Patient Access

Recent RAC activity

PARC Editor — Sun, 21 Mar 2010 12:25:00 +0000

Connolly Healthcare has added 19 issues for non-medical necessity DRG validation reviews review to its CMS-approved list for providers in Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee and Texas.

View the new issues by visiting the Connolly Web site.

HealthDataInsights has also added new issues for claims to its CMS-approved list for providers in all Region D states.

View the new issues by visiting the HDI Web Site,

In addition, CGI, the RAC for Region B, has added a new issue for non-medical necessity DRG-validation inpatient claims to its CMS-approved list for providers in all Region B states.

View the new issue by visiting the CGI Web site.

Medicare Membership Program

PARC Editor — Wed, 17 Mar 2010 12:20:00 +0000

Get answers to your questions and Medicare compliance guidance from the experts all year long. Join the Revenue Cycle Institute’s Medicare Membership and receive personal attention to your unique Medicare compliance challenges.

With your Medicare Membership, you have access all year long to Revenue Cycle Institute regulatory experts. These experts understand the complex regulatory demands and have a single mission—to keep your organization on track, up-to-date, and in compliance. Your Medicare Membership includes:

A monthly call with a Medicare regulatory expert to help your team understand recent developments and develop an action plan to integrate them into current processes
Twelve hours of on-call access to your regulatory experts to answer and help you understand Medicare developments
Medicare Boot Camp—Hospital Version™: A five-day comprehensive training session brought directly to your organization
A one-day customized training session from a regulatory expert updating your team on key Medicare, coding, or compliance topic(s)
Five seats to MedicareFind™, HCPro’s easy-to-navigate comprehensive database of Medicare rules and regulations

Download our brochure.

Four days — and off you go

PARC Editor — Mon, 15 Mar 2010 11:25:00 +0000

In 2005, the patient access team at Boca Raton (FL) Community Hospital did not have a formal training program. For a facility whose patient mix is 60% Medicare, that is not a good thing.

“[Managers] just sat with them,” says Michele Vail, manager of patient access at the 400-bed facility. “There were no documents, no tools. They didn’t have a steady manager.”

That all changed in 2007 when Boca Raton began a formal training program for new registrars—a four-day crash course of just about everything access staff members need to know. It includes training in HIPAA rules, the federal Emergency Medical Treatment and Active Labor Act (EMTALA), managed care, and basics in personal injury protection (PIP), among other information.

The new program changed the face of patient access at Boca Raton, making it a respected division of the revenue cycle and helping it achieve near-100% accuracy levels.

“We really saw an increase in staff knowledge,” Vail says. The four-day training program helped in many other ways, including:

Better chemistry among departments
Consistent supervision and monitoring
Improved accuracy rate
Confident, self-sufficient staff members

Starting next week, Patient Access Weekly Advisor will break down Boca Raton's training program, day-by-day.

CMS updates FAQs

PARC Editor — Wed, 10 Mar 2010 11:31:00 +0000

Frequently asked questions

CMS posted several new/updated frequently asked questions (FAQ).

View a listing of current FAQs.

OIG report examines RAC fraud referrals

PARC Editor — Wed, 24 Feb 2010 18:44:00 +0000

Recovery Audit Contractors (RACs) referred only two cases of potential fraud to CMS during the RAC demonstration period (March 2005 to March 2008), according to the Department of Health and Human Services (HHS) Office of Inspector General (OIG).

On February 19, the OIG released “Recovery Audit Contractors' Fraud Referrals” which examined to what extent the RACs referred fraud cases to CMS and how much training CMS provided to the RACs during the demonstration period.

Identifying overpayments and underpayments and recouping any overpayments are RACs’ primary responsibilities, but they also refer cases of suspected fraud to CMS. However, the report concludes that not receiving a contingency fee based on referred cases could create a directive for RACs to report such abuses.

The OIG found that CMS gave no fraud and abuse training to the RACs in the demonstration project. CMS did give a presentation about fraud to the permanent RACs. CMS plans to provide further training on the identification and referral of potential fraud, no date or agenda has been determined.

To improve the RACs ability to identify fraud the OIG recommends CMS:

determine the outcomes of the two referrals made during the demonstration project,
implement a system to track fraud referrals, and
require RACs to receive mandatory training on the identification and referral of fraud.

Source: OIG

32 large patient data breaches since september, says OCR

PARC Editor — Wed, 24 Feb 2010 18:37:00 +0000

OCR posted on its Web site a list of covered entities this week that have reported breaches of unsecured PHI affecting more than 500 individuals, fulfilling its obligation under HITECH.

The HHS organization, which oversees enforcement and compliance of the HIPAA privacy and security rules, reports that since September 22, 2009, 32 covered entities have reported breaches that affected at least 500 individuals.

In the cases where a business associate (BA) is involved, OCR lists those organizations as well. OCR reports that among the 32 breaches of 500 or more, seven included BAs.

Read the full report on HealthLeaders Media.

Medicaid Integrity Contractors: We want to hear from you

PARC Editor — Wed, 24 Feb 2010 17:32:00 +0000

Has your organization undergone a Medicaid Integrity Contractor (MIC) audit? If so, we want to hear about your experience. Let us know about your interactions with the MICs and how you’ve managed the process by e-mailing Mike Iarrobino at miarrobino@hcpro.com.

Pre-registering on all surgeries/procedures

jmagdits — Tue, 23 Feb 2010 19:56:25 +0000

Our facility is looking into pre-registering 100% of our patients scheduled for surgeries/procedures. I am interested in whether any other facilities are successful in doing this, and, if so, how do you streamline the process to make it easiest on the patient yet ensure the hospital gets all the necessary information/consent forms signed, prior to [...]

Registration paperwork for recurring visitors

cstaske — Wed, 17 Feb 2010 05:00:44 +0000

Wanting to know how other facilites handle patient paperwork (consent? patient rights? insurance form?) for “recurring” visits (therapy). Do you only review the required registration paperwork the first time no matter how many visits they have? Or do you complete new paperwork for each new billing episode? Cheryl Staske Editor’s note: To respond, please click the title of [...]

Centralized patient transport

jwinchester — Tue, 16 Feb 2010 05:00:49 +0000

Does anyone have a centralized patient transport department? If so, which department do they fall under? Thank you. Jennifer Winchester