Recent Articles
Patient access teams get financially smart in a tight economy
Hospitals can't escape layoffs these days, and they're not adding many jobs any time soon.
Bureau of Labor Statistics data released Friday say hospitals added only 300 payroll jobs across the entire nation, compared to 16,800 jobs in May 2008, and 8,700 jobs in May 2007.
So what are hospitals doing about it, especially on the front end where accurate registrations and upfront collections can mean the difference between a denial and a full return on a patient bill?
They are getting smarter, more technologically savvy, and analyzing their payer mix and what each entity requires.
Read the full story by HealthLeaders Media's Dom Nicastro.
Take our survey; Be part of a comprehensive look at national RAC preparedness
We invite you to take our comprehensive survey on what your facility is doing to prepare for the permanent RAC program. It should take approximately 10 minutes to complete.
We value your input and appreciate your time and effort in completing this anonymous survey. As a thank you, we will be happy to send you our completed benchmarking report detailing the results of the survey. To receive your free copy of the benchmarking report, you will have the opportunity to separately request one upon completion of the survey. Thank you for your time and consideration.
To participate in the survey, click here.
CMS updates RAC audit timeline: complex reviews still months away
CMS anticipates Recovery Audit Contractor (RAC) automated reviews will begin in late June and July, according to Marie Casey, deputy director of the Division of Recovery Audit Operations at CMS. However, this is not set in stone, she says, noting, "there is some leeway."
But complex reviews won't begin until later, says Casey. CMS is aiming to begin certain types of complex reviews (e.g., coding and DRG validation) this fall. However, medical necessity complex reviews won't begin until early 2010.
The nature of automated reviews is simpler on the whole, she says, making them an easier choice to roll out first. "The automated reviews are less burdensome on the provider, because there's no request for medical records," says Casey, adding that automated reviews are also easier on the RACs themselves to manage.
Read the full story by Andrea Kraynak of HealthLeaders Media.
Proposal would require health plans, doctors to cut appointment wait times
California soon may become the first state in the nation to set a maximum number of hours a health plan enrollee may wait before getting in to see a doctor.
Under the proposed regulations that are six years in the making, a patient needing an "urgent" appointment for a service not requiring prior authorization must be seen within 48 hours. For urgent appointments requiring prior authorization, they must be seen within 96 hours.
Patients would be allowed to speak with a doctor on the phone or receive a "triage" call back from a health professional–not answering service personnel–within 10 minutes, no matter what time of the day or night they call.
Read the full story by HealthLeaders Media’s Cheryl Clark.
Is healthcare better without doctors?
In all the talk about creating a medical home for every American, it's important to realize that increasingly, consumers are getting their healthcare outside of the traditional physician-based healthcare system. And that may very well be a good thing.
"Access to healthcare does not necessarily mean going to the doctor anymore," says health consultant Mary Kate Scott of Scott & Co. In her report for the California HealthCare Foundation released last week, Scott points to the rapid expansion of drugs and devices to test, monitor, and treat medical conditions without the physician office visit that defined access to healthcare a decade or two ago. In fact, a physician isn't required in the process at all.
"We're going to see an explosion in medical devices, and over-the counter drugs," as well as telemedicine applications for their use, Scott says.
"Consumers can purchase more than 700 over-the-counter medications whose ingredients and dosages were once available only by prescription," she writes in her report. "And in the last 15 years, numerous over-the-counter devices have become available" enabling oneself, or a non-physician to diagnose, monitor and treat a medical condition.
And that is the wave of the future, she predicts. "It's not like consumers love going to the doctor. They actually don't."
Read the full story by HealthLeaders Media’s Cheryl Clark.
Processing your MSP claims
CMS released a transmittal describing the formula it uses to determine its liability on claims when Medicare is the secondary payer. It is important practitioners accurately convey the primary payer’s group codes, claim adjustment reason codes, and associated adjustment amounts when sending claims to the Medicare contractor.
Effective date: July 1, 2009
Implementation date: July 6, 2009
View the transmittal
View the MLN Matters article
View the Job Aid article
Don’t delay because of Red Flags Rule delay
The Federal Trade Commission (FTC) pushed back its compliance date Thursday on the “Red Flags Rule” from May 1 until August 1, giving healthcare facilities considered to be “creditors” three extra months to implement an identity theft prevention program.
But that does not mean healthcare entities should delay implementing a program–especially when you’re dealing with the FTC, an organization known for harsh punishment and corrective measures.
“Don’t forget, this is a much different agency than [Office for Civil Rights] and CMS, the enforcement agencies for HIPAA, and if they do show up, the consequences will likely be severe,” says Kate Borten, CISSP, CISM, president of The Marblehead Group in Marblehead, MA.
The Red Flags Rule aims to keep the FTC away. It forces any organization considered to be a “creditor” to implement programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft.
Read my full piece on healthleadersmedia.com.
HIPAA and the HITECH Act
Your patient access staff members can never know enough about HIPAA.
I authored a white paper analyzing the new laws in the Health Information Technology for Clinical and Economic Health Act (HITECH Act) – or Title XIII of the American Recovery and Reinvestment Act of 2009, signed February 17.
Visit our Revenue Cycle Institute to download the white paper, HITECH Act and HIPAA: Strengthen your HIPAA compliance and training programs; prepare for new laws under the American Recovery and Reinvestment Act of 2009.
I’ve also written some columns about the subject for our daily online healthcare news Web site — www.healthleadersmedia.com:
Thanks!
Dom Nicastro
Senior managing editor
Patient Access Resource Center
Centralized scheduling/online fax orders
I would like to network with hospitals that have Centralized Scheduling and Online Fax orders.
Sabine McNair
Director of Patient Financial Services
Hopkins County Memorial Hospital
Got a success story with HINNs?
Looking for a successful case study for an audioconference. If you have one and would like to speak to it in an audioconference with us, please let me know!
Thanks!
Dom Nicastro