Lunch and learns educate providers
Patient access can clear up misconceptions
Staff members at provider offices often think, wrongly, that the hospital is responsible for obtaining or denying authorizations.
"They also believe that our department is somehow less mission-driven toward patient care," says Michael Prazniak, assistant director of pre-access, patient access, and patient financial services operations at Florida Hospital in Orlando.
Prazniak and other patient access leaders use "lunch and learn" meetings to educate physicians and their office staff on benefits, how a patient’s out-of-pocket expenses are estimated, and the authorization process. The meetings usually begin with a discussion on the increase in peer-to-peer reviews being mandated by payers and how payers are questioning the clinical justification of physician orders.
"Office staff typically ask what clinical information needs to be provided to the payer to best support medical necessity, such as accurate CPT or procedure codes," says Prazniak.
Patient access are able to explain their role in the care of the patient. "By diligently following up on authorization to avoid denials, we free the patient to concentrate on the clinical aspects of their stay and not the financial ones," says Prazniak.
Variety of formats
The "lunch and learns" are done in a variety of ways. In some cases, a catered lunch is provided at an informal gathering. At times, patient access leaders go to an individual provider’s office, but the meeting is usually held at a hospital-owned medical plaza that houses many physician offices, with various physicians and office staff members coming and going during a two-hour time frame.
Patient access leaders address questions or concerns about the benefits, authorization, and estimation process. "We meet with one group of people at a time, as determined by who is present at any given moment," says Prazniak. "Since groups come and go in the open house forum, we may answer the same questions a number of times."
Another format is a roundtable discussion, with lunch provided by patient access. "These tend to be under an hour and are more focused," says Prazniak. "At times, physicians are present; other times we host a discussion with the office staff."
Patient access recently met with a dozen office coordinators and physician assistants from a large oncology group. "There was quite a bit of lively discussion around denials, as well as sharing of information — not only between us and them, but also between each other — on how best to obtain authorizations," says Prazniak.
Teamwork is needed
In some cases, a patient’s chart doesn’t have enough information to prove medical necessity, warns Aaron Robison, CHAA, a patient financial advocate at University of Utah Health Care in Salt Lake City.
"Insurance companies are basically blurring the lines between patient access and clinical care," he says. "We need to work as one team to get services and tests covered for our patients."
Robison works closely with clinical coordinators and nurses, because ordering physicians are rarely available to answer questions.
"This helps immensely," he says. "They can find missing clinical items, or give me more information as to why a particular scan is being ordered instead of a different one."