Calls for healthcare transparency are growing louder. Smart patient access departments are heeding those calls. Several states have passed laws requiring that hospitals provide price quotes on request. Generic information isn’t enough; it must be personalized according to the patient’s insurance.
Are patient access staff explaining consent forms accurately to patients? Are they interpreting and explaining insurance benefits correctly? Face-to-face recordings of registrations let patient access leaders at one facility know these things for certain.
Patient access diligently obtains a required authorization from the payer and the service is scheduled. Weeks later, the claim is denied. However, it is not for “no auth,” but because the payer says it was not medically necessary.
A federal judge recently affirmed that HIPAA does not provide a mechanism for individuals to sue when they believe their privacy rights have been violated. However, the decision probably will not stop individuals from thinking they have the right to sue.