Hospital Access Management – July 1, 2019
July 1, 2019
View Issues
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Well-Trained Registrar Can Protect Hospital From EMTALA Violations
Many people, understandably, want to know if their ED visit is going to be covered by their health insurance. If the registrar tells a patient she should go to a nearby urgent care center instead of the ED specifically because her coverage is out of network, that is a possible EMTALA violation. To a CMS investigator, it might look like the patient was discouraged from staying for insurance reasons.
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Collection Goal: Half of Potential Outpatient Dollars
Through scripting, role-playing, and observation, supervisors educated employees on common errors, the Coordination of Benefits rules, how to determine the patient’s financial responsibility, and how to collect bedside.
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Patients Eager for Financial Information, But Registrars Must Be Careful
ED registrars should never discuss or ask for payment prior to meeting EMTALA requirements.
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Self-Pay Team, Financial Counselors Find Common Ground
Financial counselors and self-pay team members always worked jobs that overlapped somewhat at Bronson Methodist Hospital and Bronson LakeView Hospital in Michigan. Still, the two groups of employees rarely, if ever, met in person. That changed after four hours spent working alongside one another.
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Push Back if Planned Changes Are Bad for Patient Access
Both patient access and billing staff are part of the revenue cycle; however, they do not really feel like colleagues since they never see one another at work. Bringing these groups together could lead to various improvements.
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‘Level of Service’ Denials Cropping Up; Revenue Lost
Health plans may claim that patients failed to meet the criteria for inpatient care, meeting the criteria for observation status only instead. Often, these criteria do not follow the CMS inpatient procedure list. These conflicts cause a lot of confusion, which can be costly for hospitals.
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