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If the front end would just get it right when the patient first comes in . . . goes the refrain from billers, or the CFO, or some other party focused on putting the blame for unreimbursed care at the feet of the access department. But when a substantial number of patients walk in without insurance coverage at the time of care or are emergency patients who dont have their insurance information with them, its not quite that simple.
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When it came to streamlining the way patients, referring physicians, and other interested parties contact Geisinger Health System in Danville, PA, for various access-related services, it seems that one good idea led to another.
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At Good Samaritan Hospital in San Jose, CA, care for stroke patients is coordinated by a registered nurse who follows the patient throughout his or her hospital stay, educates the patient and family members, and coordinates with the hospitals other case managers on discharge needs.
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A dramatic overhaul of the emergency department (ED) process at Paradise Valley Hospital in National City, CA, began with a single question from the director of emergency medicine.
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When people are unhappy with case management services, they will tell someone about it. In fact, research shows that people who have a problem are likely to tell eight to 10 other people about it. However, fewer than one in 20 people who have a complaint will protest formally.
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At Delnor Community Hospital in Geneva, IL, case managers work side by side with the clinical staff nurses, an arrangement that has helped earn the hospital the coveted magnet designation from the American Nurses Association in Washington, DC.
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When you tackle problems such as avoidable days and denials management, keep the lines of communication open with all departments in your hospital, back up your findings with data, and make sure you provide training to break the cycle, advises Jim Martin, revenue cycle management consultant with VHA Inc., an Irving, TX-based health care cooperative.
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Removing financial incentives to providers and employers that are designed to influence coverage decisions and recruiting patient representatives to participate in designing health care benefit packages are two measures that can help ensure that health care coverage decisions are fair and equitable, says a new report from an independent research arm of the American Medical Association (AMA) in Chicago.
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A new study from researchers at the Dana-Farber Cancer Institute in Boston indicates that a long-held belief among oncologists that patients who participate in clinical trials have better outcomes overall than those who do not may not be supported by empirical evidence.
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As the number of international research protocols increase, the problems faced by reviewing IRBs increase. International research is taking more and more IRB time, says Howard Guenther, PhD, MBA, associate vice chancellor for research and interim executive secretary of the Institutional Review Board at the University of Illinois at Urbana-Champaign.
