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Medicare patients often are shocked to learn that they have a significant out-of-pocket responsibility due to being in observation status instead of inpatient, reports Diane C. Settle, CPA, CHFP, executive director of the revenue cycle at Sarasota (FL) Memorial Health Care System.
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Emergency department (ED) copay collections increased 20% after a process was implemented at Washington Adventist Hospital in Takoma Park, MD, that required patient access reps to perform a benefit check on patients presenting with insurance.
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Patient access departments need to prepare for a “great increase” in the volume of patients who are eligible not only for Medicaid, but also private insurance policies, as a result of the Patient Protection and Affordable Care Act (PPACA) according to Luis Guerrero, director of patient access services at Ochsner Baptist Medical Center in New Orleans.
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Have community advisory groups give feedback not only on clinical processes, but also the revenue cycle, advises Richard L. Gundling, FHFMA, CMA, vice president of healthcare financial practices for the Healthcare Financial Management Association (HFMA).
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Hospitals are left in an untenable position due to changes in policy by the Centers for Medicare and Medicaid Services (CMS) that are causing hospitals to place patients in observation status for more than 48 hours instead of admitting them, according to an April 27, 2012, amicus brief filed by the American Hospital Association (AHA).
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The publics awareness of the U.S. Senate investigation of Accretive Health, a debt collection company hired by a Minnesota hospital to do registration and upfront collections, has important implications for patient access departments, says Jessica Curtis, director of Boston-based Community Catalysts Hospital Accountability Project.
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A pilot program at MetroHealth Medical Center in Cleveland resulted in significant drops in emergency department visits among Medicaid recipients who were "ultra-users" of emergency care and participated in the one-year study.
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For years, the Centers for Medicare & Medicaid Services (CMS) state operations manual has had guidelines for surveyors to assess issues related to patient safety at hospitals. But there is such a wide range in size and scope of hospitals, says Marilyn Dahl, CMS director of the division of acute care services, that the organization decided it would be a good idea to create some sort of prompt for surveyors to use.
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To prevent readmissions when patients are transitioning from the acute care hospital to an inpatient rehabilitation center, case managers should make sure the patients are appropriate for acute rehab, that their medical conditions are stable, and that they can tolerate three hours of physical therapy every day.
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As we discussed last month, healthcare reform has changed the landscape of healthcare and of case management. Emerging trends and changes related to reimbursement, readmissions, pay for performance, outcomes and newly contracted reviewer agencies such as the Recovery Audit Contractors (RACs), have changed familiar payment methods and audits to new and different ones in a short amount of time.
