Benefits exhausted, coverage not in effect at the time of service, patient ineligible at the time of service, no authorization prior to service, and patient unidentified. Each of these reasons for a denied claim is different, but the result is the same - the hospital doesn't collect. And in today's economy, this spells trouble for patient access departments.
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Too often, patient access is an area employees come into only to get their foot in the door with a long-term goal of obtaining other medical positions in the hospital, says Vicki Lyons, patient access manager at Baptist Hospital East in Louisville, KY.
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Because of rising copays and deductibles and underinsurance, patients are getting hit with bigger balances that they don't expect. More and more, patients want to know up front what they will owe.
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Currently, Methodist Le Bonheur Healthcare in Memphis, TN, is "in the infant stage" when it comes to being able to quote prices to patients through its web site, says Jessica Murphy, CPAM, corporate director for patient access services. "But we have done a good bit of research, and believe when we do this it will be a useful product," she says.
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Technology tools that facilitate the capture and communication of data are essential for patient access, but there is a downside. "The scary part is that systems today have the capacity and structure to get bad data out faster, and can do a lot of damage if not managed or used correctly," says Kathryn Stevens, PhD, MBA, CHAM, northwest regional delegate for the National Association of Healthcare Access Management.
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The shift from handling verification, eligibility, and collection issues on the front end - before or during registration - is continuing, and this is good news for patient access.
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