Train others to fill in for access
Do more without adding staff
Obtaining an authorization for a patient's series of chemotherapy visits is no longer enough, says Mollie Drake, corporate director of access at Scripps Health in San Diego.
"Now, you have to be aware of the payer's medical rules and what drug will be used," she says. "State and federal governments increase requirements without a commensurate increase in reimbursement."
Drake's department has been asked to do much more without any additional staffing, she says. "Meeting the requirements for the delivery of the Important Message from Medicare is just one such example," she says. "We have to figure out a way to get things done without added staff."
Finding experienced staff members can be challenging, in part because there aren't any educational programs that cover hospital access roles, says Drake. "We hire people with general customer service and communication skills, and then train them in health care," she says. Here are changes the department made to maximize its staffing resources:
A structured, three-tiered training program was implemented for frontline and business office staff.
The first tier provides the training needed to get the employee up to speed in a relatively short period of time, says Drake. "The next two tiers allow employees to self-promote," she says. "This gives them some upward mobility, while still performing the functions for which they were hired."
Business office staff members fill in for access staff.
Because business office staff members also go through the first tier of training, this change means those individuals are already cross-trained in some access functions, says Drake.
"This has allowed us to use business office staff to fill in on difficult night and weekend shifts in the EDs," she says. "It prevented us from hiring additional staff to help during times of high employee absenteeism."
This change has had an added benefit of allowing the business office staff to experience registration. "Instead of complaining about registration errors, they now look for ways to help the front end," says Drake.
One biller created an extensive contact list for payers that is often found in business offices, but seldom available to the front end. An employee from the transaction area made small laminated cards with all the codes for point-of-service collection activities.
"Now, staff can easily see the correct code without referring to cheat sheets or other documents in a patient's presence," says Drake. "It's saved the transaction department a great deal of time in correcting errors."
The department centralized pre-registration functions for many of its services.
Denial rates in outpatient areas were particularly high, says Drake.
"Looking closer at the process, we found that most were scheduled three or more days out, but seldom registered until the patient arrived," she says. "Verifying benefits and obtaining an authorization were secondary to speed."
The centralized department ensures everything is in order before the date of service, and patients are contacted if their out-of-pocket responsibility is high.
"The department averages over $100,000 a month in collections," reports Drake. "The rate of denials has fallen steadily, to less that 1% of the total cash collected."
Obtaining an authorization for a patient's series of chemotherapy visits is no longer enough, says Mollie Drake, corporate director of access at Scripps Health in San Diego.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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