Revamp process for admission notification

Denials down to 0.08% from .68%

If a patient is admitted on a holiday or after normal business hours and registrars are unable to notify the payer until the next business day, the claim could be denied for late notification, warns Jeanette Foulk, director of patient access at Methodist Charlton Medical Center in Dallas.

“Our 2012 fiscal year denial rate due to authorizations/notification denials is currently at 0.08%, down from .68% in fiscal year 2010. This is a significant amount of money,” she says. These steps are taken by patient access staff to ensure timely notification of admissions:

1. Every day, a registration representative runs a census from the hospital’s registration system.

“This logs all of the previous day admissions and the insurances that were listed at time of registration,” says Foulk.

2. The reports and demographic sheets for those patients are separated and delivered to financial counselors who handle that insurance carrier.

“We routinely have high volumes. This makes it unrealistic for the registration rep to also try to obtain an authorization at point of registration,” Foulk explains. “Each financial counselor will work the report, noting completion of each patient account.”

3. Throughout the day, the financial counselor runs a same-day admission report for payers requiring same-day notification.

“We have seen a major increase in our Medicaid HMOs — which is a significant portion of our patient population — requiring same-day notification, along with several commercial payers,” reports Foulk.

The same-day report was added because the department was seeing a surge in denials for same-day admissions due to lack of notification, says Foulk. The report is “essentially an hour-by-hour census,” she says.

For patients admitted from the emergency department, staff often have trouble obtaining accurate insurance information at the time of admission, which means the patient’s coverage can’t be verified as active until later on, says Foulk.

“We may rely on a family member to provide us what is needed, which may not be within 24 hours,” she says. (See related story on new authorization requirements for procedures, above right.)

Sources

For more information on notifying payers of admission, contact:

Jeanette Foulk, Director of Patient Access, Methodist Charlton Medical Center, Dallas. Phone: (214) 947-7560. Fax: (214) 947-7566. Email: JeanetteFoulk@mhd.com.