Come up with novel ways to teach your access staff
Refresher courses, quality reviews with constructive feedback, coaching, and online courses. These are a few of the ways that access staff are kept up to date at Henry Ford Hospital/Henry Ford Cottage Hospital in Detroit.
"We are always trying to come up with new and innovative ways to teach," says Marie Sparrer, manager of hospital revenue services. Access staff come together in a "huddle" every day for 15 minutes or less. "For 24/7 operations, they are held three times a day," says Sparrer. A typical huddle covers anything from an insurance change or update, a system initiative, a change in process, a celebration for the team meeting their goals, or information one of the staff wanted to share with the team, such as the birth of a grandchild.
To keep current, Henry Ford's access staff collaborate with all registration areas related to inpatient, ambulatory, and outpatient activity. This includes quarterly meetings, one-on-ones, staff meetings, and in-services. "We depend on e-mail for last-minute, critical information needing to be dispersed quickly, with a follow up in huddle time," says Sparrer. "We provide a lot of internal training and depend on our coordinators to train on an ongoing basis as well. Our facility has a training department that we heavily depend on for core systems training."
Refresher courses cover the department's own systems, such as registration or functionality of the systems, as well as computer literacy. Quality reviews are done on individual levels. "However, much of the outcomes, numbers and goals are shared on a team level and posted for all to see," says Sparrer. "The one-on-one QAs are done to provide personal feedback, both positive and constructive, in a more comfortable setting."
Group information is shared, so that the entire access team is aware of what works well and what does not. "This initiates conversation amongst the staff when they see their peers' numbers are better than their own, and stimulates a healthy dialogue between the team," says Sparrer. Online courses are used to cover stress management, computer education, customer service, dealing with change, dealing with difficult people, and diversity.
Sparrer says that training of access staff is possibly more important than ever, for "multiple reasons. You need to keep the staff interested and stimulated in order to provide continued quality customer service, to build their skills and allow them to grow, as well as the bottom line."
More specialized training needed
Leisa Wade, CHAA/CHAM, central patient access manager for Carilion in Roanoke, VA, says that her department's original focus was "to verify current information with patients prior to their arrival for appointments. We also verified with the ordering physician's office that the appropriate authorization was in place."
Carilion has numerous patient access areas onsite at its hospitals and some stand-alone diagnostic facilities. "With the steady changes in authorization requirements and our current economical challenges, it was decided that we need to become more specialized," says Wade.
A worksheet is now posted on the Intranet for all staff to access. This worksheet includes payers, procedures, authorization requirements, addresses, phone numbers, and average turnaround time to get an authorization. "This worksheet is owned by my area, and it is updated almost daily as we receive new information," says Wade. "All patient access staff know how to use web sites and our worksheet for insurance authorization information."
Since staff are viewing the most recent information by referring to the worksheet, registrars are able to inform the patient of the authorization requirements, by saying, for example, "Your insurance company requires authorization for the procedure you are having."
"If staff have access to the authorization online, they will check to see if one has been created and inform the patient at that time," says Wade. "If it has not been created, they inform the patient so they can follow up with the physician's office." For high-dollar procedures, patient access financial reps also monitor the account for the authorization.
Wade also created three insurance "pods," each made up of a specific group of insurance payers. "Each pod has its own dedicated staff members who work exclusively with that insurance in their pod. This group of staff stay up to date on changes with their payers and communicate this on the worksheet and to the ordering physicians," says Wade. "They watch the web site for updates and talk with reps from the insurance companies to get updated information."
The staff for each pod review high-dollar accounts, scheduled admissions, outpatient surgery, magnetic resonance imaging, computed tomography scans, positron emission tomography, cardiac procedures, and sleep studies. They contact the payers either by web site or telephone to verify that the authorization has been obtained by the ordering physician, the authorization number, the date of the procedure, the procedure, and the facility where the procedure is to be preformed.
"They also have information requirements for secondary payers, as some insurers require authorizations for secondary payers and some don't," says Wade. "The next phase will be to pair them with the teams in patient accounting to discuss billing issues."
When authorizations are not in place the day prior to the procedure, the physician's office is contacted to inquire if the appointment is considered urgent. "If it is not urgent, we request the appointment be rescheduled," says Wade. The patient is given the option to reschedule, and if the patient chooses not to reschedule, he or she is informed of the financial responsibility.
"We have found that insurance companies may have the wrong dates and wrong procedures on file for the authorization number they have given the physician's office and sometimes a different authorization number," says Wade. "Some procedures may require two CPT codes and one of those codes does require an authorization. We just prevented a partial denial."
[For more information, contact:
Marie Sparrer, Manager, Hospital Revenue Services, Henry Ford Hospital/Henry Ford Cottage Hospital, Detroit, MI. Phone: (313) 916-1518. Fax: (313) 916-8200. E-mail: [email protected].
Leisa Wade, CHAA/CHAM, Central Patient Access Manager, Carilion, 213 S. Jefferson Street, Roanoke, VA 24011. Phone: (540) 224-5225. Fax: (540) 985-5367. E-mail: [email protected].]
Refresher courses, quality reviews with constructive feedback, coaching, and online courses. These are a few of the ways that access staff are kept up to date at Henry Ford Hospital/Henry Ford Cottage Hospital in Detroit.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content