The cost of healthcare is quickly rising across the nation, and patients are shouldering the majority of the price increases through higher deductibles and out-of-pocket expenses as expenditures continue to shift from employers to patients. According to a TransUnion Healthcare report released during HFMA's 2016 National Institute in Las Vegas (www.marketwired.com/press-release/-2137926.htm), patients experienced a 13% increase in medical costs between 2014 and 2015.
A rise in self-pay patients usually signifies an increase in bad debt risk that can have a sharp and negative effect on revenue streams. As expected, healthcare organizations responded to this upward trend in patient financial responsibility by dedicating more attention and resources to managing their self-pay accounts. But are additional complications necessary? Can self-pay accounts be managed more effectively by actually taking fewer and more logical steps?
Recent work with pre-acute care providers, such as emergency medical services (EMS) and emergency medicine physician groups, reveals that most of these providers are struggling to address self-pay accounts. Hospitals and health systems report similar concerns. Addressing the rise in self-pay patients requires a shift change in revenue cycle management strategies and tactics.
Instead of raising the level of complexity required to manage self-pay receivables, providers should try to simplify efforts?work smarter, not harder. Determining patient propensity to pay is one of these practical steps. Using the pre-acute care sector as one example, qualification for accounts management can be radically simplified with significantly fewer steps.
When I look back on 30 years of involvement with HIM, it's hard to believe that I was also passionate about another profession at one time. But I actually came to my career as a coder by way of my associate's degree in veterinary science.
Q: What recommendations do you have for handling medical records for staff members who are also patients at the organization where they work? Should we provide extra protection for these patients? What can we do to ensure that staff members are not accessing their coworkers' records without permission or need?
A: I am a firm believer in not adding special protection to any record, because it implies that some records are more confidential than others. In fact, all records are confidential and staff should not access any record unless it is necessary to do so to do their jobs. And, if it is necessary, they should only access the minimum necessary to do the job. HIPAA requires access monitoring, so your organization should conduct routine audits to determine whether staff are accessing records without a work-related reason. There is now software available that can conduct routine audits by staff member and department. This software can be used to reassure staff that their information is not being accessed by coworkers and to hold accountable those who are not following the policy/law. When a staff member raises a concern, an audit should be run to determine whether inappropriate access has occurred, and if it has, sanctions should be applied. Organizations should also consider having a policy that staff should not handle coworkers' (or family members') records (except in an emergency) without the permission of their supervisor.
All of these points should be reviewed at orientation and during (at minimum) annual training to ensure all staff understand that the organization takes such transgressions seriously and will take action as needed to protect the privacy of every patient's information.
So many people struggle early in their careers with finding a perfect fit for their talents and passion. My story is exactly the opposite. My entire family is in healthcare, so I chose my career quite naturally. Though I had a bit of a circuitous route into my final landing place, I cannot say I'm surprised to have landed here.
Reconciliation is a noun meaning "the process of finding a way to make two different ideas, facts, etc. exist or be true at the same time." In the world of clinical documentation improvement (CDI), "reconciliation" typically refers to diagnosis-related group (DRG) reconciliation, which is the process of adjusting DRGs when those assigned by the CDI specialist do not match those assigned by the coder.
Reconciliation is a noun meaning "the process of finding a way to make two different ideas, facts, etc. exist or be true at the same time." In the world of clinical documentation improvement (CDI), "reconciliation" typically refers to diagnosis-related group (DRG) reconciliation, which is the process of adjusting DRGs when those assigned by the CDI specialist do not match those assigned by the coder.
Q: Can I leave a patient a voicemail about an MRI procedure, including the time and date? What should I do if someone else at the patient's home answers the phone? How much info can I leave with the other person, and how can I verify that person's identity and relation to the patient?
It's no secret that hospitals struggle with assigning the most appropriate status for patients, and this challenge is compounded by CMS' frequent changes to its regulations and guidance. To combat incorrect patient status assignments, one hospital has developed a system that rewards employees for speaking up when they suspect a patient's status is incorrect.
Observation services are an ongoing point of confusion for hospitals and patients, many of whom have become fearful of out-of-pocket costs and SNF coverage eligibility associated with outpatient observation services. Developing a workflow to comply with the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act and the Medicare Outpatient Observation Notice (MOON) is essential and is intended to help hospitals ease patients' concerns by clearing up the implications of observation.
