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There will be dramatic changes in the works for patient access departments as a result of health care reform legislation. That is for certain. But many important details are still unclear.
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Does a system claim to be the "be all, do all" for your patient access department's issues, such as an eligibility system verifying benefits for all payers? If so, be skeptical.
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Reasons for claims denials often can be traced back to factors beyond patient access, such lack of medical necessity, lack of clinical documentation, or a physician not participating with a plan. This is why "patient access cannot work as a silo in reviewing claim denials," says Carol Triggs, MS, director of patient access at St. Joseph's Hospital Health Center in Syracuse, NY.
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To reduce administrative claims denials, Virtua Healthcare System in Marlton, NJ, did two Six Sigma projects. "Our major mission for the first project was to identify root causes that resulted in administrative denials at all campuses and all registration types," says Diane E. Mastalski, CHAA, CHAM, director of patient access.
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Next time you get a complaint, don't let it ruin your day. Instead, find a way to make a customer's dissatisfaction work to your advantage.
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Some patient access leaders are realizing that exemplary staff members can be a major resource for training and education. This could be because staff are more comfortable learning from their colleagues, or because the department is being charged to do "more with less" and more formal training resources are cut. Either way, it can be a successful strategy.
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Patient access jobs are challenging to fill for a variety of reasons. One is the need to recruit employees that are quick learners and flexible.
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"The goal for our staff is to reach at least a 90% monthly accuracy rating for preadmits, activations, and discharges," says Bailey Holloway, admitting evening coordinator at Maine Medical Center in Portland.
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Were departmental goals achieved or exceeded? If so, employees will feel a sense of accomplishment for a job well done, says Joy Wright, a patient registration supervisor at Lodi (OH) Community Hospital.
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Will a completed registration be problem-free or result in a claims denial? The buck stops with the registrar.
