gives the position more credibility, and if it became a requirement, it would make the market more competitive," Finkelstein says. "More important, though, than the competency and know-how to register a patient are core customer service values. I would hate to see a person hired because he or she was technically competent but lacked interpersonal skills."

And certification doesn’t ensure competency, she adds. "It usually only means that the individual passed certain criteria."

Mastering the profession

Other organizations for health care professionals have taken the lead in offering certification for front-line workers. Along with its RRA (registered record administrator) and ART certifications, which have educational requirements, AHIMA also offers two "mastery level" certifi-cations, explains Belinda Brunner, director of certification.

Traditionally, the examinations for these — certified coding specialist (CCS) and certified coding specialist, physician-based (CCS-P) — are taken by people who have worked in the medical records field for a considerable period of time.

AHIMA contracts with a professional testing service to administer the exams annually, at a cost of $220 for AHIMA members and $250 for nonmembers, she says.

Although traditionally there has been little, if any, overlap between the access and health information management fields, those boundaries appear to be blurring. Access reps who find that coding has become a big part of their jobs might want to consider obtaining this credential, Brunner notes. The next testing date is Sept. 12.

"There are two main benefits of certification," she says. "It provides a baseline of quality and skills, and the second thing is the job opportunity angle. It provides a recognition of those skills to the potential employer."

A lot of crossover potential

A description of HFMA’s CHFP credential suggests even more crossover potential for access personnel. Those seeking this certification can select a "focus" in a variety of areas, such as managed care, patient financial services, or accounting and finance, explains Richard L. Gundling, FHFMA, CMA, technical director for HFMA.

Topics covered in the exam, for which people can prepare with various study materials including a computerized self-study program, are charity care guidelines, admitting practices, and financial counseling, among others, Gundling says. "It’s real hands-on material."

The CHFP credential also can be a steppingstone to a higher HFMA certification, FHFMA (fellow of the Healthcare Financial Management Association), Gundling notes.

Information and an application for CHFP certification are available through the organization’s fax service at (800) 839-4362.

[For more information on the American Health Information Management Association and its certi-fication programs, call (312) 787-2672 or write AHIMA, 919 N. Michigan Ave., Suite 1400, Chicago, IL 60611-1683. Or visit AHIMA’s World Wide Web site at http://www.ahima.org.

If you’d like to enter the debate on certification for access reps, call editor Lila Moore at (404) 636-9264. E-mail: lilamoore@mindspring.com. Or call associate managing editor Hannah Kamenetsky at (404) 262-5509. E-mail hannah_kamenetsky@medec.com. Or fax your comments to (404) 262-7837.]