Thursday, July 20, 2017

CMS Notices on Advance Beneficiary Notice of Noncoverage, Hospital Appeal Notices and Detailed Notice of Discharge

Members have brought two CMS notices to our attention recently.

Advance Beneficiary Notice of Noncoverage

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service) beneficiaries in situations where Medicare payment is expected to be denied. Guidelines for mandatory and voluntary use of the ABN are published in the Medicare Claims Processing Manual, Chapter 30, Section 50
What's New?

In March 2017, the Office of Management and Budget  (OMB) has approved the renewal of the ABN, Form CMS-R-131, and form instructions. While there are no changes to the form itself, providers should take note of the newly incorporated expiration date on the form.  With the 2016 PRA submission, a non-substantive change has been made to the ABN. In accordance with Section 504 of the Rehabilitation Act of 1973 (Section 504), the form has been revised to include language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format if needed.  The effective date for use of this ABN form is 6/21/2017.
Here is the CMS webpage with the announcement and links to the ABN form and instructions (
Hospital Appeal Notices & Detailed Notice of Discharge
Hospitals are required to deliver the Important Message from Medicare (IM), CMS-R-193 to all Medicare beneficiaries (Original Medicare beneficiaries and Medicare Advantage plan enrollees) who are hospital inpatients. The IM informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. Beneficiaries who choose to appeal a discharge decision must receive the Detailed Notice of Discharge (DND) from the hospital or their Medicare Advantage plan, if applicable.

What's New?

The effective date for use of the updated IM and DND is 60 days from June 29, 2017. There have been a number of updates to this CMS message.

Here is the CMS webpage with the latest notices (

You may have seen this most recent notice on CMS-R-193:

On June 7, 2017, the Centers for Medicare & Medicaid Services (CMS) posted new versions of the Important Message from Medicare (IM) form (CMS-R-193) and the Detailed Notice of Discharge (DND) form (CMS 10066) on the Beneficiary Notices Initiative webpage. The associated instructions for use are also available.

The new IM form incorporates the following language related to discrimination - "For more information, call 1-800-MEDICARE (1-800-633-4227), or TTY: 1-877-486-2048. CMS does not discriminate in its programs and activities. To request this publication in an alternate format, please call: 1-800-MEDICARE or email:" The Detailed Notice also has new language related to discrimination. Both forms have new expiration dates.

CMS is requiring that the new version of these forms must be in use by August 28, 2017.

Thursday, April 20, 2017

Promoting Value Through Transparency

Presented by Stephanie Benintendi, Corporate Director of Patient Access at Centura Health

We caught up with Stephanie Benintendi to discuss her Learning Lab at this year’s NAHAM Annual Conference. She will address what “transparency” means within healthcare reform. Follow Centura Health's journey of being an industry leader in transparency for consumers using science and art to set the bar for best practice.  

Why is this a must-attend session? This session revolves around bringing transparency to the consumer in a way that is modeled after other industries to try to break down the barriers patients have in accessing care due to cost. As the Affordable Care Act has expanded insurance coverage to more people, it also brought with it higher out-of-pocket costs for some in the form of deductibles and co-insurance that they haven’t had to deal with in the past.
Why is this topic so important to the world of Patient Access today? We are the frontline associates in the hospitals who have to try to explain all this to patients when it comes time to schedule a visit or procedure, and then have the sometimes uncomfortable conversation with them about financial arrangements for that care. If the healthcare industry can become more transparent in their prices to the public so they can self-educate from a trusted source (their local hospital), our patients will not feel so vulnerable and can start to ask questions from an informed position.

Visit the NAHAM website to check out the full line-up of Learning Labs.

Tuesday, April 18, 2017

Using NAHAM AccessKeys and Benchmarking to Reduce Cost

Presented by Danielle Andujar, regional director of Patient Access at Novant Health 

We sat down with Danielle Andujar to discuss her presentation at the NAHAM 43rd Annual Conference. Join Novant Health and Danielle as she discusses how we can reduce cost in our Patient Access departments by $3.1 million.

Why is this a must-attend session? Key performance indicators are fairly easy to find, especially since NAHAM provides updated access keys regularly. Once you have this important benchmarking data, what do you do next? Learn how Novant Health leveraged this data to establish standards to improve performance while reducing cost.

Why is this topic so important to the world of Patient Access today? Benchmarking is an essential first step to improve an organization’s performance while understanding industry standards. NAHAM cites some benefits of benchmarking are: creating a culture of excellence; breakthrough thinking and innovation; creating a better understanding of competitors and the dynamics of the industry; providing a sense of urgency for process improvements; and ensuring that best practices in the industry are included in the organization’s work practices.

Visit the NAHAM website to check out the full line-up of Learning Labs.

Friday, April 14, 2017

Branding the Patient Experience in the Emergency Room

Presented by Lisa Favors, CHAA, l Six Sigma, Women in Business Certification; Patient Access emergency department manager at Washington Adventist Hospital

We caught up with Lisa Favors who will be presenting at the NAHAM 43rd Annual Conference. Her presentation will focus specifically on the POS in a busy and hectic environment — the emergency room. The session will speak specifically to the challenges of the ED, and the challenges that the Patient Access team face while attempting to collect from patients. The presentation will show how to explain to patients in the ED their copays and the breakdown of some of the fees that will occur as a result of being an ED patient. The presentation will hit on important topics such as ED registration, EMTALA laws (which include when registrars can collect), POS (how to read the insurance card to obtain the correct co-payments), when to collect, and how to use the correct verbiage in the ED while collecting their copay.

Why is this a must-attend session? The ED is an environment where the Patient Access department is dealing on a daily basis with patients and visitors who are frustrated and afraid in this environment, which is complex and busy. This workshop will show how the Patient Access department can deal with an ever-changing and stressful environment, and how they can make the patient experience in the ED a positive experience.

Why is this topic so important to the world of Patient Access today? It is very important to the world of Patient Access because, oftentimes, the Patient Access team working in the ED is not equipped with the tools to deal with the constant changes and movement in the ED.

Visit the
NAHAM website to check out the full line-up of Learning Labs.

Wednesday, April 12, 2017

Patient Connect University: Helping Connect the Pieces to Provide Better Customer Service for Your Community

Presented by Erin Brown, MPA, CHC, compliance officer and Patient Access supervisor at Jefferson Healthcare Medical Center

We caught up with Erin Brown to discuss her session at the NAHAM Annual Conference. Erin will be providing insights from the Patient Connect University. Four ladies from varied backgrounds and job roles were empowered by their leadership to create an atmosphere of shared learning models and improvement changes that became Patient Connect University. They took on obstacles such as insurance eligibility, registration errors, scheduling and EHR communications and bridged the gap between the primary hospital campus and 13 clinics to foster a teamwork atmosphere and a kick-start in morale and employee engagement. Come share in this transformational change that can easily be modeled in other facilities.

Why is this a must-attend event? Improving the patient financial experience takes more than just one or two individuals, it requires the engagement and collaboration of every staff member involved in that patient’s care experience. However, attaining engagement from all of the essential players can be challenging as healthcare workers experience the stress of doing more with less, further contributing to a culture of working in silos. This session will feature ideas on how to engage and empower — in a fun and creative way — multiple areas of your organization so that they are eager and knowledgeable participants in the patient’s care and financial experience.

Why is this topic so important to the world of Patient Access today? Patients are customers, comparing both the quality and expense of the services they receive. They not only want to know where to get the best service, but what it’s going to cost them. Being able to connect them to the answers they seek in a supportive and collaborative way is not only excellent customer service, it’s what our customers are now expecting. This learning lab will give attendees immediate tools and ideas that they can bring back to their organizations and implement and design their own patient financial experience engagement plan.

Visit the NAHAM website to check out the full line-up of Learning Labs.

Monday, April 10, 2017

Targeted Coaching to Improve Patient Experience and Increase Agent Engagement

Presented by Lynn Bancroft, business development manager at Envision

We caught up with Lynn Bancroft who will be presenting at this year’s
NAHAM Annual Conference on improving the patient experience. Coaching is the linchpin between strategy and execution. Implementing a full-circle coaching process can help your team deliver a great patient experience and increased revenue collection.

Why is this a must-attend session? Building a world-class healthcare organization that provides an exceptional patient experience can be a challenge but is a must, especially with the consumerism of healthcare. Meeting that challenge requires tactics that ensure Patient Access and registration staff have the knowledge and tools to help them do their best.

Why is this topic so important to the world of Patient Access today? Patient Access teams can take advantage of what contact center pros have been perfecting for years. Join Envision to discuss how to develop a coaching program, use it to improve the patient experience, increase agent engagement and performance, and increase revenue collection.

Visit the NAHAM website to check out the full line-up of Learning Labs.

Thursday, April 6, 2017

How to Achieve the Care Coordination Triple Aim

Presented by Danielle Pieloch, MPH, corporate administrative director of access management for Robert Wood Johnson University Hospital

We caught up with Danielle Pieloch, who will be presenting at this year’s annual conference, on Robert Wood Johnson Health System’s initiative to improve population health and patient experiences and reduce per capita cost of care. Their approach streamlines access to hospital and physician services, efficiently manages medical referrals and automates insurance authorizations across all hospital campuses. Their system-wide contact center allows patients to access services throughout its health system with ease, enhancing the experience for patients and physicians and facilitating prompt payment.

Why is this a must-attend event? The coordination of our patients’ care – from the acute setting to outpatient and to the physician office – is a key component of meeting population health and triple aim targets. Operationalizing the Patient Access components of scheduling and pre-registration, along with the task of insurance authorizations, can be daunting. Come learn how the largest health system in New Jersey began its journey of coordinated and meaningful Patient Access through the development of a patient contact center.

Why is this topic so important to the world of Patient Access today? Patient Access is the foundation of the business – from quality outcomes to the patient experience to driving growth and business development. If Patient Access is not successful, the business cannot succeed!

Visit the NAHAM website to check out the full line-up of Learning Labs.

Tuesday, April 4, 2017

Taking It to the Street: Emerging Practices for Hospitals to Engage Patients in the Field and on the Phone

Presented by Craig Deehring, BA, MBA, executive vice president at Integrated Health Management Services

We caught up with Craig Deehring who will be presenting at this year’s NAHAM Annual Conference on how to engage patients. There are multiple approaches that assist patients in obtaining healthcare coverage, either through government-based programs, local charity or prospective coverage available under the Affordable Care Act. There are significant challenges in engaging these patients once they have received care, including a field services (feet-on-the-street) program that can be uniquely effective in reaching individuals within a targeted community.

Why is this a must-attend session? Many folks consider internalizing “eligibility” related services but don’t fully understand all of the work that goes into reaching out to the uninsured once they have returned to the community. Once a patient discharges from the hospital, the responsibility for following up often passes to PFS, but there are opportunities that can be missed while the patient is still in-house. Field Services can often fill in those gaps and can make the difference between healthcare coverage or more uncompensated care.

Why is this topic so important to the world of Patient Access today? A valuable lesson we have already learned is the more that is done up front, the better your chances are in obtaining payment for services rendered. Field services and community outreach are early-intervention tools that make a difference. By engaging patients, their families and the community, you can dramatically increase overall patient satisfaction.

Visit the NAHAM website to check out the full line-up of Learning Labs.

Wednesday, February 1, 2017

AccessKeys 3.0 Now Available for Download!

A Valuable Product for Monitoring Your Facility’s Performance

NAHAM’s Industry Standards Committee (ISC) has been hard at work continually improving NAHAM’s unique tool the NAHAM AccessKeys®. Version 3.0 includes 12 new key performance indicators (KPIs) and other enhancements based on feedback from NAHAM members and leaders within the Patient Access profession. Our recalibrated benchmarks will help you evaluate your facility’s performance and track against facilities of the same size using reliable data.

New KPIs include:

·        Estimate to Registration Rate

·        Estimation Accuracy Rate

·        Conversion Rate of Insured BAI Patients to FAPs

·        Identity Resolution Rate

·        MPI Search Error Rate

·        Completed Order Rate

·        No-Show Rate

·        Pre-Reg Average Call Time
As facilities adopt the AccessKeys, revenue cycle managers will be able to correlate front-end patient access KPIs with back-end revenue cycle processes.

“We expect correlations like these will demonstrate the financial value of a front end driven revenue cycle model which operates at lower cost than traditional back-end RCM models,” said Paul Shorrosh, CHAM, MSW, MBA, Founder/CEO of AccuReg, NAHAM board member and chairman of the Industry Standards Committee.  “As further adoption of the AccessKeys continues and the financial value of the revenue cycle’s front-end becomes evident, patient access managers should be prepared for greater recognition, authority, pay and resources.” 
AccessKeys are provided to NAHAM members free of charge as part of their annual member benefits.   For more information about NAHAM AccessKeys, visit

For more information, contact the NAHAM office at or (202)367-1125.