Grooming a Top Notch Patient Access Professional Betsy Keating, RN, CHAM Senior Consulting Manager October 25, 2011. Agenda. Introduction Examples Compliance Overview Training and Education Performance Management. Introduction .
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Patient Access Associates perform a diverse and complex range of tasks during the registration process:
Embedded within the daily functions of an Access Associate are laws and regulations applicable to their day-to-day job responsibilities.
Improper payments due to:
Patient Access is at the forefront and recognized as a vital component of the Revenue Cycle and strongly influences the financial integrity of the organization.
Student Centered – Focus on the Trainee
Motivation – Build motivation activities
Activation – Give trainee opportunity for active participation
Reinforcement – Learner demonstrates a means of reinforcing newly learned skill
Transfer – Trainer checks throughout program to ensure trainee has an understanding of skill
Environment – Comfortable and suitable for learning
Compliance training is a critical component of an Access Department’s training and education plan.
Educational goals should ensure the Access Associate:
Topic: Medical Necessity and ABN Compliance
Objective: At the completion of this program, the trainee will possess the skills to perform medical necessity checks on all Medicare beneficiaries rendering outpatient procedures and be compliant when issuing an ABN.
Medical Necessity Software Demo
Policy and Procedure
Method of Delivery:
Instructor led discussion, demo, and policy review
Self Learn Training Module with post test
Practical application utilizing sample physician orders
Method of Evaluation:
Post Test Competency
CMS: The Center for Medicare Services issues Regulations for Hospitals and Conditions of Participation (COP). Every hospital accepting payment for Medicare and Medicaid patients –including Joint Commission accredited hospitals must comply with these conditions.
TJC: The Joint Commission provides evaluation and accreditation services for multiple healthcare organizations such as general, psychiatric, children’s rehabilitation, and critical access hospitals. TJC standards address the organization’s level of performance in key functions such as patient rights, patient treatment and infection control, and on its ability to provide safe, high quality care. Joint Commission sets an important standard for hospital complianceunder the premise that if an organization does the right things and does them well, there is a strong likelihood patients will experience good outcomes.
OIG: Office of Inspector General is the federal government’s Department of Health and Human Services publishes compliance program guidance for multiple sectors of healthcare and billing companies.
When: During Registration, Outpatient, Emergency Department, Central Scheduling, Financial Counseling, Admitting, Check-In
The law known as “HIPAA” stands for the Health Insurance Portability and Accountability Act of 1996. Congress, designed the Act to:
The Health Information Technology for Economic and Clinical Health Act (HITECH or "The Act") is part of the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA contains incentives related to health care information technology in general (e.g. creation of a national health care infrastructure) and contains specific incentives designed to accelerate the adoption of electronic health record (EHR) systems among providers.
HITECH also widens the scope of privacy and security protections available under HIPAA; it increases the potential legal liability for non-compliance; and it provides for more enforcement.
*Patient Access Considerations: Insured Self Pay procedure
Under EMTALA, patients are to be “triaged” by a “clinician” to determine severity of illness and degree of emergency prior to being asked about insurance or method of payment.
Three primary requirements on Medicare participating hospitals:
Regulations were amended in 2003 to specifically permit reasonable registration procedures, including inquiries about insurance, before the medical screening examination is done, again as long as those inquiries do not delay the examination. A request for payment, however, may not be made at that time.
Patient Access Responsibilities:
The Red Flags Rule requires many businesses and organizations to implement a written Identity Theft Prevention Program designed to detect the warning signs — or "red flags" — of identity theft in their day-to-day operations. By identifying red flags in advance, businesses will be better equipped to spot suspicious patterns that may arise -- and take steps to prevent a red flag from escalating into a costly episode of identity theft.
Patient Access Responsibilities:
Advance Directive means a written instruction, such as a living will or durable power of attorney for health care, relating to the provision of health care when the individual is incapacitated.
Performance Improvement Plan
Registration Quality Assurance
Insured Self Pay Policy
Patient Search, Name Standard
Key Behaviors to ensure compliance:
Ask Don’t Tell Campaign