Access Management Quarterly
Provide education on new access role
Invite others to observe staff
Many hospital associates believe that registration staff simply sit at their desk and greet patients, reports Barbara Blum, director of access, admitting, and registration at MedStar Health in Columbia, MD. "They have no idea what the registration staff's responsibilities include," Blum says.
Other departments might not realize that registration is a big part of the hospital's revenue cycle, for example, or that staff work with more than 100 insurance plans. "A goal is to verify upfront that the insurance is active. This allows a clean bill," says Blum. "Registration is a big part of upfront collections. If not collected upfront, it can result in bad debt."
Staff members in other hospital areas don't acknowledge the work of patient access because it's not understood, says Blum, but they are quick to blame access staff for mistakes they didn't make. "If there are any problems — incorrect labeling, an incorrect name in other systems, or delays in patient care — the assumption it is a registration error," says Blum. "This results in poor employee satisfaction and morale."
Blum says staff in other areas might offer to help when the registration system goes down with the attitude, "What could be so hard? Your staff are just clerks." To this, Blum responds, "It is not clerical data entry. You would need knowledge of insurance and the registration system."
Blum recommends giving a short presentation at a monthly manager's meeting on one of these topics:
- data captured on upfront copay collection for self-pay patients;
- your department's progress toward a goal of completing a registration within a certain number of minutes;
- the number of patients registered in an hour;
- claims denials due to lack of authorizations.
Blum suggests inviting managers to spend some time in the emergency department or outpatient registration areas. "In some areas, access sees over 100 patients in an eight-hour period," she says. "They will see that we are still smiling, collecting copays, verifying insurance, and identifying patients."
Inform others that you deal with every aspect of the hospital system, from data entry to diagnosis codes to complex financial problems, advises April C. Robinson, MBA, MHA, patient access manager at Palmetto Health Richland in Columbia, SC. "We are the first department that meets the patients upon their arrival at our facilities," she says. "We are also the first and last link in the revenue cycle chain for the hospital system."
Robinson suggests creating an interdepartmental team with leaders and staff members from nursing, the medical staff, patient access, pre-registration, patient billing, environmental services, and any department that is a part of patient care.
"This team should be tasked with the goal of learning about the job functions of each department," she says. "Everyone can learn how to fully utilize all talents, to provide the ultimate patient care experience."
To obtain more information on educating members of other departments on the role of patient access, contact the following persons:
- Barbara Blum, Director of Access/Admitting/Registration, MedStar Health, Columbia, MD. Phone: (410) 554-2204. Fax: (410) 554-2910. Email: [email protected].
- April C. Robinson, MBA, MHA, Patient Access Manager, Palmetto Health Richland, Columbia, SC. Phone: (803) 434-5140. Fax: (803) 434-1481. Email: [email protected] palmettohealth.org.
New access technology? A golden opportunity
Open up a dialogue
If your hospital is switching to an electronic medical record (EMR), this change is an excellent opportunity to start a much-needed dialogue with clinical areas.
"It opens up a whole new way of looking at things. You have the chance to throw out old traditions that aren't working and resolve some important issues," says Barbara Snodgrass, patient access manager at Mount Hood Medical Center in Gresham, OR.
All of Mount Hood's departments are meeting to discuss the implementation of an EMR. "You need a lot of education between the departments, including access, so everyone understands how this new software is going to work," she says. "You don't want the patient to pay the price for a lack of communication."
For example, clinical staff members specified at exactly what point tracking boards are updated to show the patient is ready for discharge, and patient safety issues were discussed regarding clinical staff printing out their own patient labels for lab draws or wristbands, instead of waiting for patient access staff to do so. Questions such as "Are there time constraints for the clinical staff to do this?" and "Do we need more patient access staff to accommodate the new changes?" were addressed.
"Small changes can have a big impact," says Snodgrass. "It is vital to re-establish roles and responsibilities so everyone can be on the same page." Decisions need to be made about whether nurses or registrars will enter appointments in the EMR, she adds, which brings up the question of whether additional training is needed for either area. "There may be something that patient access can do to help the nurse set up the orders so that the process is seamless for the patient," says Snodgrass. She suggests you take these steps:
- Be clear about every step in a process. "Talk everything through. At what point in the process is an order is going to be faxed and by whom?" advises Snodgrass. "Don't make assumptions on either side."
- Have joint meetings when rolling out a new process or technology. During the planning process for opening a new children's hospital, Snodgrass gave input on customer service from a patient access standpoint. "One issue that came up was how much space is needed for an area where an upset patient can meet with a patient advocate," she says.
- Address technology glitches. Software problems can cause tension between clinical areas and access, as when a patient's surgery is scheduled on one system but the pre-surgery blood work is entered into a different system.
"There may be duplicate accounts because the software isn't interfacing well," says Snodgrass. "That sets you up for a lot of blame going back and forth — something clinical and patient access staff don't want."
Verify insurance without costly delays
Make it simple for staff
Registrars at UK HealthCare in Lexington, KY, have had great success using a real-time insurance verification tool, reports Courtney M. Higdon, director of enterprise patient access services.
"Over the past year, we have distributed this tool to all locations where appointment scheduling and check-in or registration occurs," she says. "100% of our accounts have real-time eligibility checks performed as patients are registered."
The tool will better equip the patient access department for the future, according to Higdon. "Insurance plan coverage and accessibility will change dramatically over the coming years with the implementation of healthcare reform," she says.
The tool gives staff the ability to access the requirements of all payers, whereas previously they relied on individual payer web sites or failed to do verifications at all, she explains. "Additionally, this tool has improved our ability to know what the copay collections opportunity is for each patient as they arrive," says Higdon. "Previously we were able to measure our actual collections, but were not always certain what the full opportunity was." This change allows patient access leaders to measure the opportunity for collections, as opposed to just the actual collections.
Collections at the organization's two hospitals' admitting offices and EDs have increased more than 100% from 2010 to 2011 because of the tool and other initiatives aimed at improving upfront collections, she reports. Collections in these areas increased from $313,000 in 2010 to $663,000 in 2011. "We are expecting to see a positive impact on eligibility denials as a result of real-time insurance verification," adds Higdon.
The biggest challenge was educating more than 100 staff operating in a decentralized model who hadn't previously performed eligibility verification about what it is and why it is important, says Higdon. "We are planning to assess each area in the upcoming year to measure the adoption rate of this tool across the organization," she says. "As we find areas that have been slow to adopt the tool, we will work to support their training needs more aggressively."
For more information on insurance verification processes, contact:
- Courtney M. Higdon, Director, Enterprise Patient Access Services, UK HealthCare, Lexington, KY. Email: [email protected].
Utilize access staff in multiple areas
Cross-training is required
At Palmetto Health Richland in Columbia, SC, the admissions department's career ladder program requires cross-training in four admissions areas, financial counseling, and patient accounts.
"This has provided us with a pool of patient access representatives who are competent in multiple admissions areas," reports Ebony Seymour, CHAM, patient access manager. Seymour estimates that it costs about $1,000 for an employee to complete the cross-training. "Although it may seem like a large sum of money, the benefits of being able to utilize the staff in other areas is worth the expense," Seymour says.
A minimum of 20 hours of cross-training is required in each admissions area and financial counseling, which allows patient access representatives to provide coverage to short-staffed admissions areas.
"The career ladder process has increased our ability to flex employees between areas when we have call-ins, disasters, and holidays," says Seymour. "For example, an employee from the third shift in the emergency department can open main admissions at 6 a.m. if there is a call-in."
Because admissions processes are standardized, it's easier for patient access leaders to use access staff in other areas, says Seymour. Regardless of the admissions area in Palmetto Health's two Columbia campuses, which are Palmetto Health Richland and Palmetto Health Baptist, the registration system, forms, and signature capture are the same.
"We have the ability to utilize the patient access representatives across campuses," says Seymour. "The only information that they need to be able to perform their job responsibilities in another area is an understanding of the patient flow."
For more information on cross-training patient access staff, contact:
- Ebony Seymour, CHAM, Patient Access Manager, Admissions & Registration, Palmetto Health Richland, Columbia, SC. Email: [email protected].
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