The Complete Patient Access Handbook

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The Complete Patient Access Handbook

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Available December 2017

The Complete Patient Access Handbook

Marsha L. Sopiecha
Victoria L. Ludwig, MS 

Available December 2017

Patient access staff are often the first hospital staff members who interact with patients. These staff must possess the customer service skills to make patients feel welcome and understand the role they play in ensuring the integrity of patient data they collect. Unfortunately, high turnover in this department can make it difficult for managers and directors to get patient access operating successfully and efficiently.

The Complete Patient Access Handbook is a comprehensive, all-in-one guide to effectively operating a patient access department. This resource outlines specific tactics and strategies for developing a patient access staff training program, including best practices for mentoring and incentivizing patient access staff, as well as tips for holding staff meetings and ensuring employee satisfaction. The book takes an in-depth look at performance evaluations, attendance, and accountability.

This resource explores the role patient access plays in denials, data integrity, discharges, and more. Moreover, readers will gain a deep understanding of the impact this department has on the revenue cycle. Through effective training, you’ll give your patient access staff the tools they need to succeed in their role—and the whole facility will benefit.

This comprehensive resource not only helps revenue cycle and patient access leadership address staffing challenges, but also addresses the role of patient access in insurance eligibility, denials, data integrity, bed management and discharges, performance indicators, quality, and patient notices.

About the Author:

Marsha L. Sopiecha is an instructor for the patient access specialist program at Cuyahoga Community College, where she is also a member of the Advisory Council for Patient Access Specialist Curriculum. Sopiecha also serves as an instructor for medical billing and coding at Polaris Vocational School. Previously, she was a revenue cycle manager for St. Anthony’s Medical Center. She has significant experience in hospital patient access services, starting her career over 25 years ago as an access representative, then advancing to managerial/educational coordinator of patient access services. Sopiecha has experience in managing, educating, and training patient access staff.

Victoria L. Ludwig, MS, has worked in education since 1993. She received her Bachelor of Science in Education cum laude (1993) and her Master of Science in Pupil Services magna cum laude (2001) from the University of Akron. She was a member of the Golden Key National Honor Society, and currently serves on building and district leadership teams in her school district of employment. In addition, Ludwig has facilitated team meetings and discussions for educators, and has experience training staff on various policies and procedures in the field of education. 

Page count: 150
Dimensions: 8.5” X 11”
ISBN: 978-1-68308-660-4

Table of Contents

  • Chapter 1: Introduction
  • Chapter 2: The Role of the Patient Access Director in the Contemporary Revenue Cycle
    • Revenue Cycle
    • Data Integrity
    • New Practices and Technology
    • Building a Successful Team
    • Organizational Relationships
    • Summary
  • Chapter 3: Critical Considerations in Pre-Access Processing
    • Patient Scheduling
    • Patient Pre-Registration
    • Insurance Verification
    • Pre-Cert and Pre-Authorization
    • Case Management
    • Resolving Managed Care Requirements
    • Utilization Review
    • Summary
  • Chapter 4: Patient Arrival Processing and Other Access Activities
    • Scheduled Patients
    • Unscheduled Outpatients 
    • Bed Management, Transfers, and Discharge Activities/Electronic Bed Board
    • Hospital Clinics
    • Nursing Homes
    • Hospice
    • Process and Data Edits
    • Summary
  • Chapter 5: Patient Access Financial Activities
    • Organizational Revenue Cycle Financial Policy
    • Financial EDUCATION: CHARGES, LIABILITY, and Financial Resolution
    • Financial Counseling
    • Financial Assistance
    • Point-of-Service Collections
    • Patient Estimator
    • ED Estimator
    • Self-Pay/Medicaid
    • Summary
  • Chapter 6: Patient Access Compliance Activities
    • Compliance Overview
    • Medicare Secondary Payer
    • DRG Window
    • Importance of Medical Records
    • Important Message From Medicare
    • Observation Letter
    • Red Flag (Patient Identity Theft)
    • Medical Necessity Screening and Advance Beneficiary Notice Requirements
    • Current Compliance Issues
    • Health Insurance Portability and Accountability Act of 1996 (HIPAA)
    • Summary
  • Chapter 7: Other Patient Access Responsibilities
    • The Joint Commission
    • Quality Assurance
    • Key Performance Indicators
    • Staffing and Budgeting Considerations
    • Other Budget Considerations
    • Capital Budgets
    • Strategic Planning
    • Summary
  • Chapter 8: Access Department Organization
    • Organization Structure Options
    • Position Descriptions and Competencies
    • Role of Workflows, Policies, and Procedures
    • Summary
  • Chapter 9: Customer Service
    • Effective Listening
    • Exceeding Customer Expectations
    • Scripting
    • External Customer Service
    • E-mail Etiquette
    • Telephone Communications
    • Scripting
    • Open/Closed Questions
    • Sensitivity of Customer Needs
    • Summary
  • Chapter 10: Staff Training and Development
    • Developing a Training Program
    • Quality Monitoring and Feedback
    • Patient Access Educator Coordinator/Quality Assurance Manager
    • Incentive Programs
    • Rounding
    • Employee Satisfaction (Gallup Poll)
    • Technology Tools to Enhance the Training Experience
    • Mentoring Staff
    • Monthly Meetings With Superusers
    • Working Supervisors/Managers on the Front Line
    • CHAA Certification (Certified Healthcare Access Associate)
    • Summary
  • Chapter 11: Using a Gap Analysis to Plan Future Improvements
    • Purpose of the Gap Analysis
    • Conducting the Gap Analysis
    • Technology Gaps
    • Value of External Analyses (Benchmarking)
    • Resource Scheduling Management
    • Patient Satisfaction
    • Cost-Benefit Analysis
    • Summary
  • Chapter 12: Insurance Denials 
    • Incorrect Insurance/ID Numbers
    • MSP
    • ICD/CPT Codes (Medical Necessity)
    • Incorrect Insured
    • Important Message From Medicare
    • Medicare Outpatient Observation Notice
    • Pre-Cert/Pre-Authorization
    • Observation to Inpatient or Vice Versa
    • Out of Network Insurances (No Prior Authorization)
    • Eligibility
    • Worker's Compensation
    • Insurance and Pre-Certification Book
    • Summary
  • Chapter 13: Insurances and Eligibility
    • Government Insurances
    • Supplement/Medigap
    • Commercial Insurances
    • Third-Party Administrators
    • Affordable Care Act
    • Self-Pay and Charity Care
    • Eligibility
    • Summary
  • Chapter 14: Performances and Evaluations
    • Quality of Work
    • Attendance (Work and Mandatory Meetings)
    • Team Player/Attitude
    • Point of Service Collections
    • Flexibility
    • Going the Extra Mile
    • Compliance/Accountability
    • Safety and Security