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Learn MoreConditions of Participation are qualifications developed by CMS that healthcare organizations must meet in order to begin and continue participating in federally funded healthcare programs (Medicare, Medicaid, CHIPS, etc.) This article examines new ways healthcare organizations can use assessments and training to ensure staff understand and are adhering to policies that support compliance.
How Continuing Education and KPI Monitoring Can Make Patient Access More Effective
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:
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.
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:
"Today’s Patient Access expert is tasked with capturing patient information, as well as educating and supporting a range of individuals"
Accompanying KPIs with specific department goals leads to positive outcomes, making certain that you set your team up for success.
In many healthcare organizations, the Patient Access team is the unsung hero, yet it often receives the least amount of training. Lack of Patient Access training can be a disrupter to revenue cycle success and patient satisfaction. According to recent studies, upwards of 50% of claim denials are due to errors occurring in frontend revenue cycle processes, such as registration and eligibility. Just a single misstep in any of the necessary functions can result in many downstream consequences, including poor patient care, fraud charges resulting from inappropriate billing, lost revenue due to denials or inadequate copay collection and potential loss of the healthcare organization’s license.
According to Darcelle Johnson, Senior Manager of Education Content Development at nThrive Education, providing colleagues with healthcare education that expands their skill sets and future opportunities can help hospitals and healthcare organizations overcome the challenge of employee retainment. She recommends that providers:
A customer of HealthStream and nThrive provides staffing for their largest clients across multiple locations. To prepare staff members, this organization provides a comprehensive Patient Access Training program. Along with organizational specific training, they assign nThrive Education online courses via HealthStream to supplement their training and reduce content creation costs at the local level.
HealthStream Patient Access courses from nThrive Education provide:
The organization has received positive trainee feedback regarding the HealthStream Patient Access courses from nThrive Education. Confidence is high placing individuals in these roles, knowing they are well-trained and evaluated.
According to the organization’s spokesperson, “Training is a big piece of onboarding and proficiency, and it’s very specific in the extent to which it matches client needs.” She emphasizes the importance of learning that complements the organization’s commitment, adding that “the client expects a certain level of expertise in the work our people are doing. If we’re placing people in the organization who don’t have that level, it’s very clear from the start.” In addition to helping new employees bridge the gap between experience and knowledge, HealthStream and nThrive Education training helps the organization “use trainee test scores and the individual’s time required to complete certain modules to determine the subjects where more focused time should be spent to best serve the client’s needs.”
Successful Patient Access in the hospital or healthcare system depends on the work and commitment of many; it’s about patient interaction, education, transparency, accuracy, and providing clean information that feeds the revenue cycle downstream. It’s an area of the revenue cycle that is drawing more attention in the healthcare industry and will continue to do so as reforms continue to strengthen the clarity between hospitals, patients and payors.
For more information on how HealthStream can improve revenue cycle management, performance and outcomes at your organization through optimized Patient Access solutions and healthcare education programs, Visit HealthStream.com/ RevenueCycle
All Patient Access staff must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift towards high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity and ABNS, and the importance of the demographic and insurance information they collect and record. HealthStream offers online Patient Access training in partnership with nThrive Education. Learn more about HealthStream workforce development solutions focused on revenue cycle.
Learn more at https://www.healthstream.com/solution/ revenue-cycle/patient-access.
HealthStream’s learning management system and healthcare training solutions support medical training initiatives and allow for the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validate health outcomes and support provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
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