The Critical Role of the Patient Access Representative

It is estimated that 80% of all money that flows into a hospital is the responsibility of the Patient Access Services Representative. In fact, the initiation and arguably most important step of the Revenue Cycle is Registration, which is the focus of the Patient Access Department. Essentially all other departments, at least on the clinical and financial side of a hospital, depend on the information that is collected by the Patient Access Representative.

The Patient Access Associate, or Registrar, is responsible for the documentation of what will evolve into the patient’s medical record. This collected information will then be passed to clinicians, Patient Accounts, Health Information Management, and other dependent hospital departments. Thus the creation of the initial record is one of the most important aspects of the Patient Access Associate’s job, and this data is most typically collected through the Registrar’s interview with the patient, ideally before any other services are conducted. Bearing this in mind, the capacity for quality customer service and productive patient interviewing skills is highly important for the Patient Access Representative.

The point of the interview is to solicit information from the patient. Some of the important information collected includes:

  • Date of Birth
  • Social Security Number
  • Address and Phone Numbers
  • Ethnicity/Race and Primary Language
  • Insurance Information
  • Primary and Referring Physician

The Patient Access Registrar is responsible for the input of all of the patient’s payment information, including insurance, ability to pay, and subscriber data collection. The successful Registrar should be highly knowledgeable of types of insurance, be it various government plans (i.e. Medicare), commercial plans (i.e. Blue Cross), and patient liability and self-pay programs. The Patient Access Representative must also determine the policyholder, or subscriber. Usually this information is found on the patient’s insurance card, but often determining the policyholder involves a string of imperative questions about employers and the patient’s relationship to the insurance subscriber.

The patient interview can be complicated by a number of factors, most obviously the patient’s ability to converse and answer the Registrar’s questions. The Patient Access Representative in the Emergency Room must expect to deal with patients who are severely injured, in a state of panic, or even unconscious.