Patient Access Resource Center

Build accountability into your Revenue Cycle

Revenue cycle managers constantly search for the perfect benchmark information to compare their team’s work with others.

Don’t search too hard, says Michael S. Friedberg, FACHE, CHAM, associate vice president of patient access services for Apollo Health Street, a national revenue cycle solutions firm in Bloomfield, NJ.

It can be good to compare nationally or even regionally, but some of the best benchmarks are right under your roof.

Benchmark against yourself, Friedberg said in the September 22, HCPro, Inc. audio conference, “Use Patient Access Benchmarks to Improve Registration Accuracy.”

Hold your team accountable. Do you sit back regularly and look at the big picture for your team rather than just put out fires?

In the audio conference, Friedberg pointed to passages in “Leadership,” former New York City Mayor Rudolph Giuliani’s 2002 book, as some great examples of holding staff members accountable.

Guiliani met with the leaders of each of NYC’s police precincts once a week, reviewing crime numbers. If there were a rise in certain crimes, the mayor asked why and what the respective leader was doing about it.

Giuliani built accountability into New York city government. You can build it into your revenue cycle team.

Dunn Memorial Hospital in Bedford, IN, is doing it now.

Stephanie Smithson, CHAM, the patient accounts director, says the facility implemented best practice key performance indicators (KPIs) for the entire revenue cycle. KPIs are metrics that illustrate how to improve your revenue cycle.

Dunn’s patient access benchmarks include:

2% or less error rate at time of billing
95% pre-registration rate

Dunn creates action plans for areas below benchmark, Smithson says. Dunn also implemented ED point-of-service (POS) collections.

“ED POS collections is a new area for us, and we are actively working through the issues with ED Nursing Management to resolve,” Smithson says. “We are actively using our performance matrix to assign shifts and for evaluations.”

Each revenue cycle team reports numbers monthly to the hospital finance committee and the hospital board. A core group meets weekly to complete and report outstanding issues for the entire revenue cycle.

What has the revenue-cycle-wide initiative done for Dunn?

Allows staff members to meet and interact on all points of the revenue cycle
Educates staff members how each area interacts within the revenue cycle and what issues they have
Gives team leaders a voice and chance to showcase their team’s improvement
Exposes leaders to other leaders’ strategy on handling problems within their own areas

Dom Nicastro is a senior managing editor at HCPro, Inc. in Marblehead, MA. He edits the Briefings on HIPAA and Health Information Compliance Insider newsletters. E-mail him at dnicastro@hcpro.com.

November 03, 2009 | Dom Nicastro | Comments 0

Benchmarking in patient access

We presented an audio conference, “Use Patient Access Benchmarks to Improve Registration Accuracy,” September 22.

These days, it seems all patient access departments are ramping up efforts to be accurate, considering the economic climate.

Take a look at some of the tools we offered during the show:

Audit tool for consistent education
Training checklist
Manual monitoring tool
Outline of Albany Medical Center's training program
Productivity standards
Dashboards
Audit QA
Standard set of elements of scorecard

Learn more about the audio conference.

October 28, 2009 | PARC Editor | Comments 0

AHA RAC Program Update answers provider questions

As of September 18, all four RACs were conducting automated audits, according to an October 6 American Hospital Association (AHA) RAC program update. But only 16 of the 23 audits underway were on hospital outpatient claims, according to the AHA. (The others were therefore on physician and durable medical equipment claims.)

So unless your hospital is so very unlucky to have been selected as one of the first for an audit, chances are you still have time to make a few necessary tweaks and run a few tests on your RAC processes to help ensure you're ready when RACs do begin auditing your facility.

The AHA also updated providers on the arrival of additional types of RAC audits (e.g., DRG validation and medical necessity). RACs have already requested the ability to audit for more than 100 different issues, according to the AHA. Some of these include code and DRG validation reviews, which CMS has not yet approved, choosing instead to begin solely with automated audits involving no need for medical record review.

And while DRG and coding reviews could begin as soon as November, the AHA says CMS may delay the onset of medical necessity reviews so it can first establish a process that would give providers the ability to re-bill all eligible outpatient claims. CMS previously announced medical necessity reviews would begin in January 2010.

Click here to read more.

October 21, 2009 | PARC Editor | Comments 0

Establish a relationship with patient financial services staff

The crossover between patient access and case management is natural. Share this tip with your ED case managers:

Patient financial services (PFS) counselors offer various assistance to patients. They:

Speak with patients about insurance coverage or the lack thereof
Offer to assist with originating a Medicaid or free/charity care application
Try to answer any questions related to the financial obligations resulting from the patient’s ED visit/hospitalization

The ED case managers in your organization also can inquire about other funding opportunities available through:

Workers’ compensation
No-fault motor vehicle insurance
State crime victims’ insurance funds
Charity care, such as professional home visits, durable medical equipment, or free transportation
Individual state public health resources
Individual hospital funded programs for post acute needs

Establishing a relationship with PFS counselors can help case managers in their role as patient advocates.

This tip was adapted from the HCPro publication Emergency Department Case Management. For more information or to order your copy visit the HCMarketplace.

October 21, 2009 | PARC Editor | Comments 0

Another Medicaid reduction possible when stimulus funds are gone

The decline in tax revenue and increase in Medicaid enrollment combined to put the squeeze on the Medicaid budget for many states.

As a result, 13 states will reduce Medicaid pay for physicians in fiscal year 2010. They include: Georgia, Louisiana, Minnesota, North Carolina, Vermont, Wyoming, California, Utah, Washington, Colorado, Hawaii, Maryland, and Ohio..

In fiscal year 2009, Medicaid enrollment grew by 5.4% and total program spending increased by 7.9%, the fastest pace in five years. Without the federal stimulus bill, the current economic climate would have forced states to cut Medicaid funding even more drastically. That additional federal funding for Medicaid runs out December 31, 2010. This has Medicaid directors worried about cuts that may be in store for fiscal year 2011.

Source: American Medical Association

October 21, 2009 | PARC Editor | Comments 0

MSP makes 2010 OIG Work Plan

Something that definitely should be on your radar: The OIG promises reviews of Medicare Secondary Payer (MSP) issues.

Read about it in the Work Plan.

October 15, 2009 | Dom Nicastro | Comments 0

CMS releases new RAC FAQ

CMS released the following new RAC FAQ September 25:

Q: How long is the RAC discussion period?

A: The discussion period begins with the time of notification (demand letter for automated reviews and the review results letter for complex reviews) through the time recoupment occurs. The discussion period normally requires written notification to the RAC. The discussion period does not extend the provider's appeal time frames.

Click here to read the FAQ on the CMS Web site.

October 14, 2009 | PARC Editor | Comments 0

Collecting ED co-pays

I am the supervisor of a patient access department that also includes ED triage. I am looking for information on collecting ED Copays.

Does anyone have helpful information or programs that they have put together? I would appreciate any feedback.

Thank you
Lori Weber

October 05, 2009 | Dom Nicastro | Comments 5

How do you hold your Patient Access team accountable?

Scoring matrix?

Weekly reviews?

Benchmarking is so crucial to a patient access team’s success. I want to know your story. How do you keep your patient access team accountable? And how does it help you down the road?

Share your story here, and perhaps it would make a great column for another site we run, www.healthleadersmedia.com.

September 30, 2009 | Dom Nicastro | Comments 5

Looking for info. on CHAA

I am the Team Lead for our Patient Access department and I am looking for information on the CHAA certification.

Has anyone taken the exam? Does anyone know much about the certification?

September 29, 2009 | jwhite | Comments 9

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