Author Archive for Dom Nicastro
Dom Nicastro is a senior managing editor for HCPro, Inc.’s revenue cycle division. He manages the Patient Access Resource Center and develops training, management, and compliance products for the company’s editorial team in the areas of: • Revenue cycle • HIPAA • Corporate Compliance • Materials Management • Patient Access • Patient Financial Services. Dom is the former editor of the Gloucester Daily Times, where he led the paper to the New England News Association Newspaper of the Year in 2005 and a runner-up for the same award by the New England Press Association in 2007.
Former Cedars-Sinai employee held for identity theft, fraud
Cedars-Sinai Medical Center former employee James Allen Wilson, 44, of Los Angeles allegedly stole personal information pertaining to more than 1,000 patients to make money in an insurance scam, the Los Angeles Times reported December 23.
Hospital officials say Wilson previously worked in the hospital’s billing department, where he would have had access to patient records for billing purposes. So far investigators determined Wilson’s scam netted him at least $69,000, according to Los Angeles County district attorney's office spokesperson Jane Robison.
NEWS: Bank VP gets three years in jail for Medicare fraud
A federal judge sentenced a former assistant vice president at Wachovia Bank to three years in prison for submitting fraudulent claims to Medicare, bizjournals.com reported this week.
Prosecutors said Javier J. Ortiz, 36, opened accounts for medical companies owned by Angel Castillo Jr.
CMS launches annual provider satisfaction survey
On December 16, CMS announced the launch of its annual survey of providers’ satisfaction with Medicare contractors. CMS will send the survey to randomly selected providers.
ACCESS SUCCESS in 2008
Editor’s note: We asked several patient access managers to give us some of their highlights from 2008.
Debra Keller, CHAA, admissions/registration director, Grand Itasca Clinic and Hospital, Grand Rapids, MN
Some of our highlights this year were:
- Insurance verification software. Our biggest achievement this year was implementing our insurance verification software at our front registration. We had the registration software company basically rewrite their program to be more automated and user-friendly at our front registration area. This took many months, but the end result has been very successful, and we are able to verify eligibility for 98% of our patients checking in.
- Self-pay collection process. Creating a process that helps the front patient access staff with the tools they need to collect co-pays. This included transparency in reporting to each of the individual front patient access staff using weekly reports and mentoring.
- Competency testing yearly for staff members. This includes a multiple choice and an open three-page test along with quarterly computer tests of specific registration processes.
Our future plans include moving from a “hard console” to a computer soft console in our switchboard and implementing a new Electronic Healthcare Record (EHR).
REPORT: US emergency rooms getting creative
These days, hospitals must be creative finding ways to cut a patient’s wait time in the ED. USA Today found several hospitals that do just that in a report released this week.
FROM THE EXPERT: RAC protection
Patient access departments play an important role in protecting the hospital's reimbursement for cases that are reviewed by the Recovery Audit Contractors (RACs).
Use the holiday season to provide a review session for all access registrars by reviewing a sample of physician orders to ensure that the physician specifically states "admit as inpatient" or "admit for observation services."
Do not assume that the word "admit" means an admission to an inpatient bed. For orders written for observation services, the orders must be dated, timed, and signed, and include a clinical reason for being admitted to observation. If the reason is lacking, call the physician's office for this information. If the clinical reason is not clear, refer the order to your Utilization Review/Case Management liaison.
Editor’s note: These tips were submitted by Rose T. Dunn, RHIA, CPA, FACHE chief operating officer of First Class Solutions, Inc., in Maryland Heights, MO.
CMS provides status of PQRI
CMS published a new report -- "Physician Quality Reporting Initiative (PQRI): 2007 Reporting Experience" – last week. The government reports challenges and successes in the report on the PQRI, established to link payments to reporting quality information.
“The PQRI is an important first step toward establishing a value-based purchasing program for physicians,” CMS says in the report.
Obama administration asks for input on healthcare
President-elect Barack Obama’s healthcare team plans to gather input from concerned parties regarding the future of healthcare in America and post it on the government’s Web site, www.change.gov, the Associated Press reports.
Tom Daschle, Obama's lead man on healthcare issues, begins the “house parties” Dec. 15 and hosts them throughout the month.
Read more about the issue in the story in the Washington Post.
2008 patient access success
Editor’s note: The following is part of an ongoing Patient Access Weekly Advisor series on successful patient access departments. This is a continuation from last week’s submission from Tanja Twist.
Tanja Twist, director, patient financial services, Methodist Hospital, Arcadia, CA:
2008 has been a very busy year for my admitting department, and it isn’t over yet. A few of our major accomplishments are as follows:
- EMR system. The second quarter began by going live with a new EMR system, launching initially in the admitting and business office, then in medical records four months later. This was a big change for my front- and back-end staff. We had to learn to “let go of the paper,” which was not an easy thing to do. In admitting this meant scanning registration documents instead of copying them, and staff no longer needed to create a patient financial folder. This also required significant changes to the workflow. We have been up with the system now for about six months and are very pleased with the results.
- Better patient flow in ED. We also implemented a clinical documentation system, which my ED staff members have been able to use to help with patient flow in and out of the ED.
Things we are looking forward to in (late) 2008 and 2009 include:
- Implementation of an online registration process for our guests
- Enhancing our ability to identify alternative payment programs and/or facilitate financial assistance for our uninsured population while they are still in-house. We are looking to partner with a vendor to accomplish this more efficiently.
NEWS: Medicare trust fund may shrink faster
Healthcare officials warned earlier this year the Medicare Part A trust fund would be depleted by 2019.
It may be even sooner than that.
According to an Associated Press report, the chief actuary for Medicare said this week the struggling economy will create less revenue through payroll taxes than originally projected – possibly depleting the fund three years ahead of projections.
Read the Associated Press report in the Washington Post.