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Avoid needless ICD-10 claims denials: Act now to update access processes

Two major areas of concern for the switch to ICD-10 are medical necessity and preauthorizations, according to Susan Hoyle, CCS, coding manager at Mission Hospitals in Asheville, NC.

Access technology will need revamping

Your current systems will need to be remediated if they will be used to check medical necessity for ICD-10 standards when they are implemented in October 2013, says Jeffrey Smith, RN, MBA, CPC, a New York City-based manager at Accenture Insight Driven Health, a management and technology consulting company.

Educate yourself, staff, and physicians

Because the prior authorization process occurs well in advance of a service, your Patient access staff will need to be prepared for ICD-10 well before the Oct. 1, 2013, implementation date, warns Rennae J. Glidden, RHIT, director of data services at HealthEast Care System Midway Campus in St. Paul, MN. Use these strategies:

Payer auth requirements grow — Keep up to date

With payer requirements becoming more numerous, patient access departments face an ongoing battle to keep staff current.

Work with providers to obtain needed auths

It's taken a collaborative effort between patient access and provider offices to navigate the challenges of prior authorization and payer requirements, while continuing to give patients an excellent experience, says Adrienne Pinelle, CHAA, manager of the preauthorization team for patient access services at University of Utah Health Care in Salt Lake City.

Offer staff opportunity to move within department

Offering large salary increases or promotions is probably not an option to improve retention, even for your most irreplaceable staff members. However, it's possible that staff might jump at the chance for a lateral move within the patient access department, according to Sherrie Woodmancy, service director for patient billing and financial services at University of Utah Health Care in Salt Lake City.

Timing is key — Obtain accurate data in the ED

Sick, upset, and distracted patients often gave inaccurate or incomplete information to registration staff in the ED at Bronson Methodist Hospital in Kalamazoo, MI, notes Tina Nadrasik, the department's Patient Access manager. This problem sometimes resulted in claims denials, she adds.

Changes streamlined ED registration process

The ED verification staff, registration staff, case managers, emergency nurses, and a group of patients joined together and brainstormed ideas at Bronson Methodist Hospital in Kalamazoo, MI, with the goals of reducing denials, obtaining a better understanding of each other's roles, and obtaining accurate demographics, says Tina Nadrasik, patient access manager over the ED. Here are three areas that were identified:

Improve relations with ED clinicians, managers

The secret to any process improvement in the ED is the relationship that your registration staff have with the clinical staff and management, according to Tina Nadrasik, patient access manager in the ED at Bronson Methodist Hospital in Kalamazoo, MI.

Is your self-pay patient eligible for charity or not?

As self-pay patients continue to rise in number, you'll need effective strategies for screening these individuals for charity eligibility.

Taking on collection role can be a help to patients

When Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare (TMH), started point-of-service collections in her department about five years ago, she encountered a lot of resistance.

Are patients confused by coverage? Educate

Patients might have bought an insurance policy with lower premiums and higher deductibles, but lack understanding of what those mean. This part of the job is one of the hardest for patient access staff, according to Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare.

Access has 'very liberal, very fair' self-pay policy

Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare, says that her department has put a "very liberal, but very fair, uninsured payment policy in place."

Don't let staff settle for misleading copay data

If some particularly dismal copay collection data came to your attention, chances are you'd want to scrutinize it carefully before presenting this to senior leaders.

Hospital Access Management – April 1, 2011

April 1, 2011