Patient Access Management in your Organization

Where Should Patient Access Management be Located within the Organization?

Patient access management should be incorporated as an element of a hospital’s financial department because in today’s new financial environment, everything this department does ties into multiple areas of the revenue cycle.

Best practices hospitals use the approach where any and all information that affects the revenue cycle is disseminated among all members of the revenue cycle team. With new governmentally mandates sending thousands of patients with high-deductible insurance policies into the healthcare delivery system, it is critical that these patients and their ability to pay be identified at the very beginning of the revenue stream.

The critical data collected by the patient access staff should be shared with all key players on the revenue cycle team, including patient financial services, HIM, managed care staff members, as well as the chargemaster manager and information technology. This data can then be used to create a list of potential issues related to the revenue cycle.

Collection issues discovered early in the revenue cycle process can be assigned to the proper people in the revenue cycle so they can conduct the root-cause analyses needed to solve the issues. This early detection and problem resolution will minimize finger pointing and keep the discussions focused on resolving the issues.

A comprehensive revenue cycle approach also ensures that patient access management plays an integral part in the hospital’s management of issues such as denials, bad debt, and, of course, patient bed placement. Best-performing hospitals aggressively track denials and zero payment accounts, and diligently seek ways to eliminate process deficiencies that lead to denials. Bad debt files should be reviewed regularly and high-dollar accounts should be scrutinized. Best-performing hospitals have a sign-off system in place so patient access and patient accounting managers and directors can work collaboratively on large dollar cases.

Patient access functions have traditionally been responsible for bed placement. There is some debate as to whether this function should remain with patient access or be transferred to nursing. Regardless of whether or not patient access determines bed placement, patient representatives have a critical role to play in the collection and dissemination of critical financial information.