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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.
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.
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.
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.
Editor's note: This article 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. Visit the blog to read the complete article.
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
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 e-mail Julie McGinley at jmcginley@hcpro.com.
Of the respondents, 10 will be selected to receive a complimentary book up to $149 value from our online store! www.hcmarketplace.com/listings-M1_CAS.html.
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 first in the sequence of payors
- Medicare is second in the sequence of payors when Medicare is the secondary payor
- MSPs are to be completed on each registration to ensure proper billing
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