System gets out more 'clean' claims
More detailed information given
A new claims management system implemented at Cambridge (MA) Health Alliance in 2010 has allowed patient access staff to help get many more "clean" claims out the door, says Mary Calloe, director of patient access services.
"A lot of people think it's just for the business office or billing staff, but we have integrated this into our front-end work," says Calloe. "Staff can look at why things [are denied] from a pre-billing standpoint."
The claims management system helped patient access staff to work collaboratively to increase overall revenue received by the hospital, Calloe says. "It helped them to partner in a different way with the folks that worked in the business office and in revenue integrity," she explains. "We now have a more common understanding of denials and a tool that everyone uses in the same way."
Patient access staff are now asking for a data quality system so information can be obtained real-time during the registration process, which would ensure accuracy during all shifts, including part-time staff who work only on weekends, she adds. "Registrations can occur at many different points of entry. It's not always a defined group of people who are here Monday through Friday," she says. "Often, it wasn't our core staff that were making the repeated mistakes."
Mistakes corrected
The claims management system corrects some mistakes automatically, says Calloe, and staff members are able to correct some of their own errors.
"Historically, that type of feedback did not exist here," she says. "It is not always present in a patient access environment."
Before, staff might have been told a claim was denied because they failed to check eligibility, but the tool gives more detailed information, such as the fact that one reason for eligibility-related denials was that accounts were outsourced to a third party that intentionally was dual billing patients with multiple insurances, adds Calloe.
"Staff are thinking a lot more about our systems and what changes can be made in the flow of information, so we capture things correctly," Calloe says.
A new claims management system implemented at Cambridge (MA) Health Alliance in 2010 has allowed patient access staff to help get many more "clean" claims out the door, says Mary Calloe, director of patient access services.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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