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  Patient Access Weekly Advisor Patient Access Weekly Advisor 
 

PAWA offers best-practice tips from access professionals across the country who have found success with innovative approaches to problems. PAWA will also include a timely news brief to help you fine-tune processes and develop solutions for ongoing problems, such as collecting more money upfront and determining deductibles on high-deductible health plans.


October 1, 2008   (Volume 1, Issue 70)
 
MORE RAC TIPS: What patient access managers should watch
Editor’s note: These tips are provided by Tanja M. Twist, director of patient financial services at Methodist Hospital in Arcadia, CA. Twist is the finance chair for the American Association of Healthcare Administrative Management (AAHAM) who has fought Congress on Capitol Hill for better transparency and answers to concerns with RACs on behalf of hospitals. 1. Review your ED admissions. Twist cautions that many admissions from the ER are made because the facility needs to free up ED beds, which can lead to medical necessity problems with the RAC. “Emergency rooms are busy all across the country,” Twist says. “A key component is to make sure you meet the medical necessity criteria for the ER admissions too. The nature of the emergency department beast is things get rushed, but you have to ensure there are protocols in place to watch the ER admissions, too.” If you do not have a 24/7 ED case coordinator position that monitors admissions, ensure someone like your case manager or you, the patient access manager, comes in first thing in the morning to clean up the admissions, she says. 2. Review your one-day stays. “This is another piece the RACs are focusing on,” Twist says. “Should those patients be observations? I’ve seen admitting orders just say ‘admit.’ You have to make sure that physician orders have an ‘admit to acute or admit to observation’ designation. There could be some type of check box for the physician to clearly indicate his selection. From here, the concern is whether or not the acute admission meets criteria.”
 
SNEAK PEEK: Improving communication at Children's Atlanta

Editor’s note: The following is a preview of a story that will run in the November edition of Patient Access Advisor. It is authored by Florence Davis, is the director of Patient Access at Children’s Healthcare of Atlanta, a 489-bed pediatric health system. At Children’s Healthcare of Atlanta, with 489 beds in three campuses and 15 neighborhood locations, we saw a big opportunity to get proof of all communication exchanges from scheduling, pre-registration, pre-certifications, authorizations, notifications and verification of eligibility via e-mail, fax or phone call. As in many hospitals, our staff members use a variety of methods such as phone, fax, and web to communicate with physicians and payers, obtaining eligibility, benefit, and authorization information.

 
MSP COMPLIANCE: Take-home hints on MSP
Editor’s note: Dunn Memorial Hospital in Bedford, IN, uses these hints to help its patient access staff members successfully complete the Medicare Secondary Payer Questionnaire. Medicare is the secondary payor when: The patient is 65 or over and the patient or the patient’s spouse is still employed and has insurance through that employer. The patient is under 65 and the patient or patient’s spouse is employed by an employer with 100 or more employees and has insurance through that employer. The claim is workers comp. The claim is a Black Lung claim. The claim is a result of an accident and liability insurance is available. The claim is for ESRD and the patient is still in the 30-month coordination of benefits period. When Medicare is the secondary payor, the primary payor is #1 in the sequence of payors. Medicare is #2 in the sequence of payors when Medicare is the secondary payor. MSPs are to be completed on each registration to ensure proper billing.
 

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