Access rises from data entry clerk to major player in revenue cycle

Expanded role means growing opportunities

Typewriters were the only way to record a patient's information when Vicki Sanseverino began working as an "admit representative" at St. Elizabeth Community Hospital in Red Bluff, CA, in 1983, as there was no computer system in place at the time.

The hospital's patients received services after giving just their name, address, phone, date of birth, social security number, and emergency contacts.

"A form was used with carbon paper while typing, generating a chart," recalls Sanseverino, now the hospital's admissions manager and patient financial services liaison. "A blue card was handmade with the patient's information in a sequential number on the form."

This number became the patient's account number, with staff hand writing information in a log book for tracking purposes. "Our primary responsibility was to get information from the patients or family as quickly as possible and ask them to sign for consent," says Sanseverino.

The admit representatives created the paperwork for charging for other departments completing tests or services, which generated a bill.

At University of California — Davis Medical Center Hospital, a "check-in clerks" recorded only minimal information about patients using a typewriter, such as name and date of birth, and photocopied insurance cards. They would ask the patients to sign admission documents, and they filed these in a file cabinet.

"The access rep's role was limited to that of receptionist, confirming limited patient information, and obtaining signatures on the admission documents," says Tracy Abdalla, hospital access services supervisor.

In the emergency department, the access role overlapped with the hospital unit clerk's role. "The hospital unit clerk not only completed the 'check in' of the patient but was also responsible for transcribing medical orders and completing the necessary requisitions for lab or radiology tests," Abdalla explains.

There were no computers in use when Katie M. Davis, CAM, became admissions officer at an orthopedic specialty facility in 1985, and all registrations were typed on a triple carbon form. The registrar completed the registration, verified the insurance benefits, and called the insurance company for an authorization. If the patient could not pay their co-pay or deductible, a payment plan was set up based on the full amount owed.

"All of the training received was on the job," says Davis, now assistant vice president of corporate patient access at Carolinas HealthCare System in Charlotte, NC. "There were no specific training classes for registrars."

A typical day would include working on pre-registrations for upcoming surgeries, says Davis, and every day a different person was assigned to make bed assignments for patients being admitted. One person was responsible for taking calls from the physician's office and logging in upcoming surgeries on a paper form.

"We were expected to be able to work in any area when needed," says Davis. "We also relieved the switchboard for lunch and supper."

Much info gathering

Today's access staff members are required to obtain and input a multitude of information, to ensure claims are paid and state and federal requirements are complied with. They're also required to provide patient education and give handouts on consent of admissions and treatment, advance directives, notice of privacy, charity and discount policies, and patient rights and responsibilities, notes Sanseverino.

Registrars scan all documents, photo identifications and insurance cards, verify eligibility, and obtain authorizations, says Sanseverino. Access staff also collect at the point of service, discuss the patient's responsibility and their ability to pay, and screen patients for assistance. "We generate the paperwork for a chart or face sheets with labels and arm bands for patients, while adhering to registration and wait time goals," she says. "We do all this with speed and accuracy, and provide high-quality customer service at all times."

At one time, registrars were expected to obtain only the patient's insurance information so the claim could be billed, says Lauree M. Miller, director of patient access at Catholic Health Initiatives in Lincoln, NE. Now, staff collect demographic information, verify insurance eligibility, audit for Medicare as Secondary Payer, and obtain occurrence codes. "We are doing much more information gathering. Accuracy has become significantly more important," Miller says. "It's almost like the back end has slipped across to the front end."

Because patient access is being scrutinized more by billing areas regarding registration accuracy, staff members are doing more verification of insurances and addresses upfront. "We are working more on getting good data from the get-go. We no longer wait until the claim gets denied or we can't get an address," Miller says.

All of these developments mean new opportunities for growth in the patient access field. "It has evolved from a data entry position into a more professional career," says Miller. "A strong thought process is needed in terms of creating account numbers and fixing things such as statuses. We are really getting the medical record started."

Included at table

Miller says patient access is more often included in multidisciplinary teams, such as the newly formed Patient Access Steering Committee she leads. "Patient access is invited to the table a little bit more than in the past," she says. "We need to raise our hand to provide input."

Radiology throughput was the committee's first initiative, and the team is now focusing on short stay surgery throughput. "One of the things we've done is a 'walk in my shoes' program," Miller says. "Sometimes, we don't have a good appreciation for the importance of each others' work."


For more information on the changing role of patient access, contact:

• Tracy Abdalla, Hospital Access Services Supervisor, University of California -- Davis Medical Center Hospital. Phone: (916) 734-3282. Fax: (916) 734-0550. E-mail:

• Katie M. Davis, CAM, Assistant Vice President, Corporate Patient Access, Carolinas HealthCare System, Charlotte, NC. Phone: (704) 512.7181. Fax: (704) 512-4586. E-mail:

• Lauree M. Miller, Director, Patient Access, Catholic Health Initiatives, Lincoln, NE. Phone: (402) 219-5488. Fax: (402) 219-8008. E-mail:

• Vicki Sanseverino, Admissions Manager/Patient Financial Services Liaison, St. Elizabeth Community Hospital, Red Bluff, CA. Phone: (530) 529-8065. Fax: (530) 242-5419. E-mail: