february 2008 vol. 5, no. 2 - hcpro.com · february 2008 vol. 5, no. 2 in this issue p. 2 your...

February 2008 Vol. 5, No. 2

IN THIS ISSUE

p. 2 Your questions answeredCondition Code 44 is crucial when it comes to reimbursement, and all departments—from the front end to the back end—are involved.

p. 5 To admit or to register?That is the question for many patient access managers when it comes time to name your department. Some patients and staff members can get confused about what goes on where. The trend lately? Include “access” in the name.

p. 6 How to deliver an Advanced DirectiveHospitals vary greatly on the issue of Advanced Directives. But one thing is universal—be clear with your patients and keep all internal departments in the loop.

Kicking off A-Plus Access and director for the Center for Revenue Cycle Excel-

lence at HCPro, Inc., in Marblehead, MA. “If they fail to

get the appropriate information, then the claim may fail

or become uncollectable,” he says. “They are many times

the first people that the patient sees, and they are ex-

pected to balance customer service, wait times for reg-

istration, and

accuracy with

very little training

in most facilities.

Up until a few

years ago, most hospitals did not consider formal training

for patient access due to the turnover rate being higher

than in other locations within the facility.”

So how do managers address the never-ending turn-

over conundrum? If it were as easy as convincing CFOs

to pay them more, access staff members would be flour-

ishing. But that won’t happen in many cases.

Some say it’s adding incentives. Some say more train-

ing helps. Others say a mere pat on the back goes a long

way. Many say make staff members feel as if their role is

important and that they’re appreciated.

So what’s the answer? We think it’s all of the above.

Hence, the birth of our series, “A-Plus Access.” It’s a

series about enhancing professionalism among Access

staff members. It’s about the tools—incentives, train-

ing, appearance, and feedback—that can make their jobs

better.

In the end, it’s about making access staff members

better. And if they’re better, you, your department, and

your bottom line are better.

Turn to p. 7 to check out the first story in our series

about incentive programs. We welcome your feedback.

E-mail me at [email protected] with any comments

or ideas. n

—Dom Nicastro, senior managing editor,

Patient Access Advisor

Introducing a series

about enhancing

professionalism

Stacks and stacks of paperwork analyzing the high

turnover rate among patient access staff may be valuable

for consultants.

But ask any patient access manager a reason for the

high turnover rate, and his or her answer is simple:

Staff members do not get paid enough, and they have a

thankless job. “I think you have to pay them more,” says

Tracy Walsh, LCSW, director of patient access and case

management at Vail (CO) Valley Medical Center. “I’m

competing with Costco. We’re asking them to be the

face of the organization. We’re asking them to do billing,

medical records, data entry, and cash collections. And in

addition to that, we ask them to be professional. And it’s

demanding. It’s 24 hours, seven days a week. You’ve got

a lot of unpopular shifts to fill.”

How important are front-end access staff members?

“[These] people are truly the ones that determine if

the claim is accurate or not,” says William L. Malm,

ND, practice director of Revenue Cycle Management

Patient Access Advisor February 2008

© 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.

In some instances, a physician may order a beneficiary

to be admitted to an inpatient bed, but upon subsequent

review, it is determined that an inpatient level of care

does not meet the hospital’s admission criteria.

The National Uniform Billing Committee (NUBC)

issued Condition Code 44, effective April 1, 2004, to

identify cases when this occurs. The definition of Con-

dition Code 44 is as follows: “Condition Code 44 Inpa-

tient admission changed to outpatient, for use on out-

patient claims only, when the physician ordered inpa-

tient services, but upon internal utilization review per-

formed before the claim was initially submitted, the

hospital determined the services did not meet its inpa-

tient criteria.”

Your questions answered: Condition Code 44 breakdownThe following is a Q&A with CMS about Condition

Code 44:

Isn’t there a conflict between the Condition Code

44 policy and the standards included in the hospital

Conditions of Participation (CoP) related to review of ad-

missions for medical necessity?

No. The CoP standards in section 482.30 of the reg-

ulations are comprehensive and broadly applicable

with regard to the medical necessity of admissions to

the hospital. CMS set the policy for the use of Condition

Code 44 to address those relatively infrequent occasions,

such as a late-night weekend admission when no case

manager is on duty to offer guidance or when internal

review subsequently determines that an inpatient admis-

sion does not meet hospital criteria and that the patient

would have been registered as an outpatient under ordi-

nary circumstances.

For such cases, prior to implementation of Condition

Code 44, a hospital could only receive payment for cer-

tain nonphysician medical and other health services pay-

able under Part B that were furnished either directly or

indirectly to an inpatient for which payment could not

be made under Part A. Condition Code 44 allows hos-

pitals to treat the entire episode of care as an outpatient

encounter, to report as outpatient services whatever ser-

vices are furnished, and to receive payment under the

outpatient prospective payment system as though the

patient had been registered as an outpatient.

If the hospital complies with the requirement for

written notification within two days of the determi-

nation, can it still bill for the encounter as an outpatient

episode of care and use Condition Code 44?

Yes, as long as the patient has not yet been released

from the hospital, and provided that the other pre-

requisites for use of Condition Code 44 are met.

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

Donna K. GilleyDirector of revenue cycle and regulatory compliance, LBMC Healthcare Group, Brentwood, TN

Amy HarttVice president, VHA Southwest, Plano, TX

Diane Jepsky Healthcare consultant, Seattle, WA

Steven OrvisSenior consultant, Sinaiko Healthcare Consulting, Los Angeles, CA

Joyce Sourbeck, MS, RNAssistant vice president for patient financial services, Washington Hospital Center, Washington, DC

David S. Szabo Nutter, McClennen & Fish, LLP, Boston, MA

Sandra J. Wolfskill, FHFMA President, Wolfskill & Associates, Inc., Chardon, OH

Joe Zebrowitz, MDExecutive vice president/senior medical director, Executive Health Resources, Newtown Square, PA

Patient Access Advisor (ISSN 1933-3307) is published monthly by HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. Subscription rate: $299/year; back issues are available at $25 each. • Postmaster: Send address changes to 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 subscriptions, renewals, change of address, back issues, billing questions, or permission to reproduce any part of PAA, call customer service at 800/650-6787, fax 800/639-8511, or e-mail: [email protected]. • Visit our Web site at www.hcpro.com. • Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish 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.

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.

February 2008 Patient Access Advisor Page �

© 2008 HCPro, Inc.


Can a case manager or utilization management staff

member change a patient’s status from inpatient to

outpatient after determining that the hospital’s admis-

sion criteria were not met?

CMS has received many questions regarding who

may make the status change and requests for clari-

fication as to whether utilization management staff or a

case manager may implement the change.

The CoP in section 482.30 of the regulations requires

that the utilization review committee be composed of at

least two doctors of medicine or doctors of osteopathy,

although it may include other specified practitioners.

The CoP provides that the determination concerning the

medical necessity of an admission or continued stay must

be made by members of the UR committee (or QIO) in

consultation with the practitioner(s) responsible for the

care of the patient.

Section 482.12(c) of the CoP provides that patients are

admitted to the hospital only on the recommendation

of a licensed practitioner permitted by the state to admit

patients to a hospital.

If a Medicare patient is admitted by a practitioner not

specified in Medicare regulations, the patient must be

under the care of a doctor of medicine or osteopathy.

Therefore, a case manager or other utilization man-

agement staff person who is not a licensed practitioner

permitted by the state to admit patients to a hospital or

a doctor of medicine or osteopathy would not have the

authority to change a patient’s status from inpatient to

outpatient.

However, we encourage and expect hospitals to employ

case management staff members to facilitate the applica-

tion of hospital admission protocols and criteria, to facili-

tate communication between practitioners and the UR

committee or QIO, and to assist the UR committee in the

decision-making process.

Use of Condition Code 44 is not intended to serve as

a substitute for adequate staffing of utilization manage-

ment personnel or for continued education of physicians

and hospital staff members about each hospital’s existing

policies and admission protocols. As education and staff-

ing efforts continue to progress, the need for hospitals to

correct inappropriate admissions and to report Condition

Code 44 should become increasingly rare.

Is the concurrence of any physician or practitioner

acceptable when a hospital has determined that a

patient’s status should be changed from inpatient to

outpatient?

One of the requirements for the use of Condition

Code 44 is physician concurrence with the determi-

nation that an inpatient admission does not meet the hos-

pital’s admission criteria and that the patient should have

been registered as an outpatient. The practitioner(s) re-

sponsible for the care of the patient must concur with the

hospital’s finding that inpatient admission criteria were

not met. This prerequisite for use of Condition Code 44

is consistent with the requirements in the CoP in section

482.30(d) of the regulations. This paragraph provides that

the practitioner or practitioners responsible for the care of

the patient must be consulted and allowed to present their

views before the UR committee or QIO makes its determi-

nation that an admission is not medically necessary.

How does a hospital bill using Condition Code 44?

When the hospital has determined that it may sub-

mit an outpatient claim according to the provisions

applicable to the use of Condition Code 44, the hospital

should report the entire episode of care as an outpatient

encounter, as though the inpatient admission never oc-

curred. When a hospital submits a 13X or 85X type of

bill for services furnished to a beneficiary whose status

was changed from inpatient to outpatient, the hospital

must report Condition Code 44 in one of form locators

24–30, or in the ANSI X12N 837 I in Loop 2300, HI seg-

ment, with qualifier BG, on the outpatient claim. Condi-

tion Code 44 will be used by CMS and the QIO to track

and monitor these occurrences.

> continued on p. 4


© 2008 HCPro, Inc.


How should the hospital bill Medicare if the criteria

for using Condition Code 44 are not met but all re-

quirements in section 482.30 of the CoP have been com-

plied with?

If the provisions for use of Condition Code 44 are not

met, the hospital should submit a bill using Type of

Bill 12x for covered Part B–only services that were fur-

nished to the inpatient.

Medicare may still make payment for certain Part B

services furnished to an inpatient of a hospital when

payment cannot be made under Part A because an in-

patient admission is determined not to be medically

necessary.

Information about Part B–only services is located in

the Medicare Benefit Policy Manual (Chapter 6, Section 10).

Examples of such services include, but are not limited to,

diagnostic x-ray and laboratory tests, surgical dressings

and splints, prosthetic devices, and other services.

The Medicare Benefit Policy Manual includes a complete

list of the payable Part B–only services.

How should the change in patient status from in-

patient to outpatient be reported in the patient’s

medical record? Can the hospital simply discard the

inpatient record?

Entries in the medical record cannot be expunged or

deleted and must be retained in their original form.

Therefore, all orders and entries related to the inpatient

admission must be retained in the record in their origi-

nal form.

If a patient’s status changes in accordance with the re-

quirements for use of Condition Code 44, the change

must be fully documented in the medical record, com-

plete with orders and notes that indicate why the change

was made, the care that was furnished to the beneficia-

ry, and the participants who made the decision to change

the patient’s status.

Why has CMS required that the patient still be in the

hospital when his or her status is changed from inpa-

tient to outpatient? Most hospitals have agreements with

QIOs for UR, and determinations about medically unnec-

essary admissions can be decided days or weeks after the

patient leaves the hospital.

The patient rights CoP in section 482.13 of the reg-

ulations require a hospital to protect and promote

each patient’s rights.

Medicare beneficiaries have the right to participate in

treatment decisions and to know their treatment choic-

es. Beneficiaries are also entitled to receive information

about coinsurance and deductibles. CMS has a duty to

protect these rights.

Requiring that the decision resulting in a change

in patient status be made before the beneficiary is dis-

charged is intended to ensure that the patient is fully

informed about the change in status and its effect on

the coinsurance and deductible for which the benefici-

ary would be responsible.

For example, if a patient has already met his or her

Part A deductible, informing the beneficiary a month

after discharge that he or she will now be responsible for

additional coinsurance as an outpatient could impose a

financial hardship.

Additionally, the hospital is responsible for ensur-

ing that when there is a question regarding the medi-

cal necessity of an inpatient admission, the required

UR of that patient’s status is conducted as stated in

42 CFR 482.30.

The UR committee’s responsibilities and functions

may be conducted by the QIO that has assumed bind-

ing UR.

However, it is the hospital’s responsibility to have

either a UR committee or a QIO that carries out the UR

activities as described in 42 CFR 482.30, including the re-

view for medical necessity of an inpatient admission and

continued stay. n

Condition Code 44 < continued from p. 3

February 2008 Patient Access Advisor

© 2008 HCPro, Inc.


What’s in a name?Admitting or registration? How about neither?

For many patient access managers, it is a common

problem: A patient walks into a hospital and is confused.

The signs—“Admitting” and “Registration”—are meant

to guide them.

But do they really help? Often, they don’t.

That’s why many access managers have lobbied their

facilities to change the name to cover services more

broadly. Most of the time, those names include “Access”

in the title.

“It’s just not as simple as registration anymore,” says

Fran Landry, patient access director at the 451-bed

West Jefferson Medical Center in Marrero, LA. “It’s so

much more involved now.”

Why the confusion? Some hospitals have access staff

members who wear badges that say “Patient Registra-

tion.” But the same staff members answer the phone

with the greeting “admitting,” and other staff members

in the facility call them “admitting staff.”

Landry’s facility now goes with “Patient Access.” West

Jefferson, like many other large metropolitan facilities,

has several access points for the patient—hence, the in-

clusion of “Access” into the title of the department.

“I guess in the last couple of years we changed to

‘Patient Access’ since it already involved so much more

than just admitting,” she says. “There’s also so much

more than just registration. We took scheduling.”

Landry says the name was changed four years before

she arrived at West Jefferson. Asked if she had a choice

to name a department admitting or registration, Landry

said she would go with the latter.

“If I were given a choice, I would choose registration,”

Landry says. “To me, admitting is one type—inpatient—

whereas registration encompasses all patient types.”

Catherine Pallozzi, CHAM, CCS, director of Patient

access at the Albany (NY) Medical Center, says her facil-

ity underwent a similar change in 2001.

It began with an executive administrative request to

have what was then “Access Management” (bed control)

and the entire ED clerical team report to the registration

department.

“As part of this request, I felt it important to capture

the true essence of all the units, thus ‘Patient Access’ was

born,” Pallozzi says. “It better represented our primary

purpose and function.”

But any name change has its challenges. Communi-

cating with staff members is one of them, Pallozzi says.

“Any name change always takes a bit to catch on,”

she adds. “During this change, a name change of bed

control was made to ‘Bed Access.’ The most difficult

challenge was going from 40 FTEs [full-time employees]

to over 95 FTEs and assuring each staff member under-

stood what units actually made up the patient access

department and having the staff identify with their

new team.”

Pallozzi’s umbrella under “Patient Access” is regis-

tration, preadmission, bed access, insurance verifica-

tion, a patient assistance unit, an ED, and quality and

development.

In all, it’s been a move for which Pallozzi is thankful.

“Events such as Patient Access Week and our depart-

ment’s involvement in the financial arm as well as the

clinical arm have assisted in having the entire institute

understand,” she says. “In many forums, patient ac-

cess is referred to, and it is able to be identified that the

full scope of services [are] also [offered]. The only glitch

we still find every so often is bed access sometimes

being used to describe patient access, but this too is

subsiding.” n

Contact Senior Managing Editor Dom Nicastro

Telephone 781/6�9-1872, Ext. �41�

E-mail [email protected]

Questions? Comments? Ideas?


© 2008 HCPro, Inc.


Transparency—with staff members and with patients—key to delivering Advanced Directive

It all comes back to the front end in the healthcare

revenue cycle. It is certainly true with Advance Directive

forms. The forms, to be completed by patients in case

they are unable to make medical decisions for them-

selves, most often are presented by patient access staff

members. But any lack of communication among access,

nursing, and case management staff members can lead to

unnecessary confusion and headaches come compliance

checks.

Mandatory requirements from CMS, including the Fair

Patient Billing Act, are on the minds of access managers

lately. The goal is to comply and present Advance Direc-

tive forms in the most patient-friendly, transparent way.

Just ask

The responsibility lies with access staff members to ask

whether patients have or need a form.

“My staff are informed during training on how to ask,”

says Vonda DeLorenzo, patient registration supervisor

at Central Michigan Community Hospital in Mt. Pleasant.

“For example: ‘I see that you don’t have an Advanced Di-

rective for Healthcare. Would you like a copy?’ ”

And what if a patient asks about the form? DeLorenzo

says they explain it as if it were a “living will,” although

Michigan doesn’t recognize that term.

“It is where you set up in advance your medical wishes

should you become incapacitated and are unable to speak

for yourself regarding your medical care,” DeLorenzo adds.

“You usually appoint an advocate who will act on your be-

half, and [he or she has] to agree to act on your behalf.

We try to keep it short and sweet and not spend too much

time on it. Very few people are interested. You always get

the one who wants to know if they are going to die today.”

Some facilities do not go over them, but they comply

with other forms. “We have a registrar visit every admis-

sion for card copies and demographic verification,” says

Brittany Evans, patient access coordinator at Harrison

County Hospital in Corydon, IN, which is licensed for

49 beds. “So we have them sign the consent for treat-

ment, Medicare notice, and HIPAA notice. We also offer

them the patient’s rights and HIPAA forms. As we tran-

sition to the new hospital, we will also be collecting the

Advance Directives once we implement electronic med-

ical records. Right now, the care coordinator gets the

second Medicare waiver and any other necessary paper-

work signed as they visit every inpatient.”

Get folks involved

Tracy Walsh, LCSW, director of patient access and case

management at Vail (CO) Valley Medical Center, says the

most important part of handling the Advanced Directive

form is ensuring that multiple entities are involved.

When she was the director of patient registration at

Tahoe Forest Hospital in Truckee, CA, Walsh says, there

were trigger points for different departments to become

involved in the process—all the way from the beginning

when the facility concocted the form. “All the different

entities had to get together and agree on it,” Walsh says.

It all began in patient access, which would establish

with the patient what the form means.

“A lot of times people didn’t know what it was,”

Walsh says. “We were making it simplistic enough for

a registrar to explain it. That was the difficult part. You

map out your process, then you try to find something

that carries over to the other entities. You try to develop

a simple one-page document that is easy for anyone to

pick up and know their responsibilities.”

After the form left access, it would trigger the ward

clerk to get it from medical records. Then a social worker

was contacted if necessary.

And in comes case management.

“Case management needed a trigger because they re-

view 100% of cases anyway,” Walsh says. “They needed

to know if there was something they needed to do.” n


© 2008 HCPro, Inc.


Pat them on the backA good incentive program goes a long way for access staffs

With the high staff turnover in patient access de-

partments, employers need to seek out ways to pro-

vide as much motivation as they can offer.

Michael Friedberg, in the HCPro book Staff Compe-

tency in Patient Access, wrote, “When talking to my col-

leagues throughout the access community, I’ve found

that the one common challenge—regardless of the size

of the hospital, type of hospital, or location—is finding,

training, motivating, and retaining good, qualified staff

members to work in patient access.”

With all the effort that goes into finding and train-

ing reliable patient access staff members, many man-

agers ask themselves, “Why not put a little more effort

into creating an incentive program for those staff mem-

bers?” It can take a lot of work on the front end to de-

vise a reasonable plan that will be approved by the

administration, but if done right, an incentive program

could prove to be effective not only in retaining good

staff, but ultimately as a cost benefit for the facility.

In September 2007, HCPro held an audioconference

about employee incentive programs, “Incentive Pro-

grams for Access Staff.” The speakers discussed their

incentive programs from two angles—one devised for

central scheduling, which has been in place for sever-

al years and has provided measurable results, and the

other for registration.

Central scheduling: A proven incentive

program

Linda Hogel, RN, project coordinator for access

and care management at TriHealth, Inc., Good Samari-

tan, and Bethesda North hospitals in Cincinnati says

developing and implementing an employee incentive

program was “quite a challenge,” but the backing of

HR was a big help.

The program, which was implemented in 2000,

assesses three areas of central scheduling: quality,

productivity, and attendance.

“Those are our three key criteria for measuring the

outcomes for the incentive program and awarding the

bonuses to the

individual em-

ployees,” says

Hogel. Each de-

partment then

develops its own

quality, produc-

tivity, and atten-

dance standards to be measured against the company

standard.

Beverly McCauslin, manager of central scheduling

and communication support for TriHealth, Inc., says

the program has three levels of incentives: 4% pay-

out, 6% payout, and 8% payout. To measure quality,

target indicators are checked on a monthly basis for

each scheduler, such as incomplete and missing ICD-9

codes, diagnosis misspellings, mismatching of the diag-

nosis and procedure, and scheduling errors.

To measure productivity, McCauslin’s department

relies on the phone and scheduling systems to provide

accurate statistical data reports.

A productivity chart is given to each scheduler

every month. It contains all data elements, such as

inbound and outbound calls, number of procedures

scheduled, and the average time a caller is on hold.

The productivity chart allows them to see which staff

members are eligible for incentives and gives staff

members the opportunity to view their own perfor-

mance and know for what raise they might qualify.

“ The goal is to ultimately

reduce costs and make the

program pay for itself by

reducing costs . . . You want

the incentive program to be

self-funding.”

—Marilyn Lipka

> continued on p. 8


© 2008 HCPro, Inc.


“There are no surprises for our employees—they

know how they are doing month to month, and even

day to day, because they get their auditing sheet back

on a daily basis,” McCauslin says.

Return on investment

Since the inception of the program, McCauslin’s de-

partment has seen increased productivity with only a

0.5 FTE increase. She reports that since 2000, their in-

bound and outbound calls have increased by 30%, and

the number of scheduled procedures has increased by

32.5%. At the same time, accuracy improved. “When

we implemented this incentive plan, our accuracy in

2000 was at 90%. Our accuracy is currently at 97.8%,”

McCauslin says. “Our phone monitoring—where we

listen into the calls and see how our script is going and

if our employees are touching on the appropriate data

elements—in 2000, that was 85%. In 2001, after imple-

mentation of the incentive plan, it went up to 90%, and

currently, it’s 99%.”

McCauslin says that at the time they started the in-

centive program, staff members felt the goals might be

unattainable. “They just felt overwhelmed; that this

was impossible,” she says. “After it was implemented,

and we did some training with the employees, in 2004

the targets had to be adjusted again because everyone

was making the incentives.” As each employee reaches

a target, they can receive $300–$800 per quarter de-

pending on which target they achieve and their hourly

rate. McCauslin reports that 19 out of 22 of her em-

ployees are eligible for an incentive bonus. Most of her

employees also receive a 6% raise annually because

they’ve met all their incentive targets.

“The incentive program in central scheduling at Tri-

Health has been very successful,” she says. “It has real-

ly helped us to maintain and encourage our staff.”

Setting up an incentive program

Marilyn Lipka, vice president of Wolfskill & Asso-

ciates, a national healthcare revenue cycle consulting

firm in Ohio, provides some guidelines about how to

start incorporating an incentive program from a regis-

tration perspective. She says the first step is to define

what your program will be and specifically what you

want it to achieve.

Some of the questions to answer in determining

your program are:

Who will be included?

Will it be only staff members in a centralized area,

or will it include registration staff members in spe-

cific departments?

What will be audited, and how will the auditing be

accomplished?

What will you use as your quality and productivity

standards?

➤

➤

➤

➤

< continued from p. 7

Audioconference: ‘Managing Bad Debt’

The OIG said in its 2008 WorkPlanthat it will be auditing

Medicare bad debt payments. Hospitals need to understand

what the OIG will be looking at, but also how to ensure

their processes are compliant for writing off bad debt. Please

join us for our audioconference, “Managing Bad Debt—Best

practices to ensure a compliant process,” February 26, from

12:30 p.m. to 2:40 p.m. (EST). Speakers Joe Rivet, CPC,

CCS-P, and Sandra J. Wolfskill, FHFMA, will discuss:

What the OIG is looking for and what hospitals can do

to be proactive

Best practices for writing off bad debt

Determining the clear difference between bad debt and

charity care

To sign up, please contact our customer service center

at 800/650-6787.

➤

➤

➤


© 2008 HCPro, Inc.


1. Start by setting achievable targets. Keep re-

viewing them to make sure they make sense as

things progress.

2. Validate that the audits are fair and objective.

Ask your staff members if they think your auditing

process is fair.

3. Communicate all along the way. Communicate

not only with each staff member about their day-

to-day performance, but allow them to know how

the facility is performing as a whole. One way of

doing this is to put your costs and debt reduction

charts up for the department to view. This gives

staff members the chance to view the effect their

individual work is having on the organization.

4. Listen to the feedback. Based on the feedback you

receive, revise and adjust your program as needed.

5. Celebrate. Aside from the incentive payout for staff

members who meet the eligibility standards for the

incentive, Lipka says: “I think you also have to rec-

ognize that most of the staff within the registration

areas . . . are doing better to the extent that the orga-

nization is reducing bad debt . . . and meeting each

of the individual goals, and you should celebrate that

as a department. Have dress-down days; bring in

lunch. Don’t forget to reward everyone.” n

When and what incentive payouts will you set up?

What external software will you need for tracking

and auditing information?

You should also determine your audit sample size.

“The industry basically says, ‘If you want to reach a

95% competence [level] . . . you need to review about

5%. If you want to get to 99%, you need to review

about 10% of registrations,’ ” she says.

After you’ve defined your program and what you

want to accomplish, you will need to explain to ad-

ministration why you think an incentive program is

important for patient registration and present a cost-

benefit analysis to them. “The goal is to ultimately re-

duce costs and make the program pay for itself by

reducing costs . . . You want the incentive program to

be self-funding,” Lipka says. Once you obtain approv-

al, make sure you write down your program’s specific

policies and procedures and walk your staff members

through them. They should fully understand the ex-

pectations that have been set for them.

Achieve your goals

To realize the goals you’ve set for your department,

Lipka outlines some important steps:

➤

➤

Your source code: N0001

Name

Title

Organization

Address

City State ZIP

Phone Fax

E-mail address(Required for electronic subscriptions)

❏ Payment enclosed. ❏ Please bill me.❏ Please bill my organization using PO # ❏ Charge my: ❏ AmEx ❏ MasterCard ❏ VISA

Signature(Required for authorization)

Card # Expires(Your credit card bill will reflect a charge to HCPro, the publisher of PARC.)

❏ Start my subscription to Patient Access Resource Center immediately.

Options No. of issues Cost Shipping Total

❏ 1 yr membership 12 issues $299 (PARC) $24.00

Sales tax (see tax information below)*

Grand total

Order online at www.hcmarketplace.com.

Be sure to enter source code N0001 at checkout!

*Tax Information Please include applicable sales tax. Electronic subscriptions are exempt. States that tax products and shipping and handling: CA, CO, CT, FL, GA, IL, IN, KY, LA, MA, MD, ME, MI, MN, MO, NC, NJ, NM, NY, OH, OK, PA, RI, SC, TN, TX, VA, VT, WA, WI, WV. State that taxes products only: AZ. Please include $27.00 for shipping to AK, HI, or PR.

Mail to: HCPro, P.O. Box 1168, Marblehead, MA 01945 Tel: 800/650-6787 Fax: 800/639-8511 E-mail: [email protected] Web: www.hcmarketplace.com

For discount bulk rates, call toll-free at 888/209-6554.

PARC Subscriber Services Coupon


© 2008 HCPro, Inc.


FormThis Month’s

➤ DownloadthisentireforminthePatient Access Advisorsectionofwww.accessresourcecenter.com.

Whenappropriate,check“Yes”toindicatethatthetaskiscomplete.

A supplement to Patient Access Advisor February 2008

Training ToolTraining ToolSample Advanced Directives form

Source: Tahoe Forest Hospital District.

february 2008 vol. 5, no. 2 - hcpro.com · february 2008 vol. 5, no. 2 in this issue p. 2 your...

Documents