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practices are consistent across our organizations by
training the staff to recognize and correct mistakes.”
“I think all providers can agree that every patient
deserves the best trained workforce. We accomplish
this by hiring well, onboarding well, and continuing to
professionally develop our teams. This path will reduce
turnover and increase employee and patient
satisfaction,” according to Gurzynski-Wells.
Maximize Point of Service Collections
According to the Wall Street Journal, hospitals are 60%
less likely to receive payment for the patient portion of
the bill once that patient leaves the hospital. “With high
deductible plans and higher co-pays, patient out-of-
pocket costs are rising. The access staff at hospitals
must navigate insurance eligibility and benefit coverage,
and then strategically and confidently communicate and
collect the financial responsibility from the patient,”
Gurzynski-Wells says.
“Not all providers have mastered the art of collecting
the maximum amount of revenue at point of service.
We find that when staff members start financial
conversations with patients ahead of their visits,
organizations seem to be more successful,” she
observes. In her experience, Gurzynski-Wells explains,
“educating patients in advance about their financial
obligation also improves their satisfaction. When you
educate them early, they aren’t surprised when they get
to the hospital or their healthcare facility and are asked
for payments.”
AHIMA recommends the organization’s financial
policies should provide guidance to patients regarding
collection of co-payments and unpaid balances.
“Providers should use financial policies to provide
guidance and outline patient responsibilities regarding
both insurance requirements and financial
arrangements for unpaid balances. This includes charity
care and other payment arrangements,” Gurzynski-
Wells advises.
“Across scheduling and registration, everyone should
be doing the same thing and following the same
procedures. When we have a mixed bag of different
practices, it makes things both difficult to manage and
unprofitable,” cautions Gurzynski-Wells.
Patient access is also the stage when patient data,
including insurance information, provider eligibility, and
diagnosis codes, are gathered and stored. Accurate
patient registration eliminates reworking on the
backend, but it also creates a solid foundation for a safe
patient encounter.
Preventing Claims Denials
Up to one in four claims are denied, according to
research from the Government Accountability Office.
In 2013, hospitals were underpaid for medical services
by $51 billion, according to the American Medical
Association. The average denial rate for Medicare
patients in 2013 was 4.9%. Failed claims are among the
most labor-intensive issues healthcare organizations are
tackling today. If healthcare professionals do not watch
claims closely, they will be unable to determine when
an error or coding issue has occurred. As a result,
revenue can be lost.
“Organizations can shift from
rework to proactive correction.
By training revenue cycle
personnel to recognize and
identify the origin of these
patterns and providing education
in the areas where those patterns
originated, errors can be corrected
before claims are submitted.”
Scrubbers highlight claim errors so billers know what’s
wrong. Incorrect codes are often chosen from the
charge master due to inadequate education of clinical
personnel who are entering the charges. Some of the
most common issues found in hospital claim scrubbers
are entering out-of-date ICD, CPT, and HCPCS codes;
entering incorrect place of service or revenue codes;
attaching conflicting or confusing modifiers on HCPCS
or CPT codes; and entering the wrong number of digits
for ICD 10, CPT, and HCPCS codes.