“
Price transparency and consumerism have a direct impact
on today’s hospital Patient Access operation and more
changes are coming in 2021 due to new, stringent Federal
and State regulations. Considered the hospital’s “front
door,” the role of Patient Access has traditionally begun
with the initial patient encounter — where staff confirm
patient identity, verify insurance status and more.
Healthcare reform has changed the role of Patient Access
substantially, focusing revenue cycle leadership more on
the expanding role and expertise of its Patient Access staff.
Today’s Patient Access expert is tasked with capturing
patient information, as well as educating and supporting a
range of individuals—patients, hospital personnel, and
providers—helping to ensure comprehensive,
quality healthcare service delivery and patient satisfaction.
Healthcare industry challenges, such as a payor mix shift
and rising patient debt, have also expanded the role of
Patient Access into upfront collections at healthcare
organizations across the country. A robust health
information technology suite and Patient Access presence
assist in securing patient out-of-pocket costs and/or
alternative payment solutions, integral to maintaining a
healthy bottom line. From the first patient interaction,
today’s Patient Access team:
• Schedules healthcare service appointments
• Determines patient insurance eligibility
• Enters required demographic and billing data
• Collects co-pays and discusses alternative
payment solutions
Today’s Patient Access
expert is tasked with
capturing patient information,
as well as educating
and supporting a range
of individuals
”
HealthStream.com/contact • 800.521.0574 •
The bar is set high regarding responsibilities required of a
Patient Access team. They must operate at maximum
performance levels, create a positive patient experience,
and protect revenue integrity by ensuring appropriate
insurance reimbursement and patient payments for
services rendered.
How can hospitals and healthcare organizations ensure
their Patient Access team is executing at a high level?
Implementing key performance indicators (KPIs), providing
education, and mentoring your Patient Access
representatives comprise an impactful first step to
achieving patient satisfaction and revenue cycle success.
DEVELOP AND MONITOR KEY
PERFORMANCE INDICATORS (KPIs)
To ensure a high level of productivity and accuracy, Patient
Access operations should be measured on KPIs to monitor
quality, process, financial, and customer service.
Healthcare organizations throughout the medical industry
have established guidelines on appropriate Patient Access
KPIs with examples, including:
1. QUALITY – A best practice benchmark for
duplicate medical records is 2% or less says American
Health Information Management Association
(AHIMA). Duplicate medical records can lead to
patient safety issues. Patient Access has the best
opportunity to validate patient identification and
prevent duplication by reviewing key identifiers.
2. PROCESS - Benchmark for resolving prior
authorization and medically necessary services are
both key for successful denial prevention. According
to the National Associations of Healthcare Access
Management (NAHAM) the benchmark is >90%. As
part of patient scheduling/intake, the Patient Access
team must validate that authorizations are in place
and services are medically necessary.