Revenue Cycle Institute » Patient access

How much charity care must hospitals give to remain tax-exempt?

Case Management Weekly — Wed, 29 Jul 2009 12:38:00 +0000

If Sen. Charles Grassley has his way, nonprofit hospitals will have to prove they spend at least 5% of expenses on charity care if they are to keep their tax-exempt status. But a review of what's happened in Maryland suggests such a rule would be unrealistic and largely inappropriate.

That's the conclusion of a report, published recently in the online edition of the journal Health Affairs, which found extremely wide variation in levels of all types of community benefit each hospital reported.

For example, charity care, a subset of community benefit defined generally as that care given to patients without any expectation of payment, varied from .05% to 6.33%. Only two hospitals reported contributing 5% or more.

But total community benefit, which included other categories of uncompensated care, such as health professionals' education, community health services, and "mission-driven" programs and research, varied from 1.17% to 14%.

Source: HealthLeaders Media

Hospital’s pre-registration efforts pay off in collections

Patient Access Weekly Advisor — Thu, 16 Jul 2009 04:00:00 +0000

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 IPPE template

The RAC Report — Thu, 09 Jul 2009 04:00:00 +0000

Take advantage of a handy tool to ensure that your physicians don’t overlook Initial Preventative Physicial Examination (IPPE) requirements.

Editor’s note: To view the sample tool, which is courtesy of www.justcoding.com, visit the Revenue Cycle Institute Web site and click on “Tools.”

Hospital’s ’what if’ scenario becomes reality

Patient Access Weekly Advisor — Thu, 02 Jul 2009 19:23:00 +0000

The patient access team at Skagit Valley Hospital has many goals as it works through this economic recession: Sustain morale, maintain trust, minimize criticism, and acknowledge success.

Michele Hill, CHAM, patient access manager at the Mount Vernon, WA, facility, knows it's not easy considering what the hospital faces:

Federal and state budget cuts
Change in payer mix
Increased charity care requests
RAC audits

"Our facility, like many others, is facing significant challenges during this time of economic downturn," Hill says.

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

ED wait times drop slightly; patient satisfaction rises

Patient Access Weekly Advisor — Thu, 25 Jun 2009 04:22:00 +0000

Despite a recession and continued crowding, a new study shows that the average wait time in the nation's emergency departments fell by two minutes in 2008 to 4:03. Even with the long waits, Press Ganey's Emergency Department Pulse Report 2009 finds that patient satisfaction rose in 2008, continuing a five-year improvement trend.

Leigh Vinocur, MD, on the emergency physician faculty at the University of Maryland School of Medicine, says she's not surprised that patients leave the ED satisfied.

"First of all, they probably can't get in to see a primary care doctor," says Vinocur, who is also a national spokesperson for the American College of Emergency Physicians. "And when you go to a doctor's office, he decides you could need a CT scan or a neurologist and you're waiting another few weeks for a referral.

"So, even though people are waiting four and five hours in the ER, they have an idea they are going to have a diagnosis when they leave. That doesn't always happen. But we can do a lot of procedures and things while you are there to get closer to the diagnosis," she says.

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

Patient access leaders must remain flexible in difficult economy

Patient Access Weekly Advisor — Thu, 25 Jun 2009 04:00:00 +0000

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 consecutives 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.

Tip: Analyze your registration process

Case Management Weekly — Wed, 24 Jun 2009 14:17:00 +0000

Patients typically arrive at the hospital as planned, urgent, or emergent admissions, and are registered in different ways. Errors made during the registration process can have a negative impact all the way to throughput and discharge planning. For this reason, the hospital may want to consider a performance improvement project to identify if there are registration errors, the types and frequency of these errors, and when they occur. For example, do errors occur more often on emergency admission on the night shift? What types of errors are they? Are they duplicate medical record numbers, errors in Social Security numbers, or the spelling of patient names? Any of these issues will have an impact on patient safety, discharge planning, and even billing or denials.

Editor’s note: This tip comes from HCPro’s newest training resource for hospital case managers—Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes by Beverly Cunningham, MS, RN, and Toni Cesta PhD, RN, FAAN, available now at HCMarketplace.com.

Patient access teams get financially smart in a tight economy

Patient Access Weekly Advisor — Wed, 10 Jun 2009 19:35:00 +0000

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.

Discuss patient financial information early in the hospital stay

Case Management Weekly — Wed, 03 Jun 2009 18:42:00 +0000

The Patient Friendly Billing Project, a collaborative effort spearheaded by the Healthcare Financial Management Association (HFMA), has developed guidelines for care providers to help inform patients of their financial liability as early as possible during a hospital stay.

The guidelines describe these discussions as an opportunity to help patients make informed decisions about their care. Such discussions also help patients learn about payment alternatives, such as Medicaid or charity care, and begin the application process as early as possible.

Early discussions of treatment and financial options, says the HFMA, increases the likelihood that providers will receive sufficient payment. This helps ensure they will be able to continue providing high quality care.

Source: Healthcare Financial Management Association

Revenue Cycle Institute posts free ABN Audit Preparation tool

Andrea Kraynak, CPC-A — Mon, 01 Jun 2009 14:43:35 +0000

Help ensure your facility properly obtains ABNs from patients for Medicare noncovered services with this 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.

Benchmarks in patient access accuracy

Patient Access Weekly Advisor — Wed, 27 May 2009 19:47:00 +0000

This Patient Access Resource Center’s quarterly benchmarking report is designed specifically for patient access managers and finance professionals. This report is based on the results of a survey in which we asked your peers to provide information about their registration accuracy rates.

We wanted to compare the results from our previous survey on registration accuracy back in May 2007.

Here, the good news is that more of your peers are tracking accuracy rates than they were 19 months ago. About 25% of managers said they did not track accuracy rates in May 2007, but only 3% say they do not track rates today.

We suspect that is a direct effect of the CMS Medicare Recovery Audit Contractors (RAC) program, which began its nationwide rollout. The three-year demonstration project collected more than $900 million in overpayments.

Optimize patient flow to protect against RACs

Case Management Weekly — Wed, 15 Apr 2009 14:57:00 +0000

The article below is an excerpt from HCPro’s newest resource for hospital case managers—www.CaseManagementMentor.com—a free online blog dedicated to connecting hospital case managers to industry pacesetters, peers, and best practices.

Waits, delays, and cancellations are so common in healthcare that patients and providers have come to expect waiting as part of the care process. But poor patient flow can have seriously adverse effects on patient outcomes and your facility’s bottom line—and can even increase your susceptibility to RAC audits.

According to Kelly Cooke, MSN, RN, the director of clinical resource management, social work, and documentation improvement at the Hospital of the University of Pennsylvania, part of maintaining optimal patient flow is placing patients in appropriate level of care and creating a system that guards against readmissions.

“If you can initially place your patients in the appropriate level of care, this will enable your facility to have a very successful RAC audit,” says Cooke. In addition to up-front processes, she recommends creating strategies to prevent unnecessary readmission.

Read the rest of this post, or share your thoughts on this topic.

Browse more blog posts at www.casemanagementmentor.com.

Q&A: Submitting ABNs

Patient Access Weekly Advisor — Thu, 02 Apr 2009 08:04:00 +0000

Q. Do we include a copy of the Advance Beneficiary Notice (ABN) with the claim form?

A. No, do not submit a copy of the ABN unless requested to do so by the carrier.

Source: Centers for Medicare & Medicaid Services

Tell us about your readmissions cases and win a free book!

Case Management Weekly — Wed, 25 Mar 2009 11:23:00 +0000

We would like to find out about your experiences with transition of care challenges for a research study HCPro is undertaking. We’re interested in understanding the challenges your organization faces with patients who have transitioned between multiple healthcare settings (e.g., from home health care to the hospital to a nursing home, or from a hospital to a skilled nursing facility and then back to a hospital.) If you are interested in providing information about an actual case, please email Julie McGinley at jmcginley@hcpro.com.

Of the respondents, ten will be selected to receive a complimentary book up to $149 value from our online store! http://www.hcmarketplace.com/listings-M1_CAS.html.

Patient Access sample tool published

Andrea Kraynak, CPC-A — Thu, 05 Mar 2009 00:00:00 +0000

Have you visited the Revenue Cycle Institute Web site lately? We’ve recently added a new free sample checklist for you to use when performing daily and monthly quality assurance checks on your patient access staff members. In addition, now that we know the RAC rollout is back on, you may want to consider attending HCPro’s RAC Defense Summit later this month. And as always, you can sign up to receive e-mails when we post news, tips, Q&A, and other helpful information to our news feed.

Hints for when Medicare is the secondary payer

Patient Access Weekly Advisor — Wed, 11 Feb 2009 00:00:00 +0000

Medicare is the secondary payor when:

The patient is 65 or older and the patient or the patient’s spouse is still employed and has insurance through that employer.
The patient is under 65 and the patient or patient’s spouse is employed by an employer with 100 or more employees and has insurance through that employer.
The claim is workers’ compensation.
The claim is a Black Lung claim.
The claim is a result of an accident and liability insurance is available.
The claim is for ESRD and the patient is still in the 30-month coordination of benefits period.

Additional MSP tips:

When Medicare is the secondary payor, the primary payor is #1 in the sequence of payors.
Medicare is #2 in the sequence of payors when Medicare is the secondary payor.
MSPs are to be completed on each registration to ensure proper billing.

Editor’s note: Dunn Memorial Hospital in Bedford, IN, uses these hints to help its patient access staff members successfully complete the Medicare Secondary Payer Questionnaire.

Tip: Handle Advance Beneficiary Notices of Noncoverage

Case Management Weekly — Thu, 29 Jan 2009 14:36:14 +0000

By Jackie Birmingham, RN, BSN, MS, CMAC. A Medicare beneficiary (or authorized representative) who has been given an Advance Beneficiary Notice of Noncoverage (ABN) may elect to receive the item or service anyway. In this case, the beneficiary should indicate that he or she is willing to be personally and fully responsible for payment by marking options [...]

Prepare for approaching ABN deadline

Medicare Weekly Update — Tue, 27 Jan 2009 14:14:08 +0000

By Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc. Medicare has been going through a number of transitions recently. One of these transitions relates to the appropriate form of notice when certain providers, including hospitals and physicians, believe that the outpatient services ordered by the patient’s physician fall under the limitation on liability provisions of the [...]

Consider ED bedside registration

Patient Access Weekly Advisor — Thu, 15 Jan 2009 16:16:28 +0000

York (ME) Hospital finds bedside registration in the emergency department one of the most effective tools to ensure an accurate and compliant patient claim. Pat Finnemore, CHAA, who works on the patient access team at the 11-bed ED facility, says bedside registration in the ED: Increases efficiency of workload for registrars Opens strong lines of communication between [...]

Delivering the Advanced Directive form

Patient Access Weekly Advisor — Mon, 05 Jan 2009 14:12:03 +0000

Advance Directive forms, to be completed by patients in case they are unable to make medical decisions for themselves, most often are presented by patient access staff members. But any lack of communication among access, nursing, and case management staff members can lead to unnecessary confusion and headaches during compliance checks. Mandatory requirements from CMS, including [...]