Clinicians and access work side by side

Claims denials are prevented

Registrars at Georgia Regents University in Augusta work side by side with utilization review/precertification nurses to prevent claims denials.

“We are located in the same office space. Utilization review nurses are split by services, just like our registrars are,” explains Nikki Taylor, director of patient access services. “This has greatly opened up communication between departments.”

This system allows registrars to convey insurance information for patients with scheduled day surgeries, procedures, and inpatient admissions. At the same time, registrars learn about the specific clinical requirements that are needed.

“Patient access staff have a better understanding of the precertification requirements,” says Taylor. For example, registrars explained that workers compensation may take up to 30 days to approve and obtain precertification, while Medicaid and other commercial payers would require a lesser time frame. Also, Medicare does not require precertification for scheduled service but has procedures that are on an inpatient only-list and would not be covered as outpatient,” adds Taylor.

More than 80 outpatient clinics schedule procedures or surgeries at the facility, with staff divided out by those services. For example, one registrar handles cardiology, catheterizations, cardiothoracic surgery, chemotherapy and surgery oncology patients.

“Dedicated patient access staff are working with the same physicians, residents, and nurses,” says Taylor. “They build very strong relationships with the staff in those clinical offices that are referring the patients in for surgeries.”

Clinicians give insight

Clinicians teach registrars about the medical aspect of the case, which gives insight into why it’s urgent for their work to happen rapidly for the health and well-being of the patient, says Taylor.

“At times, patient access staff see things more technically, as opposed to the personal aspect of the patient,” says Taylor. “They work a lot with insurance companies and scheduling programs. It is important for patient access to remember that the visits are attached to real people.”

In turn, registrars educate clinicians on insurance requirements, timing limits set by insurance companies in obtaining authorizations, and insurance benefits such as coinsurance, deductibles, and copays. “It is important that patient access staff understand what the work they are doing does downstream, and how it affects the rest of the hospital,” says Taylor. Care of a patient being discharged for additional follow-up care at a skilled nursing facility or nursing home could be held up due to invalid insurance issues on registration, for example.

“The information we are placing on our visits does not just benefit the patient for the current visit. It assists the patient in getting care after their hospital stay, as well,” adds Taylor.