Stop needless and costly write-offs
Hundreds of thousands in revenue at stake
A simple communication process has reduced writeoffs by hundreds of thousands of dollars at Milwaukee-based Wheaton Franciscan Healthcare.
"We had a huge problem with radiology procedures changing, but we have resolved the issue," says Kim Gehl, manager of patient access, central scheduling, and central precertification.
Patient access leaders worked with the radiology department and developed a communication tool. This form is one that the servicing department completes and faxes to the central precertification department. They do this step anytime the procedure changes from what was authorized.
"The department knows what was authorized, as that information is provided to the servicing department," Gehl explains."
These steps are taken when a procedure changes from what originally was authorized:
- The fax from the servicing department is received in central precertification.
- "The form is faxed the same day the new procedure was done," she says. "This notification is a trigger to the precertification department to update or obtain a new authorization."
- The precertification rep contacts the insurance company to obtain a new authorization for the new procedure or additional service.
- The information is documented in the billing system.
Team effort needed
At Danbury (CT) Hospital, patient access associates strive to offer customers same-day scheduling if at all possible, reports patient access director Cindy Thomas Lowe, CHAM. This creates challenges in obtaining the necessary preauthorization, however.
"Most times, we are able to accommodate the need," Lowe says. "It takes a team. Some of the challenges are required test preparations, precertification in order to get paid for the testing, and then making sure demand can be met."
The team effort involves scheduling with a member of the department where the test will be performed, and financial clearance to verify benefits and review authorization needs. "Usually, a nurse from the physician’s office is available for a quick peer-to-peer [consultation]," says Lowe.
The hospital has found that its freestanding facilities have the competitive edge on same-day testing.
"We are trying to meet the demand to so that physicians and patients look to us for their service," says Lowe. "Physicians usually drive this sort of testing. We need to market the ability to take care of their patients."
