Health Care Reform For Patient Access Reps
May 1st, 2010 | 
Author: Of course the most talked about subject in healthcare is the new Healthcare Plan that is now a law. As Medical Clerks we really need to understand the changes coming and to be able to help our patients understand some of their rights under the new plan. There are literally hundreds of different websites that have information on the changes that are taking place now and in the future. Which one you choose to read is really up to you. Read your employers information as well as some of the different medical associations websites for updates now and in the future. Be sure to bookmark the ones you find the most useful.
http://www.whitehouse.gov/issues/health-care
Here is an excerpt from their website:
“It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps 32 million Americans afford health care who do not get it today – and makes
coverage more affordable for many more. Under the plan, 95% of Americans will be insured.
It sets up a new competitive health insurance market giving millions of Americans the same choices of insurance that members of Congress will have. It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of
care.
It will end discrimination against Americans with pre-existing conditions. It puts our budget and economy on a more stable path by reducing the deficit by more than $100 billion over the next ten years – and more than $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.”
The second website we looked at is simply called the HealthReform.gov The information on the website is geared mostly towards patients and small business who are most affected by the changes. There is a pretty good FAQ section for both. It also has news sections for each state.
So give these two websites a try and read through the information. The more you know and understand about insurance the better able you will be to help your patients and your employer!
Posted in 
Tags: 
Educational Opportunites
As we stated in the previous posting we are gathering information on educational resources for our subscribers. I read all the time and enjoy reading about a variety of different things. I was emailed a link to this article by the author, Chris Thorman, who blogs about medical billing software, and am happy to post a link to it here:
The article talks about outsourcing your billing and some of the factors you should consider when or if your practice should do it. Granted, you may not have the input into the decision of if or when to outsource your employers billing but it is a very informative article none-the-less. Remember that keeping yourself informed about every aspect of Patient Accounting is always a good thing. You never know when an article, website or newsletter information may spark an idea to help your company’s bottom line. You may even get inspired to change your current job and explore other areas in this field that might prove financially and emotionally beneficial.
If you have read an article online that might be informative and/or educational to your fellow patient access reps, medical insurance clerks, registrars, etc then please send us the link and we will be happy to write a posting about it. We would greatly appreciate it if you would send a link to our blog to your fellow employees as well. The more patient accounting people who subscribe to this blog and send in articles, links and give us educational resources the better we can do our jobs!
Patient Access Reps
Are you a doctor’s office or hospital patient access rep? Maybe you are called something else by your employer such as a Medical Office Clerk or Insurance Clerk or maybe even an Admission Clerk or Registrar. Whatever the title we all do about the same thing. We collect demographic and insurance information about patients and input them into some kind of software program. Some of us do more than that such as post charges, collect co-pays and coinsurance amounts from patients and some of us even bill insurance companies or follow-up with the patient’s insurance to get them to pay the claims that have been billed to them. A few will even have to call the insurance companies to get pre-certification for a procedure. Whatever your duties are you need to know that you are “The Face of a Medical Practice” . And by that I mean you will generally be the first and possibly the last person that patient sees when getting medical services. You will set the tone of the visit for the patient and you could actually get a patient to return for future services or end up losing that patient for the clinic or hospital if you do not do your job correctly.
Most of us do not have specific training in our field. There is no college courses for our particular specialty. There are so vocational courses that can be taken and we will post another article on that soon enough. You can even take a certification exam as discussed in the CHAA Exam posting previously. Mostly, we are taught how to do our jobs by someone already doing the job. On-the-job training is the best way to learn how to do a new job, if you have the right trainer. So much depends on the trainer actually have the done the job, done it well and be willing to impart that knowledge to the trainee. But you must also be willing to learn some stuff on your own as well. To that end I would like to suggest, again, that you find and bookmark websites that give you updated information on insurances, medical regulations that affect patient access reps and possibly find a local source such as a state agency that keeps up on the current trends in our area of expertise. To start click on some of our links and bookmark them. Read through the materials on each and check back on them about once a month or so to see if anything new has been posted. We would even suggest that if they offer a newsletter or updating email service that you sign up for that as well.
Remember, learning some new everyday should be your motto or mantra!
Visit Insurance Websites
Almost every major insurance type has a main site that is just filled with free information for the Patient Access Representatives as well as their customers. Most companies are required to tell you about their requirements for billing, precertification, etc. Visiting their websites and going to the provider section should net you a billing manual and contact information to followup with claims, notify them for precertification and where the claims should be going. Getting the right information the first time is what we should strive to do. This will decrease our Accounts Receivable Days and bring the money in quicker. This will make the management people happy and may translate into more money for your pocket in the form of raises. I don’t know about you but getting paid is why I go to work.
Medicare has a great site with loads of information. There are several states that have more Medicare patients than others and if you are in one of them then going to the www.medicare.gov website is essential. Of course, those will Railroad Medicare have their own site at: http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Railroad%20Medicare~Resources
If you have a large military base in your area then you really should go to the Tricare Site for Your Area. There are three of them depending on your state. Tricare West is http://www.triwest.com/provider/. Tricare South is http://www.humana-military.com/south/provider/provider.asp. And finally Tricare North is http://www.tricare.mil/tma/providerinformation.aspx
Every state has their own Medicaid site. To Find yours you can go to your favorite search engine and type in your states name and then Medicaid or you can go to the Federal Medicaid site and you will get the Federal Guidelines that all states must follow and find the links for each of the states as well. The Federal site is at: http://www.cms.hhs.gov/home/medicaid.asp. To find all the state sites in one place go to this website: http://64.82.65.67/medicaid/states.html.
These should get you started and next month we will get you more information about other insurances!