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December 2008 Vol. 5, No. 12
Manual instructions issued
for revised ABN form
by Judith L. Kares, JD, CPC
More than one year after several rounds of review
on proposed revisions to existing Advance Beneficiary Notice (ABN) Forms ABN-G and ABN-L, CMS published revised ABN Form CMS-R-131.
beneficiaries from unexpected financial liability, which
is a Medicare requirement referred to as the limitationon-liability provision.
Noncoverage most commonly arises with respect to
diagnostic services (e.g., lab tests and imaging services) for which the physician order does not support the
medical necessity of the services.
The previous and revised ABN forms are designed
to inform beneficiaries of the specific services that are
As with the prior ABNs, the revised ABN is designed
expected to be
for use by hospitals, physicians, and certain other health-
denied and the
care providers to notify Medicare beneficiaries when out-
reasons for that
patient services are expected to be denied, such as when
denial. Thus, pro-
the services:
viders give benefi-
➤➤ Fail to meet Medicare’s medical necessity guidelines
ciaries a choice of
➤➤ Involve screening patients more frequently than
having those ser-
what Medicare covers
➤➤ Are custodial in nature
Presumably, the biggest
challenge in moving to
the revised ABN is the
requirement to provide a
reasonable cost estimate
for each of the services
expected to be denied.
vices performed.
If they choose to do so, they agree to assume financial
liability if Medicare denies coverage.
In order to be effective, such notice must occur
prior to the performance of these services to protect
Significant changes to the revised ABN
When CMS initially published the revised ABN earlier
IN THIS ISSUE
p. 4 How to train your staff members
for the ABN
Take a look into the world of two trainers
who specialize in working with patient
access staff members.
p. 6 New ABN breakdown
Check out the highlights of the new ABN versus the older version.
p. 7 Time to celebrate 2008
We talked to several patient access and revenue cycle managers about
their accomplishments this year and what they look forward to in 2009.
p. 10 MSP help
Use our detailed form to retrieve all the right information to stay in
compliance with MSP claims.
this year, CMS had not had time to make the necessary
revisions to related sections of Chapter 30 of the Medicare Claims Processing Manual. In the interim, CMS published Revised ABN Frequently Asked Questions (ABN FAQs)
and Form Instructions Advance Beneficiary Notice of Noncoverage (ABN) OMB Approval Number: 0938-0566 (Form Instructions), both of which were intended to provide guidance
on the use of the revised ABN.
In the ABN FAQs, CMS noted that the revised ABN:
➤➤ Has a new official title, the Advance Beneficiary Notice of Noncoverage (ABN), in order to more clearly
convey the purpose of the notice
➤➤ May also be used for voluntary notifications, in place
of the Notice of Exclusion from Medicare Benefits
> continued on p. 2
Patient Access Advisor
Page 2
Revised ABN
December 2008
< continued from p. 1
➤➤ Replaces the existing ABN-G and ABN-L
or Form Instructions. In particular, there were concerns
➤➤ Has a mandatory field for cost estimates of the items
about language in the Form Instructions that indicated the
beneficiary or his or her representative must sign and date
or services at issue
➤➤ Includes a new beneficiary option, under which an
the revised ABN. CMS did not list this requirement as a
individual may choose to receive an item or service
change in the ABN FAQs, and it is contrary to manual in-
and pay for it out-of-pocket, rather than have a claim
structions for other limitation-on-liability forms, including
submitted to Medicare
Forms ABN-G and ABN-L.
In the meantime, CMS informally advised healthcare
providers to follow prior guidance for Forms ABN-G and
ABN-L in Chapter 30 of the Medicare Claims Processing Manual if their questions were not answered in the ABN FAQs
Editorial Advisory Board Patient Access Advisor
Group Publisher: Lauren McLeod
Executive Editor: Lori Levans
Senior Managing Editor: Dom Nicastro
[email protected]
Rose T. Dunn, RHIA, CPA, FACHE,
FHFMA
Chief Operating Officer
First Class Solutions, Inc.
St. Louis, MO
Robin J. Fisk
Attorney At Law and Principal
Fisk Law Office
Ashland, NH
Michael S. Friedberg, FACHE,
CHAM
Director of Patient Access Services
Apollo Health Street
Bloomfield, NJ
Debra Keller, CHAA
Admissions/Registration Director
Grand Itasca Clinic and Hospital
Grand Rapids, MN
CMS initially planned a six-month transition period
beginning March 3, which it extended to March 1, 2009.
During this transition period, healthcare providers may
continue to use Forms ABN-G and ABN-L or begin to
use the revised ABN. However, for outpatient services
provided on and after March 1, 2009, they must use the
revised ABN exclusively.
Presumably, the biggest challenge in moving to the revised ABN is the requirement to provide a reasonable
illiam L. Malm, ND, RN
W
President
Health Revenue Integrity Services, Inc.
Westlake, OH
cost estimate for each of the services expected to be de-
Steven G. Orvis, MPH
Manager
Consulting firm
Los Angeles, CA
of a cost estimate is permitted, not required. The failure
Catherine M. Pallozzi, CHAM, CCS
Director of Patient Access
Albany Medical Center
Albany, NY
significantly different from the actual cost does not in-
Sandra J. Wolfskill, FHFMA
President
Wolfskill & Associates, Inc.
Chardon, OH
Joe Zebrowitz, MD
Executive Vice President/
Senior Medical Director
Executive Health Resources
Newtown Square, PA
Patient Access Advisor is one of
the resources from the Patient
Access Resource Center from
HCPro, Inc. For information,
call 800/650-6787 or go to
www.accessresourcecenter.com.
Patient Access Advisor (ISSN: 1933-3307 [print]; 1937-7525 [online]) is published monthly by HCPro, Inc., 200 Hoods
Lane, Marblehead, MA 01945. Subscription rate: $299/year; back issues are available at $25 each. • Patient Access
Advisor, P.O. Box 1168, Marblehead, MA 01945. • Copyright © 2008 HCPro, Inc. All rights reserved. Printed in the USA.
Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without
prior written consent of HCPro, Inc., or the Copyright Clearance Center at 978/750-8400. Please notify us immediately if you
have received an unauthorized copy. • For editorial comments or questions, call 781/639-1872 or fax 781/639-2982. For new
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customer service at 800/650-6787, fax 800/639-8511, or e-mail: [email protected]. • Visit our Web site at
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to be included on this mailing list, please write to the marketing department at the address above. • Opinions expressed
are not necessarily those of PAA. Mention of products and services does not constitute endorsement. Advice given is
general, and readers should consult professional counsel for specific legal, ethical, or clinical questions.
© 2008 HCPro, Inc.
Revised transition timetable
nied. Under rules for the prior ABN forms, the provision
to provide a cost estimate or the fact that an estimate is
validate an otherwise valid Form ABN-G or ABN-L.
Revised manual instructions
As promised, CMS published revisions to Chapter 30,
Section 50 of the Medicare Claims Processing Manual relating to the use of the revised ABN September 5. These
revisions are in the Medicare Claims Processing Manual
Transmittal 1587.
Although these manual revisions are effective March
3, CMS will not implement them until March 1, 2009.
However, if healthcare providers use the revised ABN prior to March 1, 2009, they should follow the guidance in
the manual revisions.
Alternatively, if they continue to use Forms ABN-G
and ABN-L, they should follow the prior guidelines in
Chapter 30.
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Patient Access Advisor
December 2008
In Section 50.4.3 of the revised guidelines, consistent
Page 3
➤➤ Any dollar estimate equal to or greater than $150
with similar standards that apply to inpatient notifica-
➤➤ $150–$300
tion requirements, notifiers are to follow applicable state
➤➤ No more than $500
or other laws to determine who can make healthcare and
financial decisions on behalf of a Medicare beneficiary.
Multiple items or services that are routinely grouped
These are more stringent guidelines than apply to the pri-
can be bundled into one cost estimate (e.g., a group of
or ABN forms.
laboratory tests, such as a basic metabolic panel).
In Section 50.5, CMS notes that limitation on liabil-
As noted in the list of key changes in the ABN FAQs,
ity typically occurs at three points during a course of
there are now three, rather than two, options from which
treatment:
the beneficiary is to choose.
➤➤ Initiation: at the beginning of a new patient en-
If there are multiple items or services listed on the ABN
counter, plan of care, or treatment, in which case
and the beneficiary wants to receive some, but not all of
the ABN must be issued prior to receiving the non-
them, the notifier can accommodate this request by using
covered care.
more than one ABN.
➤➤ Reduction: when there is a decrease in a component
The notifier can furnish an additional ABN that lists
of care. For example, there might be a situation in
the items or services the beneficiary wishes to receive,
which a beneficiary is receiving physical therapy (PT)
with the corresponding option.
five days per week and wishes to continue to do so,
The notifier is not to preselect an option for the bene-
but the notifier believes that three days per week will
ficiaries, but may permit and encourage the beneficiaries
be sufficient to meet the beneficiary’s therapy goals. In
this case, the reduction in treatment would trigger the
requirement for an ABN.
➤➤ Termination: at the discontinuance of certain items
or services (e.g., when a physical therapist no longer
considers the outpatient speech therapy described in
a plan of care reasonable and necessary). In such a
case, an ABN must be issued prior to the termination
of the service.
In Section 50.6.3, relating to the completion of the revised ABN, CMS states that notifiers must make an honest effort to insert a reasonable cost estimate for all of the
items or services that are expected to be denied. In general, CMS states that such an estimate “should be within $100 or 25% of the actual costs, whichever is greater;
however, an estimate that exceeds the actual cost substantially would generally be acceptable, since the beneficiary would not be harmed if the actual costs were less
than predicted.”
For example, for a service that costs $250, a notifier
to select the option for themselves.
Section 50.6.5 provides for annotation of the ABN in
the event that the beneficiary changes his or her mind.
In that case, the notifier should present the previously
completed ABN to the beneficiary and request that he
or she annotate the original ABN.
Alternatively, the notifier may make the annotation
to reflect the beneficiary’s new choice and immediately
forward a copy of the annotated notice to the beneficiary to sign, date, and return.
If the beneficiary refuses to choose an option and/
or refuses to sign the ABN when required, the notifier
should annotate the original copy of the ABN, indicating
> continued on p. 4
Questions? Comments? Ideas?
Contact Senior Managing Editor
Dom Nicastro
Telephone 781/639-1872, Ext. 3413
E-mail [email protected]
could provide the following estimates:
© 2008 HCPro, Inc.
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Patient Access Advisor
Page 4
Revised ABN
December 2008
< continued from p. 3
the refusal to sign, and may list witnesses to the refusal
➤➤ Review the revised ABN form
on the notice, although this is no longer required. Nev-
➤➤ Review the ABN FAQs and Form Instructions, as well
ertheless, for documentation purposes, having additional
as the revised provisions in Chapter 30, Section 50,
witnesses is preferable.
in the Medicare Claims Processing Manual
Section 50.7.2 provides options for delivery of the
ABN to the beneficiary or his or her representative, if it
is not possible to deliver the notice in person. These op-
➤➤ Identify any outstanding questions that require clarification before proceeding
➤➤ Determine key changes that need to be implemented
tions are similar to inpatient notification requirements
in order to be able to transition to the revised ABN by
in such circumstances.
March 1, 2009
➤➤ Create a transition action plan, with timetables and
Thorough review recommended
In light of the many changes to the revised ABN,
accountability by departments and key individuals
➤➤ Implement the action plan, with ongoing monitor-
including the related revisions to Chapter 30, Section
ing and evaluation to determine whether target dates
50, of the Medicare Claims Processing Manual, and the
and plan objectives are being met n
potential adverse financial consequences for failure to
provide effective advance notification when limitation
Editor’s note: Judith L. Kares, JD, CPC, is an instructor for
on liability applies, healthcare providers are encour-
HCPro’s Medicare Boot Camp®–Hospital Version. She is an at-
aged to:
torney and consultant who provides legal services and related
➤➤ Form a cross-disciplinary team with related responsi-
healthcare compliance services to a wide variety of clients, in-
bilities to transition to the revised ABN
➤➤ Review the existing Forms ABN-G , ABN-L, and the
current ABN notification process
cluding hospitals, health systems, HMOs, third-party payers,
physician practices, and other healthcare entities. Visit www.
hcprobootcamps.com to learn more.
ABN training tips from patient access training professionals
CMS released new instructions on the revised Advance
Beneficiary Notice of Noncoverage (ABN) more than once in
the past year. Now that your facility is aware of the changes,
it’s time to put the training to use.
Melissa Pillars, patient access supervisor and trainer at
Pillars provides the following tips to help prepare for
the ABN changes:
➤ Obtain ICD-9 and CPT codes. “Essentially, I would
stress the need to obtain the ICD-9 codes and CPT codes
from the physician offices—exactly what they want done
Hillcrest Medical Center in Tulsa, OK, trains about 65 people
and what diagnosis to use,” Pillars says. “Often, the in-
in the main registration, preregistration, financial counsel-
formation given is vague, and we have to make multiple
ing, ER registration, and outpatient registration areas.
phone calls to the physician offices to get what we need
Hillcrest also has approximately 10 decentralized registration areas that have one to two registration people each.
The facility is licensed for 500 beds and is adding another
hospital (Heart Hospital) in spring 2009.
Hillcrest also has regional hospital facilities in Henryetta,
Cushing, and Owasso, which have 50 to 100 beds each.
© 2008 HCPro, Inc.
to check for medical necessity.
Billers and patient access staff members can’t tell the office
what they need, Pillars adds. They will not be able to suggest
that a certain procedure will pass and become a clean claim if
the physicians give a certain diagnosis code, especially if there
is no documentation to support the procedure.
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Patient Access Advisor
December 2008
Page 5
ABN training tips from patient access training professionals (cont.)
➤ Get familiar with medical terminology. “Train-
details about the departments that have improved most in
ing-wise, there is no formal background in coding needed,
accuracy and updates to the registration system, policies,
but a familiarity with medical terminology is helpful,” Pillars
plan codes, etc.
says. “The software program we use is very user-friendly—
➤➤ Patient access e-mail distribution. Baptist created
just plug in the codes. The training comes in on where to
a patient access e-mail distribution group, which is
find the information you need (e.g., the CPT code book and
composed of all patient access supervisors and manag-
Web sites). Some hospitals do use actual coders to check
ers. All related updates, changes, and issues regarding
for medical necessity; we just don’t have that luxury here.
patient access (e.g., system, policies, and regulatory
We’re all slowly becoming one, though. It is a definite work
guidelines/laws) are communicated to this group, who
in progress.”
then distribute the information to their staff members.
Khristine Anderson, training and data integrity special-
Baptist also posts this information on its Web site and in-
ist at Baptist Health South Florida, which includes seven hospi-
corporates it into its introductory training course, when
tals in the Miami area, says her facility has provided extensive
applicable.
training to 465 patient access staff members and remedial
training to 70 patient access staff members.
Included in that two-week training course are daily quiz-
However, Anderson says, “It is difficult to ensure all of our
zes, a final assessment patient access staff members must pass
patient access staff scattered throughout multiple facilities in
with an 85% or greater accuracy score, and a mentoring as-
varying shifts are provided with consistent and standardized
sessment that measures their hands-on knowledge after they
education for ABN and all other forms of information pertain-
have been released to their department.
ing to patient access.”
Anderson’s health system has implemented the following
As for feedback, Anderson says it’s a mixed bag. “They
enjoy the games incorporated in class to keep things enter-
training materials for ABN education:
taining and lively,” she says. “They appreciate the mentor-
➤➤ Training course. Baptist Health requires that all newly
ing phase of the program, which gives them one-on-one
hired patient access staff members attend a two-week
time with their trainer. The training program involves a
training course before starting work in their assigned
great amount of detail—computer system, regulatory re-
department.
quirements, insurance, HIPAA, workers’ comp, EMTALA,
➤➤ Refresher courses. Baptist offers refresher courses to
address each employee’s needs. The supervisor or manager can indicate the areas of need, and the trainers will
address those concerns.
➤➤ Department Web site. The training and data integ-
policies, etc. They feel it is too much information to retain
at once.”
As for the new ABN instructions, Baptist used several approaches to inform its staff members. It held a department
training session for the training/data integrity staff members
rity department maintains a department Web site, avail-
and updated the introductory training course and manual
able through the organization’s intranet, which contains
accordingly. For patient access staff members, Baptist sent
training manuals, updates, helpful hints, training sched-
an e-mail communication with attachments and instruc-
ules, and a Q&A section that allows access staff mem-
tions to supervisors and managers to provide education to
bers to ask patient access questions directly to the entire
their staff members.
department. Questions are answered and posted in a
monthly newsletter.
➤➤ Monthly newsletter. Baptist distributes a monthly newsletter to all of its patient access departments, providing
© 2008 HCPro, Inc.
Baptist also posted the information on the department
Web site and mentioned it in the monthly newsletter. This
process remains consistent for any update affecting patient
access.
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Patient Access Advisor
Page 6
December 2008
Summary of changes: Advance Beneficiary Notice of Noncoverage
The following is a breakdown of the new instructions to the Advance Beneficiary Notice of Noncoverage (ABN) form.
Effective date
Current
Changes
All current forms can be used
March 3
until February 28, 2009
Note: The new ABN form must be implemented by
March 1, 2009
Title
Advance Beneficiary Notice
Advance Beneficiary Notice of Noncoverage
Abbreviation
ABN
ABN (no change)
Forms
ABN-G (General)
The new ABN form replaces all existing forms
ABN-L (Laboratory)
Notice of Exclusion from
Medicare Benefits
General
The beneficiary must have a
Minimum of two copies:
requirements
signed ABN on file with the
➤➤ Beneficiary
provider of services
➤➤ Notifier (provider)
The beneficiary has the option to:
The beneficiary has the option to:
➤➤ Have the test and be held
➤➤ Have the test, submit the claim to Medicare, and be
responsible for payment if
held responsible for payment if Medicare does not
Medicare does not cover
cover the test
the test
➤➤ Not to proceed with the test
if it is not covered
Customization
N/A
➤➤ Not to proceed with the test if it is not covered
➤➤ Have the test and not have services submitted to
Medicare, thereby agreeing to pay for the services
The font sizes as they appear on the ABN form from the
CMS Web site should be used.
Font size should be 12-point, and all titles should be
14-16–point. Insertions in blanks of the ABN can be as
small as 10-point, if needed.
If preprinted information is utilized to describe items/services and/or common reasons for noncoverage, the provider
must clearly indicate which portions of the preprinted information are applicable to the beneficiary on the ABN form.
Note: Use caution when customizing. If alterations are not
in compliance with CMS guidelines, the ABN form might
be invalid.
Source: Catherine M. Pallozzi, director of patient access, Albany (NY) Medical Center.
© 2008 HCPro, Inc.
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Patient Access Advisor
December 2008
Page 7
This year’s patient access success
Celebrating one year’s worth of achievements on the front end
The best word to describe life as a patient access manager this year is uncertain.
There seems to be increasing uncertainty regarding
or insurance is identified as the training topic of the
month. The team creates the training document,
and the QIT members are responsible for training
many facets of the patient access manager’s job, such as
all staff members. In addition, the QIT is responsible
Medicare’s Recovery Audit Contractor (RAC) program,
for a monthly puzzle pertaining to The Joint Com-
which collected more than $900 million in overpay-
mission, the hospital strategic plan, and department
ments from providers during its three-year demonstra-
goals and objectives.
tion project, and the nation’s economic crisis, which is
➤➤ Created an incentive for staff eduction. We host
causing some patients to feel the pinch and not pay their
a drawing in which one staff member who has suc-
hospital bills.
cessfully completed a puzzle will win a themed gift
We heard your concerns at the May 3–6 National As-
basket purchased and created by our management
sociation of Healthcare Access Management conference
team. The more puzzles staff members complete, the
in Dallas. However, no matter how big the cloud of un-
better their odds are of winning.
certainty is above revenue cycles nationwide, this year
was not without its successes for patient access teams.
We feel there is no better time to celebrate those successes than in the December PAA. A few managers told
us the following about their triumphs this year and what
they look forward to in 2009.
We look forward to the following changes in 2009:
➤➤ Implementation of a front-end price estimate software application
➤➤ Realignment of preregistration activity to include prefinancial counseling
➤➤ Exploration of an ED bedside collection, as opposed to
Catherine Pallozzi, patient access director,
Albany (NY) Medical Center
Most of our year has been spent on internal institu-
the dedicated discharge desk that is currently in place
➤➤ Further concentrated focus on identifying and reaching out to our uninsured population sooner and part-
tional changes, such as staff realignment, training, and
nering with vendors and insurance companies that
implementation of our clinical systems.
support facilitated enrollment programs
The following are some achievements by our team:
➤➤ Implemented HDX-integrated eligibility system. We worked with our information technology
partners to ensure that the design was what would
Beth Hunley, registration manager, Jay County
Hospital, Portland, IN
We are currently doing a major remodel of our hos-
make us most successful. Our quality and develop-
pital focusing on our ancillary services, including the
ment unit assisted with the significant amount of
patient registration department. The goals for our new
training required. Most importantly, we devised a
space include the following:
very controlled manner in which to identify and re-
➤➤ Moving forward with a professional dress code that
will complement our new area
solve issues.
➤➤ Developed a staff-driven quality improvement
➤➤ Develop a new customer service plan that focuses on:
team (QIT). Staff leaders and managers meet once
–– Patients first
per month to review the quality standards of the de-
–– Compassion
partment. A problem area such as registration field
© 2008 HCPro, Inc.
> continued on p. 8
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Patient Access Advisor
Page 8
Success
December 2008
< continued from p. 7
–– Walking a mile in the patient’s shoes
We had to learn to let go of the paper, which was
–– Giving all your attention to the patient sitting in
not easy. In admitting, this meant scanning registra-
front of you, as patients will be escorted to the reg-
tion documents instead of copying them, and staff
istration booths instead of being told to have a seat
members no longer needed to create a patient fi-
➤➤ Implementing an electronic medical records (EMR)
system
nancial folder. This also required significant changes
to the work flow. We have been using this system
➤➤ Using GUI registration instead of character-based
registration
for approximately six months and are pleased with
the results.
➤➤ Having a switchboard operator
➤➤ Holding training sessions for all employees, focusing
on any weaknesses in a positive manner
➤➤ Better patient flow in the ED. We also implemented a clinical documentation system, which helps my
ED staff members with patient flow.
➤➤ Completing the CHAM exam for myself and CHAA
for the registration employees
In 2009, we are looking forward to:
➤➤ Implementation of an online registration process for
Tanja Twist, director, patient financial services,
Methodist Hospital, Arcadia, CA
our guests.
➤➤ Enhancement of our ability to identify alternative
This year has been very busy for my admitting de-
payment programs and/or facilitate financial assis-
partment, and it isn’t over yet. A few of our major ac-
tance for our uninsured patients while they are still
complishments include:
in-house. We would like to partner with a vendor
➤➤ An express unit. We began the year by fine-tuning
to accomplish this more efficiently.
our preadmission process and opened up an express
registration unit, which guarantees that our prereg-
Debra Keller, CHAA, admissions/registration
istered guests are processed in less than five minutes.
director, Grand Itasca Clinic and Hospital,
This has been beneficial not only for our patients,
Grand Rapids, MN
but for our physicians and ancillary receiving departments as well.
➤➤ A new-hire program. We began an aggressive
Some of our highlights this year were:
➤➤ Insurance verification software. Our biggest
achievement this year was implementing our insur-
new-hire training program and staff reeducation
ance verification software at our front registration.
course, hiring a staff education coordinator to facili-
We had the registration software company basically
tate all training for staff members. We put leads
rewrite the program to be more automated and user-
in place to facilitate registration audits and found a
friendly at our front registration area. This took many
significant decrease in registration errors and an in-
months, but the end result has been successful, and
crease in up-front collections since implementing
we are able to verify eligibility for 98% of our patients
these initiatives.
checking in.
➤➤ An EMR system. The second quarter began by
➤➤ Self-pay collection process. We created a process
going live with a new EMR system, initially launch-
that helps the front patient access staff members with
ing in the admitting and business office, then in
collecting copays, including transparency in report-
medical records four months later. This was a big
ing to each front patient access staff member, using
change for my front- and back-end staff members.
weekly reports and mentoring.
© 2008 HCPro, Inc.
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Patient Access Advisor
December 2008
➤➤ Yearly competency testing for staff members.
We test staff members using a multiple-choice and an
Page 9
front end, POS collections, centralized registration,
denials management, and other departments.
open three-page test, along with quarterly computer
tests on specific registration processes.
Brittany Evans, patient access coordinator,
Harrison County Hospital, Corydon, IN
Our future plans include moving from a hard console
Our highlights at Harrison County Hospital in the past
to a computer soft console in our switchboard and im-
year have been our brand-new facility, implementing an
plementing a new electronic healthcare record.
EMR, and online bill pay.
The move took a lot of planning and training. We
Stephanie Smithson, CHAM, director of patient
hired a company that specialized in big moves, and I
accounts, Dunn Memorial Hospital, Bedford, IN
basically rewrote and added every policy and pro-
We have been through several changes in patient ac-
cedure I could think of into a brand-new registra-
cess this year at Dunn Memorial Hospital, including:
tion manual. I then held a separate on-site training
➤➤ Restructuring patient access
for the registration clerks, in addition to the training
➤➤ Restructuring centralized scheduling to include finan-
held hospitalwide.
cial counseling and preregistration
➤➤ Implementing passport program software for insurance verification in all areas of patient entry
➤➤ Implementing insurance verification for therapies,
rehabs, and recurring services
➤➤ Creating denial reports for front-end education
➤➤ Reporting point of service (POS) for preregistered
patients
The EMR implementation is being done in phases.
Registration led the pack and went live in November.
This has been a group effort with HIM, IS, physicians,
and clinicians. I have also created a step-by-step manual
for registration and have conducted individual training
for this EMR project.
In 2009, we are looking forward to streamlining
more processes with the assistance of our new EMR
➤➤ Using automated patient estimates
system and will possibly look into up-front collections
➤➤ Implementing a physician call calendar and database
and new software to better help the clerks determine
for switchboard staff members that will be rolled out
insurance eligibility. We are also going to concentrate
hospitalwide this month
on customer service.
David Mier, vice president/chief revenue officer
Michele Hill, patient access manager, Skagit
at Children’s Hospital, Omaha, NE
Valley Hospital, Mount Vernon, WA
We have a lot to be proud of, especially our patient ac-
Our primary focus this year has been on streamlin-
cess staff members. Their willingness to buy into the mis-
ing the customer experience and, concurrently, im-
sion of the organization and the vision we have tried to
proving and strengthening our revenue cycle. This
create has been phenomenal.
year, we:
Without their dedication and commitment, we could
➤➤ Implemented bedside registration in the ED and
not have created changes such as implementation of
for our direct admission patients. We have seen
POS collections and electronic eligibility functionality,
our customer satisfaction scores soar using great
ED registration ownership, and revamping the financial
technology, including HDX for insurance eligibility
counselor role.
verification, duplex scanners, and electronic signa-
We look forward to a continued focus on account
segmentation that will place more responsibility on the
© 2008 HCPro, Inc.
ture pads.
> continued on p. 10
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Patient Access Advisor
Page 10
Success
December 2008
< continued from p. 9
➤➤ Provided some specific scripting to assist our regis-
improvement, as well as increased revenue due to
trars in setting the stage for a great patient experi-
the ability to scrub for medical necessity at the time
ence. For example, we introduce ourselves to our
the order is completed and reduce lost orders and
patients and say we are members of their care team
reschedules.
and let them know what we will be doing for them.
When the registration is concluded, we ask wheth-
In 2009, we plan to centralize our scheduling pro-
er there is anything else we can do before the next
cesses with the assistance of a schedule maximizer and
member of their care team arrives.
are working on developing a dedicated preregistration
➤➤ Identified specific areas of need for training and de-
team that would handle preregistration housewide,
veloped checklists for the audit that give consistent
both of which will improve the quality of our prehos-
education to all staff members. This has resulted in
pital services and improve patient and physician satis-
an increase in our accuracy rates as well.
faction. I also hope to add an automated QA process for
➤➤ Evaluated and identified some processes that needed
to be moved to the front end. Our revenue cycle was
registration accuracy.
Overall, I am most proud of the fact that patient ac-
heavy on the back-end due to rework and denials
cess staff members have come to recognize that they are
issues. We have worked to put accuracy and verifi-
healthcare professionals and take much pride in their role
cation on the front end in order to alleviate unneces-
in the revenue cycle and our organization. n
sary rework.
➤➤ Are currently in the process of implementing soft-
Editor's note: If you have any success stories to share, please
ware from a healthcare information provider to assist
call Senior Managing Editor Dom Nicastro at 781/639-1877,
in further customer and physician office satisfaction
Ext. 3413, or e-mail [email protected].
This Month’s
Form
Editor’s note: This is the third part in a series on the Medicare Secondary Payer (MSP) questionnaire.
Asking more questions is one way to avoid denials when an MSP is involved in a claim at your healthcare facility, says
Kevin Willis, director of Medicare Operations at Claim Services, Inc., in Naperville, IL.
Most of the time, registrars in patient access are more concerned with the speed of their registrations and whether the
customer is satisfied, says Willis.
“Accuracy falls third at best,” he says.
You can use the following form to ensure accuracy in your MSP process; it will be an important resource for your facility, as Medicare’s recovery audit contractors collected $12.7 million in MSP errors alone in the three-year demonstration
project.
It is provided by Claim Services and is also featured in Medicare Secondary Payer Questionnaire Training Toolkit, a CD-ROM
from HCPro, Inc.
© 2008 HCPro, Inc.
For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
Patient Access Advisor
December 2008
Claim Services, Inc.
Page 11
Medicare Secondary
Payer questionnaire
Medicare patient information:
Patient name: ______________________________________ Patient account number: ________________________________
HIC number: _____________________________________________ DCN: __________________________________________
Provider number: _________________________________________ Date of service from: ______ through: ______________
Information supplied by: _____________________________ Relationship to patient: ________________________________
Hospital representative: ______________________________ Date: ________________________________________________
1. Workers’ compensation (WC):
Should the illness/injury be covered by a WC claim? _____ Yes _____ No
If “No,” go to #2. If “Yes,” this should be an MSP claim, not Medicare primary.
Note: WC is primary only for claims related to a WC injury.
Original date of illness/injury: ________________________ Claim number: _________________________________________
Name of WC plan: _________________________________________________________________________________________
Mailing address: ___________________________________________________________________________________________
City: ___________________________________ State: _________________ ZIP: ______________________________________
Name of employer: ________________________________________________________________________________________
Mailing address: ___________________________________________________________________________________________
City: ___________________________________ State: _________________ ZIP: ______________________________________
2. Federal Black Lung (BL):
Is the patient covered by the BL program? _____ Yes _____ No
If “No,” go to #3.
Date benefits began: ___________________________________________
Note: BL is primary only for claims related to BL.
3. Department of Veterans Affairs (DVA):
Is the patient entitled to benefits through the DVA? _____ Yes _____ No
If “No,” go to #4. If “Yes,” has the DVA authorized and agreed to pay for care at this facility? _____ Yes _____ No
4. Public Health Services (PHS) or government grant:
Are the services to be paid by a government program such as a research grant? ____Yes ___ No
If “No,” go to #5. If “Yes,” the government program will pay primary benefits for these services.
What is the name of the PHS? _______________________________________________________________________________
Mailing address: ___________________________________________________________________________________________
City: ____________________________________ State: ____________ ZIP: __________________________________________
> continued on p. 12
© 2008 HCPro, Inc.
For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
Patient Access Advisor
Page 12
December 2008
This Month’s
Form
< continued from p. 11
5. Accident:
Are these services the result of a non–work-related accident? ______ Yes ______ No
If “No,” go to #6. If “Yes,” please give a description of the accident (e.g., auto, slip and fall, malpractice, product liability,
homeowner’s): _______________________________________________________________________________________________
Date of accident: _____________________ Location of accident (e.g., home, restaurant): ______________________________
A. Nonliability/no-fault insurance:
Is nonliability insurance (e.g., premises medical, auto medical coverage, no-fault, homeowner’s) available? _____ Yes _____ No
If “Yes,” name of the insurance company: _______________________________________________________________________
Mailing address: _____________________________________________________________________________________________
City: ______________________________________________ State: _______________ ZIP: ________________________________
Who is listed as the insured? _____________________________ Claim number: _______________________________________
B. Liability insurance:
Does the patient feel someone else is responsible for the accident/injury*? _____ Yes _____ No
*The act of holding an entity responsible entails pursuing and/or receiving financial reimbursement as a result of the accident.
If “Yes,” name of responsible party’s insurance company: _________________________________________________________
Mailing address: _____________________________________________________________________________________________
City: ______________________________________________ State: ________________ ZIP: _______________________________
Name of responsible insured party:________________________ Claim number: _______________________________________
6. Working age:
Is the patient aged 65 years or older? _____ Yes _____ No
Is the patient currently employed by an employer with 20 or more employees? ____ Yes ____ No
If “Yes,” name of the employer: ________________________________________________________________________________
Mailing address: _____________________________________________________________________________________________
City: ______________________________________________ State: ______________ ZIP: _________________________________
If the patient is no longer employed, please give a retirement date*: ________ (MM/DD/YYYY)
*If more than five years ago, default to five years from today. If on or prior to Medicare entitlement, may also default to
Medicare entitlement.
Is the spouse currently employed by an employer with 20 or more employees? ____ Yes ____ No
If “Yes,” name of the employer: ________________________________________________________________________________
Mailing address: _____________________________________________________________________________________________
City: ______________________________________________ State: ________________ ZIP: ______________________________
If the spouse is no longer employed, please give a retirement date*: ________ (MM/DD/YYYY)
*If more than five years ago, default to five years from today. If on or prior to Medicare entitlement, may also default to
Medicare entitlement.
➤
Download this entire form in the Patient Access Advisor section of www.accessresourcecenter.com.
Source: Claims Services, Inc.
© 2008 HCPro, Inc.
For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
TrainingTool
Medical necessity
Editor’s note: This month’s training tool is provided by Khristine Anderson, training and data integrity specialist at Baptist
Health South Florida, which includes seven hospitals in the Miami area. Baptist uses the following script for Medicare compliance and documenting medical necessity, which Medicare defines as services or items reasonable and necessary for the diagnosis or
treatment of illness or injury. A provider who bills Medicare for services that Medicare deems not medically necessary can be prosecuted for fraud. This script is only a guide; departmental protocols should be followed for all circumstances not covered.
Script
Notifying the physician’s office:
Good morning/afternoon, my name is ________. I’m calling from ________ (facility or department). The diagnosis provided for patient ________ for ________ (procedure) does not meet Medicare’s requirements. Is there another
diagnosis that would cover the test?
If “Yes”:
Please fax us a new prescription that includes that diagnosis. Thank you for your time and assistance.
If “No”:
We will be contacting _________ to ask him/her to sign an Advance Beneficiary Notice on arrival at our facility.
Notifying the patient if the physician has been contacted:
Good morning/afternoon, my name is ________. I’m calling from _________ (facility or department). The diagnosis
provided by your physician for _______ (procedure) on _________ may not be covered by Medicare. We have contacted your doctor, who has found that there is no other diagnosis he/she can assign for this test. When you come in
for your appointment, the registrar will have you sign an Advance Beneficiary Notice, which states that in the event
Medicare does not pay for the test, you will be responsible for the charges.
Notifying the patient if unable to reach the physician:
Good morning/afternoon, my name is ________. I’m calling from (facility or department). The diagnosis
given by your physician for ________ (procedure) on _________ may not be covered by Medicare. We have
contacted your doctor for his/her review of your medical record. At this time, we have not received a reply.
We can reschedule the appointment for a later date in order for your doctor to review the record. If you would
like to proceed with the test, I must make you aware that when you come in, the registrar will ask you to sign
an Advance Beneficiary Notice, which states that in the event Medicare does not pay for the test, you will be
responsible for the charges. n
A supplement to Patient Access Advisor
December 2008
Registration
accuracy rates update
Quarterly benchmarking report
A supplement to the Patient Access Resource Center
Dear reader:
Welcome to the Patient Access Resource Center’s final quarterly benchmarking report of this year,
designed specifically for patient access managers and finance professionals. This report is based on the results
of a survey in which we asked approximately 150 of your peers to provide information about their registration
accuracy rates.
We wanted to compare the results from our May 2007 survey on registration accuracy. Today, the good news is
that more of your peers are tracking accuracy rates than they were 19 months ago. About 25% of managers said
they did not track accuracy rates in May 2007, compared to 3% today. We suspect that this decrease is a direct
result of the CMS Medicare Recovery Audit Contractor (RAC) program, which begins its nationwide rollout at
the end of this year. The three-year demonstration project collected more than $900 million in overpayments.
The overpaid claims originate on the front end, where accuracy is as important as ever. CMS’ auditing also
included a Medicare Secondary Payer (MSP) RAC, which collected more than $12 million in the demonstration. Although CMS terminated that program, MSP auditing is still a part of the nationwide RAC rollout.
More than 30% of you said your errors come from MSPs.
The report will cover the entire registration auditing process from how providers track results to the criteria they
use when analyzing the mountain of data. The report will also examine the types of errors most providers find
and how they are tackling these mistakes through comprehensive quality assurance and training programs.
If you have any questions about this report or if you’d like to suggest a topic for a future benchmarking
report, please contact Senior Managing Editor Dom Nicastro at [email protected].
And remember, your revenue cycle is only as good as your front end.
Best regards,
Dom Nicastro
Senior Managing Editor
Patient Access Resource Center
781/639-1872, Ext. 3413
[email protected]
2
Registration accuracy rates update
Most managers track accuracy rates
Twenty-five percent of patient access managers
stated that they did not track accuracy rates in our May
2007 survey.
What approach do they use?
Seventy-two percent of managers said they still use
a manual approach, 19% use a software package, and
They said they bemoaned the time restraints in doublechecking their registrars’ work.
the remaining 10% use a combination (Figure 2). One
respondent whose facility tracks accuracy rates manu-
Today, 97% of our respondents check accuracy rates,
seeing it as a crucial step toward a healthy revenue cycle
in which denials are down and claims remain safe from
government auditors (Figure 1).
ally said they are reported to the registrars monthly.
The data originate from a quick visual inspection of
the demographic sheet and any failed electronic claims.
As for the automated approach, some of the more
“We track every entry required for a complete registration,” one respondent wrote.
common software systems mentioned in the survey were:
➤➤AHIQA
Others said they simply don’t have the time or system
to do so and that tracking accuracy rates is difficult.
“Sometimes, you don’t know there are errors until
➤➤AccuReg
➤➤CPSI
➤➤Emdeon Denial Manager
after the bill is denied,” one respondent said. “Also, there
➤➤Compass and EPIC
are so many points of registration to track.”
➤➤McKesson n
Figure 1
Figure 2
Do you track registration
accuracy rates?
If you do track accuracy rates,
what approach do you use?
4%
10%
19%
72%
97%
Electronic (software package)
Yes
No
Manual
Other
Note: Percentages in some graphs might not add up to 100% due to rounding of figures.
December 2008
3
Half of respondents perform audits daily
Fifty percent of our respondents said they perform
sheet,” one respondent wrote. “We review to see if all
registration audits on a daily basis (Figure 3). That rep-
is correct before going to our financial auditor. We are a
resents a 12% increase from 2007, when 38% said they
small rural hospital and we have time to do this daily.”
track rates daily.
Others judge the content of their reviews by patterns.
Thirteen percent said they perform these audits weekly,
“If a pattern of poor work performance is noticed,
20% perform audits monthly, and another 2% perform
an intense audit will be conducted to determine the ex-
annual audits. Some facilities do not audit on a regu-
tent of the issue,” one respondent said. “Performance
lar basis. One manager said his facility performs audits
improvement plans are then created with a three-month
“whenever we can.”
period in which improvement must be made. If improve-
Another said audits are performed for individual clerks
ment is not evident, disciplinary action is taken until the
as needed, meaning audits are conducted when there is a
problem is corrected or the clerk becomes unemployed.”
consistent pattern of errors.
Survey respondents listed a wide variety of answers
to what they look at in terms of accuracy, including:
Content of the audit
➤➤ Demographic information
So what are you looking at to determine your facility’s
➤➤ Social Security number
registration accuracy? It depends on the size of your facil-
➤➤ State of birth
ity, the number of staff members who report to you, and
➤➤ Referring doctor
your available time. Some have enough time for a thor-
➤➤ Admitting category
ough, regular review.
➤➤ Source code
“We use current Web sites for eligibility, and that
insurance is checked against what we have on our fact
➤➤ Durable power of attorney or living will
➤➤ Pregnancy field
➤➤ Patient employment information
Figure 3
➤➤ Medicare Secondary Payer questions for Medicare
How often do you perform
registration audits?
patients
➤➤ Accident or medical code
➤➤ How information was obtained
50%
50%
Daily
➤➤ What documents were signed
Weekly
➤➤ Where information was sent
Monthly
Some facilities simply include everything. “We have
Yearly
40%
over 100 rules built in the system to catch errors before the
No audits performed
Other
30%
sible for correcting prior to billing the claim.” n
Questions? Comments? Ideas?
20%
20%
13%
10%
10%
6%
2%
0%
4
bill drops,” one respondent said. “The registrar is respon-
Contact Senior Managing Editor
Dom Nicastro
Telephone 781/639-1872, Ext. 3413
E-mail [email protected]
Registration accuracy rates update
Error rates getting better, but same struggles exist
The good news with registration accuracy is that facilities seem to be doing better now than they were 19
➤➤ F
ront-line staff/departmental ownership of all nonmedical duties
months ago. Fifty-eight percent of our respondents have
➤➤ Training issues with new information
91%–98% accuracy rates. In May 2007, that percentage
➤➤ Antiquated registration systems
was 44%. Twenty-one percent now fall below the 85%
➤➤ Patients’ lack of knowledge
mark (Figure 4).
➤➤ Registrar apathy
One respondent spoke about trying to get staff mem-
➤➤ Lack of real-time feedback
bers to work efficiently and effectively using the facility’s
own resources.
Eighty-six percent of respondents said insurance is
“We have trouble getting staff to think outside the box
and use the resources to obtain missing information,” the
respondent wrote. “Also, getting them to understand the
where most errors occur. Another 50% said data entry,
and 43% answered guarantor/subscriber (Figure 5).
Demographics (35%) and Medicare Secondary Payer
revenue cycle impact on their errors is a problem. And
(MSP) errors (30%) were also high on the list. Other
our decentralized staff that is not under patient access has
managers said ED patients might give false information,
no buy-in, and we do not have full support of their man-
which can lead to claim nightmares.
agement staff.”
They also talked about errors with referring and pri-
Other problems that led to registration errors included:
➤➤ Consistent equipment malfunctions
mary care physicians.
Poor hours and the pressure-packed environment of
➤➤ High pressure to produce speedy registrations with
insufficient staffing levels
the ED can also lead to errors, one manager said. “Most
of our errors come with emergency department registra-
➤➤ Lack of appreciation at the senior administration level
for the tasks and functions of the front end
➤➤ Poor full-time equivalents and equipment budgets
tions,” the respondent said. “There’s the urgency needed
to register the patients as well as the higher turnover rate
due to the evening and midnight shifts.” n
Figure 4
Figure 5
What are your accuracy rates?
What types of errors are you
finding most often?
30%
30%
28%
Data entry
4%
25%
Insurance info
100%
MSP questionnaire
Emergency contact info
86%
20%
Guarantor/subscriber
80%
15%
Demographics
Co-pay/deductible info
13%
11%
10%
60%
10%
Other
50%
43%
5%
4%
0%
40%
20%
Below 80%
86%–90%
96%–98%
80%–85%
91%–95%
99%
35%
30%
16%
12%
7%
0%
December 2008
5
Variety of leaders handle training
Twenty-nine percent of respondents reported that
Almost all of our respondents said they include read-
their lead registrar conducts their organization’s registra-
ing insurance cards (92%) and a review of their facility’s
tion training. Fourteen percent said that responsibility
policies and procedures (93%) as part of their training
falls on the patient access director (Figure 6).
(Figure 8).
But there are others who do the training, such as the
In the age of self-pay patients, 45% of managers are
quality assurance (QA) leader (14%) and the PFS director
still providing training sessions on how to offer financial
(about 2%). Other trainers included:
assistance. n
➤➤ Registration supervisors
Figure 6
➤➤ PFS educator
➤➤ Information technology, medical records, and patient
Who conducts your registration training?
access coordinators
➤➤ Combination of lead registrars and education team
➤➤ Education unit leaders
2%
14%
➤➤ Supervisors
34%
➤➤ Administrator/business managers
➤➤ On-site trainers
29%
How they train
9%
Managers used a variety of training tactics, including
7%
5%
use of classroom settings (65%) and competency quizzes
(44%). Thirty-two percent said they use PowerPoint presentations, and 6% rely on audio conferences (Figure 7).
Patient access director
QA leader
PFS director
QA staff
Other
Lead registrar
QA leader & staff
Many managers also said one-on-one training works best.
Figure 7
Figure 8
What method of training do you use
with your registration staff members?
What is included in your training?
How to read insurance cards
PowerPoint presentation
80%
How to determine
financial assistance
Classroom setting
Audio conference
70%
86%
100%
16%
86%
Competency quiz
Other
60%
Your facility’s policies
and procedures
Other
80%
43%
50%
16%
40%
60%
30%
50%
30%
40%
43%
20%
10%
0%
6
30%
20%
0%
Registration accuracy rates update
Managers not overwhelmed by number of registrars
Patient Access Advisor spoke with consultants earli-
Figure 9
er this year who said more patient access manager responsibility is moving toward the front end.
How many registrars do you have on staff?
Fifty-four percent of the respondents in our survey
said they manage 1–25 registrars, 24% have 26–50 reg-
3%
3%
6%
istrars, and 10% said they have 51–75 registrars on their
staff (Figure 9).
1 to 25
10%
26 to 50
Few managers said they have more than 100 registrars
51 to 75
(6%), but if that’s the case, many consultants say it’s the
number of direct reports, or the number of registrars that
54%
24%
76 to 100
More than 100
I don’t manage
directly report to you, that matters. Having more than 15
is a little high, says Steven Orvis, revenue cycle consultant in Los Angeles. n
Medicare Secondary Payer Questionnaire Training Toolkit
The best opportunity to find out whether a patient has
➤➤ Samples of proven-effective policies and procedures
another form of insurance that will supersede Medicare is
➤➤ Audit preparation steps and guidelines
during the registration process. The Medicare Secondary Payer
➤➤ A Medicare accident detail form
Questionnaire Training Toolkit is the best source of insurance
➤➤ MSP terminology, definitions, and resources
information and will provide your staff members with the most
efficient registration form during the admission process.
If Medicare determines that another source, such as an
Engage staff members and ensure that they retain crucial
information with this multidimensional product. With this
auto insurance company or workers’ compensation, should
training resource, your patient access staff members will be
be the primary payer of a patient’s treatment, it will not reim-
prepared to:
burse your hospital for the full amount of the claim. Facilities
➤➤ Identify the complexities of the MSP questionnaire and
can lose significant reimbursement dollars if the proper hierarchy of payers is not identified during the registration process.
The Medicare Secondary Payer Questionnaire Training Toolkit
understand its significance
➤➤ Determine when the MSP questionnaire is applicable and
when it needs to be introduced during registration
is a CD-ROM packaged with an instructor’s manual that pro-
➤➤ Recognize the importance of obtaining MSP information
vides you with a collection of practical tools to help prepare
from the patient and applying a proper claim submission
your access staff members to ask the right questions about
➤➤ Explain the purpose of the form to the patient
who is responsible for paying the patient’s bill.
The CD-ROM contains:
➤➤ A PowerPoint presentation covering the basics of the
Medicare Secondary Payer (MSP) questionnaire
➤➤ Training scripts to help staff members explain the form
Save money when you purchase multiple copies! Ask
your customer service representative about money-saving
discounts and bulk orders. To order, call 800/650-6787 or
e-mail [email protected].
and communicate with patients
➤➤ An interactive Jeopardy!®-style game to add fun to the
training and help reinforce information
➤➤ Case study–based quiz questions to teach correct responses in various situations
December 2008
Editor’s note: Jeopardy!® is a registered trademark of Jeopardy
Productions, Inc., in Culver City, CA. The MSP questionnaire game
on this CD-ROM is not endorsed by Jeopardy Productions, Inc.,
nor is it affiliated with Jeopardy Productions, Inc.
7
Speaking out: Your greatest barriers, successes
The challenges to achieving a solid accuracy rate during
➤➤ Dealing with lab and radiology technicans who per-
the past 19 months remain the same: Turnover, staff buy-
form registrations in the respondents’ outreach loca-
in, and lack of proper resources all contribute to setting
tions, because they make the most errors and report
back your patient access team.
to departments other than registration
We wanted to hear about those challenges directly from
the field. So we asked our respondents to tell us about their
greatest barriers. We also asked them to share with us some
of their recent process improvements that have helped
accuracy rates. Respondents said they struggle with the fol-
➤➤ Getting new employees to take their job seriously
➤➤ Not having a computerized system to expedite the
monitoring task
➤➤ Taking the time to collect accurate information from
patients
lowing barriers:
➤➤ Incorrect information on insurance Web sites
➤➤ Understanding the Medicare Secondary Payer (MSP)
➤➤ Changing payers and coordination of benefits because
questionnaire, such as how to correctly complete
it and where some of the information is keyed into
Meditech
patients do not always provide all insurances
➤➤ Inability to attract staff members with higher education
and experience because of inadequate pay-scale levels
➤➤ Educating long-term employees about new methods
and registration needs
➤➤ Dealing with confusing insurance companies
➤➤ Bringing new hires up to speed with reading insurance cards
➤➤ Dealing with registrars who hurry through the registration process to get patients to their appointments
➤➤Handling too many other responsibilities (e.g., cashier-
Respondents’ improvements included:
➤➤ I mplementing a quality assurance (QA) system, retraining all staff members on the MSP questionnaire,
and mandating that all decentralized staff members
use a QA system even if they are not under patient
access
➤➤ Applying new rules, improving the AHIQA process,
ing, mental health insurance preauthorization, and
and boosting the accuracy rate from approximately
patient escorting)
86% to 98% n
12/08
SR5208
This special report is published by HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. • Copyright © 2008 HCPro, Inc.
All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced,
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8
Registration accuracy rates update
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Dear reader:
HCPro, Inc., recently made the difficult decision to stop publishing Patient Access Advisor (PAA). The December issue will be the last issue of this newsletter.
You will continue to receive our free weekly e-newsletter, Patient Access Weekly Advisor. You will also have access
to our Web site, Patient Access Resource Center (www.accessresourcecenter.com). Existing PAA subscribers will
receive a free copy of HCPro’s Medicare Secondary Payer Questionnaire Training Toolkit and a CD of our successful audio conference, “The New ABN and HINN: Master Medical Necessity and Collect Appropriate Reimbursement.”
It is a small token of appreciation for being a subscriber to PAA. We were proud to produce PAA each month and
enjoyed meeting the many individuals involved in patient access, from the critical access hospital patient access
manager whose team scored a 100% on Medicare Secondary Payer (MSP) compliance to the patient access director who led a team of more than 200 registrars and created a solid policy and procedure manual.
We think this final issue in many ways captures the essence of PAA. It includes:
➤➤ An eight-page benchmarking report. We surveyed more than 100 patient access professionals about their
registration accuracy rates in May 2007. This month, we sent out a similar survey to compare the results and
see whether the trends and best practices of 19 months ago still apply today.
➤➤ A medical necessity training tool. Medicare’s recovery audit contractors (RAC) will scrutinize your facility’s
documentation of medical necessity. One PFS manager we spoke with in the September PAA believes it will be
a major part of the RAC project.
➤➤ A comprehensive MSP form. RACs collected more than $12.7 million due to MSP errors uncovered during
the three-year demonstration project. We’ve provided a form that helps you retrieve the right information and
ask the right questions.
➤➤ A story on ABN training. We talked to two training specialists who work with patient access representatives
on everything that is access-related, including the new ABN.
➤➤ A story of success in 2008. Your colleagues share with us their successes this year.
I appreciate your loyalty to PAA over the life of your subscription and look forward to providing you with more
helpful training tools and up-to-date news in our e-newsletter and Web site. Thank you again.
Sincerely,
Lori Levans
Executive Editor, PAA
HCPro, Inc.
[email protected]