CHAA Examination
Preparation
Encounter - Session I
Pages 70-80
University of Mississippi Medical Center
What to Expect…
• This module covers various aspects of
Patient Access knowledge found in pages 7080 of the ENCOUNTER section of the 2010
CHAA Study Guide.
• A quiz at the end will measure your
understanding of the content covered.
Patient Access Roles in a
Nutshell
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The Basic Responsibilities of a Registrar are to:
Gather information to identify the patient and
insure reimbursement for services
Communicate required complex information to
patient regarding patient rights, HIPAA, Advanced
Directives, and medical necessity
Obtain consents and authorizations
Collect co-payments and deductibles
Direct the patient to the point of service
And do so in a way that makes the patient feel
comfortable and important
The Encounter
• First Impressions are made during the
encounter.
• First impressions are lasting impressions.
This important time can make or break the
entire visit.
• Customers observe staff behaviors and
attitudes and will be quick to determine if
they are important to you or not.
Patient Identification
• THE MOST IMPORTANT TASK UNDERTAKEN BY
PATIENT ACCESS IS PATIENT IDENTIFICATION!
• Gathering the patient’s legal name and birthday
allows you to check this info against the existing
Master Patient Index (MPI) to determine if the
patient has been to your facility before.
• THE #1 GOAL OF THE JOINT COMMISSION’S
NATIONAL PATIENT SAFETY GOALS IS IMPROVING
PATIENT IDENTIFICATION.
Patient Identification
• All healthcare workers must use a minimum
of TWO identifiers when providing care,
treatment, and services.
• Securing the patient’s demographic and
financial information is also crucial due to
the rise of identity theft and insurance fraud
over the past few years.
Special Needs of the Patient
• Special Needs refer to anything from needing a
private room to a large wheelchair for obese
patients.
• According to the Americans with Disabilities Act,
hospitals are required to communicate effectively
with patients, family members, and VISITORS who
are HARD OF HEARING.
• They must also take REASONABLE STEPS to provide
meaningful access to a person with Limited English
Proficiency (LEP).
Special Needs of the Patient
• At point of first contact, patient access staff
must identify communication barriers not
only for patients, but for FAMILY MEMBERS
and VISITORS.
• The PHYSICIAN ORDER is a good source of
information on determining special needs.
Special Needs of the Patient
• The Joint Commission requires hospitals to establish
a FALL REDUCTION program that includes an
evaluation of the physical environment, as well as
staff, patient, and family education.
• Patient Access staff should be aware of the
environment and actively communicate potential
hazards to the appropriate department.
Patient Placement
• Also known as bed control or bed
management, this is the process of providing
the patient with the most APPROPRIATE
LOCATION and level of service necessary for
OPTIMUM CLINICAL CARE.
• Special consideration should be given to
infection control when assigning the
appropriate bed.
Infection Control
• Patients who require contact precautions should be
placed in a single patient room when available.
• When that’s not available, patients with the same
MRSA should be placed in the same room or patient
care area.
• MRSA is a type of bacteria resistant to certain
antibiotics and is common in hospitals with large
numbers of people with weakened immune systems.
Infection Control
Standard Precautions
The Centers for Disease Control and
Prevention (CDC) RECOMMEND the following
precautions for infection control:
1. Hand Hygiene
2. Cough Etiquette
3. The use of Personal Protective
Equipment (PPE) for staff when exposure to
blood, body fluids, secretions, etc. is
anticipated.
Infection Control
Standard Precautions
• An ALCOHOL BASED rub is the preferred method of
hand decontamination if hands aren’t soiled (If
hands are soiled, use soap and water first).
• Personal Protective Equipment (PPE) is specialized
clothing or equipment worn by an employee for
protection against infectious materials.
• The Occupational Safety and Health
Administration (OSHA) issues REGULATIONS for
workplace and safety.
Levels of Care
• Acute Care – medical attention given to patients
with conditions of sudden onset that demand urgent
attention or care of limited duration when a
patient’s wellness would deteriorate without
treatment.
• Acute Inpatient Care – a level of health care
delivered to patients experiencing acute illness for
generally less than 30 days.
Levels of Care
• Observation Care – services furnished by a hospital
to monitor a patient’s condition to evaluate the
need for a possible admission. Usually doesn’t
exceed 24-48 hours.
• Ancillary Services – scheduled or non-scheduled
services such as radiology, laboratory, or other
services.
• Emergency Services – patients examined on an
unscheduled emergent basis for immediate
treatment in the emergency facilities of a hospital.
Levels of Care
• Ambulatory/Same Day Surgery – surgical treatment
that patients receive from a facility and are
discharged within 4 to 6 hours of procedure.
• Long Term Care – care generally provided to the
chronically ill or disabled in a nursing facility or rest
home. Medicare beneficiaries are eligible for 100 days
and Medicaid coverage is available for those who have
exhausted their resources.
Levels of Care
• Respite Care – allows families caring for physically
dependant members time off in their care giving
responsibilities. NOT REIMBURSABLE under Medicare or
Medicaid.
• Hospice – this is a support system to patients with less
than 6 months to live who choose to spend their
remaining days in the comfort of their own home or
hospice designated facility.
• Pallative Care – medical treatment specially focused on
the relief of the pain and symptoms of a serious illness.
Collecting Demographic
Information
• Demographic Information is defined as patient identifying
and contact information.
• Gathering and entering this has both clinical and
financial purposes.
• Examples of Demographic Info: legal name, birthdate,
SSN, address, phone number, employer, employer
contact info, emergency contact/next of kin.
• Verify Demographic info by obtaining positive
identification and by using open ended questions during a
verbal interview.
Explaining and Obtaining
Consents
• Consent refers to the various forms and signatures involved
in registering patients.
• Either the patient or the patient representative is required
to sign consent forms which should be explained to them
beforehand.
• Most consent forms include basic consent for treatment and
usually a consent that authorizes the provider to release
information for financial purposes.
• Patient Access Representative may also have to sign form as
a witness.
Emergency Room
Consents
• IMPLIED CONSENT BY LAW states that when a
patient’s condition prevents them from
signing the form and no patient
representative is present, the patient access
employee may document on the form and
sign as a witness.
• In this situation, it is important to follow up
to obtain written consent with the patient or
the patient representative (EXPLICIT
CONSENT).
Consent Regarding Minors
• Consent must be gained from parents or guardians
of a minor when providing NON-EMERGENT services.
• If a minor presents for NON-EMERGENT services
without parent or guardian, the staff member may
contact the parent/guardian by phone to obtain
verbal consent. This needs to be documented on
the consent form.
• Some facilities may require a second staff member
to verify and document as well.
Consent Regarding Minors
• In some states, certain services do not
require consent from a parent or legal
guardian. These include:
– Pregnancy Related Services
– Contraceptive/Sexually Transmitted Disease
services
– Mental Health Services
– Substance Abuse Services
– Emancipated Minors for any service
Emancipated Minors
• In most states there are three circumstances
in which a minor becomes emancipated.
These are:
– Enlisting in the Military
– Getting Married
– Obtaining a court order from a judge
In most instances, legal documentation is required
as proof minor emancipation
HIPAA Privacy Notice
• The Notice of Privacy Practices (NPP/NOPP) is a
document that explains how Protected Health
Information (PHI) is used and disclosed by a
healthcare entity.
• A signed NPP acknowledges that the information
was offered to the patient.
• The NPP remains in effect for subsequent visits and
has to be SIGNED ONLY ONCE, unless the Notice
changes.
The Patient Self-Determination
Act (PSDA)
• This act affords patients the right to participate in
their own healthcare decisions, including the right
to receive or refuse treatment.
• Patients have the right to file a complaint or
grievance at ANY TIME during the healthcare
encounter.
• An Advance Directive or Living Will is written
instructions regarding patients’ wishes when they
cannot make healthcare decisions themselves.
The Patient Self-Determination
Act (PSDA)
• A Durable Power of Attorney for Healthcare is the
portion of the Advance Directive where the patient
appoints a proxy to make medical decisions on their
behalf if they become unable to during treatment.
• While the ENCOUNTER SETTING isn’t the ideal place to
initiate an Advanced Directive, the PSDA requires that
patients be educated regarding what an Advanced
Directive is and asked if they have completed one.
• An Advanced Directive becomes active when a patient
becomes incapacitated and can be revoked at any time
by destroying all copies.
The “Important Message from
Medicare” Form
• This form must be presented to ALL MEDICARE
PATIENTS prior to admission and re-presented to
them within 48 hours of discharge.
• It explains Medicare beneficiary rights under law
regarding filing an appeal in the event they disagree
with the discharge plan or if they have a complaint
about the care they received.
• The main idea is that the patient has the right to
file an appeal before discharge occurs.