Hospital Access Management

Growing Role for Patient Access: Payer Contract Negotiations

Including patient access in the process is part of acknowledging the ever-expanding importance of front end participation in the revenue cycle.

Patient Access Leaders Tell Important Stories at Conferences

Hospital leaders may view patient access leaders as operating mostly “behind the scenes.” Presenting at conferences is a great way to change that outdated perception.

More Patients Newly Eligible for Medicaid; Many Unaware

Medicaid has expanded in many states so previously uninsured patients can access coverage. However, many may not be aware they qualify. Learn how one health system helps eligible patients enroll.

Missing Clinical Documentation Reason for Many Claims Denials

More health plans are asking for certain pieces of clinical documentation before paying claims. If it is not there, the claim is denied. What are the specific issues arising?

Payers, Hospitals Disagree About Whether Patient Meets Inpatient Criteria

Payers are refusing to pay claims for gastric bypass, joint replacement, and even cataract extraction. Why? Because documentation in the record does not support the need for surgery.

Some Patients Present With ‘Hidden’ Insurance Coverage; Patient Access Can Uncover It

Certain patients who say they do not have any insurance actually are covered in some way. It is the job of patient access staff to find it — and avoid uncompensated care for the hospital.