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Using Assessments and Training to Improve Conditions of Participation

April 1st, 2021
April 1st, 2021

Conditions 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.


TWO KEY STRATEGIES FOR IMPROVING PATIENT ACCESS SUCCESS IN HEALTHCARE:

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:


  • Schedules healthcare service appointments
  • Determines patient insurance eligibility
  • Enters required demographic and billing data
  • Collects co-pays and discusses alternative payment solutions

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.
  3. FINANCIALS – Benchmark for point-of-service cash as percentage of total cash collected is >2% says the Healthcare Financial Management Association (HFMA). Patient Access staff must be familiar with the various types of up-front cash collection required.
  4. PATIENT SATISFACTION – Benchmark for patient wait time is <10 minutes says HFMA. An impactful first encounter is key to preserving loyalty and ensuring that patients return for future services. A patient’s experience, including registration and wait time impacts their decision to become a loyal consumer.

"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.


PATIENT ACCESS PLAYS A CRUCIAL ROLE IN THE REVENUE CYCLE

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.


WHAT CAN A COMPREHENSIVE PATIENT ACCESS EDUCATION PROGRAM OFFER HOSPITALS?

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:


  1. Invest in an online education system to keep colleague knowledge current while maintaining standards of proficiency
  2. Perform team assessments to identify knowledge and skill gaps that could affect the revenue cycle
  3. Fill knowledge deficiencies and increase colleague skill levels through course assignments based on assessment results
  4. Provide colleagues with opportunities for growth within your organization by offering certification and badge programs that broaden and enhance skill levels
  5. Offer webinars that help colleagues maintain credentials and stay current with regulatory updates To ensure a high level of productivity and accuracy, today’s Patient Access operation should be measured on Key Performance Indicators to monitor quality, process, financial, and customer service.

WHAT DOES SUCCESSFUL PATIENT ACCESS TRAINING LOOK LIKE?

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:


  • BROADER ARRAY OF PATIENT ACCESS/ REVENUE CYCLE EDUCATION – Prepares learners beyond what is possible during initial in-person orientation training
  • EXTENSIVE ORIENTATION FOR PATIENT ACCESS ROLES – Newly hired staff are better prepared for meeting client needs
  • EFFICIENT USE OF TRAINING TIME – In-house training reduced from four to three days, decreasing the amount of necessary resources
  • INDIVIDUAL TRAINING PATH REPORTS – Adaptive learning targets areas where new employees need more focus
  • CONSISTENCY IN STAFF ONBOARDING – Assigning the same suite of courses helps create a workforce whose preparation, knowledge and performance is more uniform, and aligns with the client’s expectations

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.”


PATIENT ACCESS SUCCESS IS A GROUP EFFORT

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.

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