Author Archive for PARC Editor

RACs officially set to begin

Heads up, healthcare providers: Connolly Healthcare, the RAC for Region C, has posted the first set of issues eligible for RAC review on its Web site.

The issues are approved for outpatient hospital and physician providers in South Carolina. But even if you aren’t located in South Carolina, if Connolly is your RAC, prepare for these issues in your state as well, says Nancy Beckley, MS, MBA, CHC, of the Bloomingdale Consulting Group, Inc.

Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro, Inc., agrees that providers outside Connolly’s jurisdiction may want to review the issues as a clue to what RACs might audit in their area. However, she notes that providers should anticipate that RACs will audit for different issues for different jurisdictions although there certainly could be some overlap.

Read the full story on our Revenue Cycle Institute Web site.

Red Flags Rule deadline pushed back again

Remember that August 1 deadline for the Red Flags rule? Never mind.

The Federal Trade Commission announced July 29 that—for a third time—it has pushed back enforcement of the anti-fraud regulations until November 1, a full year after it was first scheduled to take effect.

The additional three months—which comes at the request of the House Appropriations Committee—will be used to educate small businesses about Red Flag compliance and to allow financial institutions and creditors more time to implement written identity theft prevention programs, according to the FTC.

Read the full story by HealthLeaders Media’s John Commins.

EDs can’t sustain care in current economic environment

A recent federal report casts more concern that hospital emergency rooms are having increasing difficulty treating all comers, especially because federal payments and the uninsured don't pay their full cost of care.

"There is a growing concern that EDs will not be able to sustain care for all persons in the current economic environment," according to the report, entitled "Payers of Emergency Department Care, 2006," that was published by the U.S. Agency for Healthcare Research and Quality.

"Between 1993 and 2003, there was a 23% increase in ED visits and a closure of 425 hospital EDs. In addition, a recent Institute of Medicine report notes that EDs have become increasingly overcrowded, overburdened, and underfunded. Yet little is known about who is paying for ED care, what the charges are for the care, and how to potentially relieve this pressure," the report said.

Of all visits to hospital emergency departments in 2006, 41.8% of the care was billed to the federal government–21.6% to Medicaid and 20.2% to Medicare. Another 17.7% were uninsured. An estimated 34.6% was billed to private insurance, and the rest to other private payers.

Read the full story by HealthLeaders Media’s Cheryl Clark.

Have you had an experience with Medicaid Integrity Contractors?

Medicaid beneficiary fluctuations are leading to more costs

Medicaid's "cumbersome" policies often lead to patients not getting or filling their prescriptions, receiving important diagnostic tests, or managing their chronic disease, which will lead to more costs down the road, according to a new report released by the Association for Community Affiliated Plans.

The Medicaid system, which varies by state, requires beneficiaries to show proof more than once a year that they and their children are still eligible for the public program. This leads to many falling off the rolls, which is a cycle that interrupts their continuity of care and jeopardizes their health.

Additionally, with so many people "churning," which means dropping out and back in to the Medicaid rolls every few months, the federal goal of measuring the quality of the patient care has become extremely problematic if not impossible, according to the group, which represents 42 nonprofit safety-net health plans serving six million beneficiaries in 23 states.

Read the full story by HealthLeaders Media's Cheryl Clark.

Hospital’s pre-registration efforts pay off in collections

The last thing you want to learn at your hospital, as a patient sits at your registration desk:

•  They can't pay, and no one knew prior to service
•  Their insurance changed, and authorization is required
•  They recently lost their job and have not paid their COBRA benefits

At this point, you may end up with an unpaid account—and in this economy, that's not good news when hospitals continue to lose reimbursement dollars.

Read the full story by HealthLeaders Media’s Dom Nicastro.

Revenue Cycle Institute posts free ABN Audit Preparation tool

Help ensure your facility properly obtains Advance Beneficiary Notices (ABN) from patients for Medicare noncovered services with an auditing checklist.

Click here to download the sample ABN Audit Preparation tool.

Editor’s note: This sample tool is excerpted from the Medical Necessity Training Toolkit, published by HCPro, Inc.

Care Card technology improves health system’s patient flow and waiting time

At Heritage Valley Health System in Beaver, PA, patient flow was a major concern, as it has been for many facilities nationwide.

The facility was well aware of the long process patients had to go through to be seen by a physician. In 2006, it implemented electronic kiosks along with a Care Card to help the registration process move more efficiently and maintain constant patient flow.

"Modeled in part on successful implementations in both the airline and hospitality industries, the board and senior management of Heritage Valley developed a strategic plan for enabling and promoting greater consumer participation in the healthcare process through various self-service initiatives," says Robert Swaskoski, director of enterprise resource systems at HVHS.

Read the full story by HealthLeaders Media’s Sarah Kearns.

MedicareFind.com launches

HCPro, Inc. is pleased to announce it has launched MedicareFind.com. MedicareFind is a new regulatory database product that allows you to easily find Medicare-related source authorities. You can sort by date and also check just certain years, document types (e.g., transmittals), or sources of information (e.g., OIG, CMS).

Patient access managers may want to check out our “EasyFind” link to ABN-related documents.

You can also read analysis of recent Medicare-related regulations and tips for using the new MedicareFind site on the MedicareMentor Blog -- http://blogs.hcpro.com/medicarefind/

Patient access leaders must remain flexible in difficult economy

Sometimes, your health information managers need to code. And your patient access managers need to register patients.

In these tough economic times, your hospital staff members should be ready for different roles on any given day. No one is immune to change.

At Albany (NY) Medical Center, managers in the patient access department are prepared to handle staff shortages.

During a recent string of illnesses and consecutive days with short staffs, department leaders took off their managers' hats and got on the frontline to register patients.

"The leadership team are working managers, much like any other patient access area," says Cathy Pallozzi, CHAM, patient access director at Albany Medical, noting the staff recently experienced colds and GI, which sprang the managers to action. "So the managers are on the front end, as well as the associate director. If I am needed, I will be on the front end as well."

Read the full story by HealthLeaders Media’s Dom Nicastro.