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If registrars are more accurate when completing registrations, fewer claims denials will result. This clearly improves your hospital's fiscal situation, but remains a daunting challenge for many patient access departments. Here are some steps taken by the patient access department at St. Joseph's Hospital Health Center in Syracuse, NY:
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Here is a payment planÿ
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Here is a payment plan matrix for self-pay patients used by patient access staff at Skaggs Regional Medical Center in Branson, MO.
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By taking a proactive approach to patient status and instituting a series of checks and balances, Good Samaritan Hospital in Dayton, OH, keeps denials at a minimum.
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By redefining the roles of case managers and social workers and working with physicians on patient throughput and length of stay, Fauquier Hospital in Warrenton, VA, significantly reduced its Medicare length of stay by almost a day and decreased the revenue lost because of denials by medical necessity by 70%.
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If there are any doubts that improving patient flow also enhances patient safety, the recent experience of the ED at Enumclaw (WA) Regional Hospital should dispel them.
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As reimbursement shrinks and health care providers tighten their belts, hospitals need to take a proactive approach to denials to make sure they get paid appropriately for the care they provide, experts say.
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By conducing real-time concurrent denials management, Jewish Hospital and St. Mary's Healthcare, a not-for-profit health care system in Louisville, KY, keeps its average denials rate below 1%, consistently exceeding the hospital's goal of a denials rate of under 2% for commercial patient days, including Medicare managed care patients.
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Recognizing that chronically ill patients benefit from care management beyond the walls of the hospital or their physician's office, Middlesex Hospital in Middletown, CT, has created The Center for Chronic Care Management, which offers four National Committee for Quality Assurance- (NCQA) accredited disease management programs to help patients manage their conditions.
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Childbirth at Evergreen Hospital Medical Center in Kirkland, WA, is viewed as a family experience, rather than a medical event.
