Make your job easier by surfing the Internet

Wealth of resources available to access managers

If you’ve dismissed the Internet as an entertaining diversion for people with time to burn, think again. It also offers a wealth of information that can make you a more savvy and productive access manager.

The latest Medicare regulations, the fees other hospitals charge for outpatient services, and feedback from colleagues on your latest staff crisis are just a few of the resources at your command when you begin surfing the Net, says Leonard Womack, CPC-H, manager of revenue management for ScrippsHealth in San Diego.

"There are an incredible number of sources that are helpful for almost anyone, Womack says. While searching the Internet on a recent evening for information on productivity management systems for hospitals, for example, he found three position papers and 10 companies offering their services. "It’s like a national Yellow Pages for software, consulting functions, etc.," he says.

Need information on Medicare coverage? Check the Health Care Financing Administration Web site at http://www.hcfa.gov, from which you can download Medicare and Medicaid manuals into your own computer or cut and paste excerpts into a document you’re preparing. You can run a search of the coverage issues manual and type in "thermography," for example, to see if it’s covered. (It’s not.)

"During the registration process, if a patient is receiving a noncovered service, [the patient] needs to get advance notice of nonbenefits," Womack points out. "If you provide a service that’s not covered [without informing the patient in advance] and you should have known — and Medicare considers that if it’s in the manual you should have known — then the patient has no responsibility to pay.

"It’s surprising how many people know these manuals exist but don’t have a copy," he notes.

ScrippsHealth’s Medicare intermediary, Blue Cross of California, has its own Web site, which provides all Medicare bulletins and notices issued over the past 18 months, Womack says. Sometimes the information is available on the Web site before it’s sent to providers. "The other night, I found out that Medicare no longer requires pacemaker registry information, like the serial number, when [the hospital] bills for a pacemaker," he says.

On another evening, Womack downloaded Med Par (Medicare provider) data showing, by diagnosis-related groups (DRGs), all the services that Medicare paid for last year throughout the country. That includes total patient payments, length of stay figures, and the numbers of patients admitted for every DRG. "When you’re doing a trending analysis, asking, ‘Where does my facility fit into the national average?’ this is information it’s good to have," he adds.

Womack also has downloaded resource-based relative value system–relative value unit information (RBRVS-RVU), which is the basis of all Medicare outpatient payments since 1991. "This is helpful in evaluating your own charge structures and in negotiating contracts on behalf of your facility with other vendors," he points out. "Instead of having to create my own spreadsheets, I now have on disks 16,000 line items."

One of the most common applications of RBRVS-RVU information is for adding new services, Womack explains. "One of the biggest questions is, ‘What should we charge for this?’ By using this information, every CPT code in the system has an RVU [RBRVS-RVU] value. If you take an existing charge, identify its CPT code and corresponding RVU value and divide that value into the charge, you will have the charge per RVU. Then multiply that amount by the RVU for the CPT code associated with your new charge. This will result in a consistent charging mechanism for new services."

With access managers in mind, Womack randomly checked some Web sites. He found that Blue Cross Blue Shield of Delaware, the Medicare provider for that state, has an on-line provider inquiry at its site (http://www.bcbsde.com/ prov.htm). "You can download forms you might need for your business, and [Delaware providers] can query their system as to the payment status for patient accounts." It’s worth checking, he suggests, to see if your state’s provider offers a similar service.

The Oklahoma Hospital Association, Womack discovered, has a great Web page with several interesting links — to the magazine Modern Healthcare News Today, the Agency for Health Care Policy and Research, the American Hospital Association, the American Medical Association, and the Joint Commission on Accreditation of Healthcare Organizations, to name a few. It even provides a link to the Federal Register, a source of proposed and adopted federal legislation, he notes.

One of the most effective uses of the Internet for a health care organization is in marketing, Womack says, noting that ScrippsHealth, like most large medical entities, has its own Web site. With their expertise and involvement in information systems, access managers are a logical choice to become involved in these endeavors, he suggests.

Two-way communication over the Internet is another valuable resource, says Womack, who uses e-mail to help manage his own outside consulting business. Searching for Internet news groups, using key phrases such as "access management," access managers may find colleagues across the country who can offer help and feedback on various work-related issues, he adds.

"I encourage anybody to look, and if they don’t find anything, to start their own discussions," Womack says. "There are a lot of news groups out there where you start with a question and people start responding. Remember that you’re hidden behind the computer, and don’t be afraid to try."