CHAA ExaminationPreparation

Pre-Encounter – Session II

Pages 33-41

University of Mississippi Medical Center

What to Expect…

• This module covers various aspects of Patient Access knowledge found on pages 33-41 of the Pre-Encounter section of the 2010 CHAA Study Guide.

• A quiz at the end will measure your understanding of the knowledge covered.

Resource Scheduling• RESOURCE SCHEDULING is necessary to ensure

that there are STAFF, RESOURCES and EQUIPMENT available to meet the patient’s needs.

• COORDINATING with different departments assists them in MAXIMIZING their department’s PRODUCTIVITY by managing their schedules accordingly.

• The overall goal of Resource Scheduling is to MAXIMIZE PATIENT FLOW and MINIMIZE PATIENT WAIT TIME.

Document, Document, Document!!!

The following phrase cannot be overstated:

“If it is not documented, it did not happen.”

• Be sure to note anything unique or special about the patient’s account in the appropriate section. Doing so protects your reputation by providing evidence that you did your job completely and accurately.

Continual Growth & Development

As a professional, you must constantly improve your ability to provide excellent customer service. Continually focus on the following areas:

• DON’T APPEAR RUSHED, even if you are. Treat the patient as if they are the ONLY ONE THAT MATTERS.

• Listen WITHOUT INTERRUPTING.• RELATE WITH YOUR EYES. Don’t gaze at your

computer screen during the ENTIRE interview.• EMPOWER your patients by encouraging them to

ASK QUESTIONS.• Provide MORE INFORMATION IN LESS TIME.

Pre-Registration

On a patient’s first visit to the facility, theyare assigned a unique ID number. This

numbercan be referred to as an:

• Enterprise Number• Master Patient Index Number• Medical Record Number

Medical Records• A patient’s medical record will be

maintained for a minimum of 10 years.• Patients can request a copy of their

medical records at any time.• A patient’s signature will be required any

time a non-referring/ordering physician, etc. requests a copy of their medical record.

• Patient’s medical records are always to be protected from any unauthorized review.

Patient Rights and Organizational Ethics

Patient’s have a fundamental right to receiveconsiderate care that safeguards their personal dignityand respects their CULTURAL, PSYCHOSOCIAL, and

SPIRITUAL values. Do so by:• Promoting consideration of patient values and

preferences, including the decision to DISCONTINUE TREATMENT

• Recognizing the hospital’s responsibilities UNDER LAW• Informing PATIENTS of their RESPONSIBILITIES in the

care process• Managing the hospital’s relationships with patients

and the public in an ETHICAL MANNER

Patient & Family Education

The goal of patient and family education is to provide accurate, consistent, and understandable information to patients

and their family about their healthcare TREATMENT and

ENVIRONMENT.

Clinical Pre-Requisites

Clinical pre-requisites are a MEDICALLYRELATED list of “do’s and don’ts” for thepatient to follow prior to their appointment.Examples may be:

– Don’t eat or drink anything other than water on the day of the appointment.

– Avoid using your inhaler (if possible) on the day of your pulmonary test.

Financial ClearanceAlso known as “Financial Pre-Determination,”

this is where the provider:• Identifies actual payment sources• Assists patients in determining their expected

reimbursement, out of pocket expenses, and alternative funding sources.

The goal is for the patient to understand their financial obligation PRIOR to providing services and avoid billing SURPRISES.

Point of Service Collections

• Refers to collecting the patient’s portion of the bill AT THE TIME SERVICE IS RENDERED.

• For patients who cannot pay their portions in full at time of service, make every effort to collect full payment before offering alternatives.

• Access Representatives working in outpatient departments are responsible for collecting DEDUCTIBLES and CO-PAYS whenever possible.

EMTALA• EMTALA is a federal law stating that all patients

who enter the Emergency Department must be SCREENED and STABILIZED before we can ask for payment.

• It was written to protect patients from discrimination based on ECONOMIC STATUS.

• Access Staff CAN ASK ED patients for a copy of their INSURANCE CARD PRIOR TO BEING SCREENED and STABILIZED but cannot discuss coverage or payments until the patient is stabilized.

The Joint Commission

• This goal of this agency is to IMPROVE the QUALITY of healthcare for the public by providing ACCREDITATION to support PERFORMANCE IMPROVEMENT in healthcare.

• They regulate or police healthcare organizations to ensure a nationwide standard quality of healthcare.