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Just how meaningful is national certification for access managers and the staff they oversee? Is it possible to design a standardized curriculum that has real relevance for an industry where the devil is in the details? The answers to these and other questions related to access credentialing vary, depending on which access professional you’re asking, and some of the differences in opinion have as much to do with what part of the country they’re from as with any particular philosophical stance.
The Washington, DC-based National Association for Healthcare Access Management (NAHAM) has offered the certified health care access management (CHAM) credential (formerly called AAM for accredited access manager) since shortly after the organization’s inception in 1974, notes president-elect Nancy Farrington, MBA, CHAM. The CHAM examination is in the process of being updated, Farrington says, but currently is in four parts: access management, general management, finance, and medical records. "Our vision is to have it more closely aligned with the NAHAM access model," she adds, which breaks the subject matter into "pre-encounter," "encounter," and "future development."
As of late April, there were 384 NAHAM members — about a third of the membership — with the CHAM credential, Farrington says, not including those who have been CHAMs in the past but have let their certification lapse. (To maintain their status, CHAMs must complete 30 hours of continuing education during a two-year cycle.)
Although she says there is a large untapped market for both NAHAM membership and the CHAM certification, Farrington adds that the credential has increasing importance within the access field. Within the organization, she notes, CHAMs earn about 20% more than their non-CHAM counterparts.
In response to demand from its membership for assistance in staff education, Farrington says, NAHAM instituted the certified health care access associate (CHAA) certification in the fall of 1999. Response to that credentialing opportunity has been enthusiastic, she adds. (See "Hospitals and frontline staff queue up for test," in this issue.)
A national certification for frontline access personnel is as much about legitimizing the profession as anything else, suggests Anthony Bruno, MPA, corporate director for registration and financial services at Crozer-Keystone Health System in Upland, PA. "As an industry, we don’t do enough to emphasize their importance," he says. "Every hospital is built upon the work done by the folks who do inpatient and outpatient registration. It all has to be accurate and timely, plus all the customer service amenities. Anything we can do to help improve their image and self-respect . . . this is one way of doing that."
Hospitals can no longer afford to look at these front-end employees as secretaries or clerks, Bruno points out. "We need to attract those who can do the job best, and that doesn’t come with paying a little more than McDonald’s might pay."
It’s also important that hospitals can see the value in making the investment in national certification for their employees, says Jack Duffy, FHFMA, director and founder of Integrated Revenue Management in Carlsbad, CA. "Right now, the value statement is not very sophisticated. People in a personal training program get personal certification, but the company never measures the impact of that investment." What would be meaningful, he suggests, is if that self-study effort were reflected in, say, the registration accuracy rate. "Without success stories, without the ability to treat the expenses like an investment, it’s [only] the wealthy hospital or the visionary hospital [that will participate].
Jeanne Hughes, CHAM, regional director for quality assurance and training at Providence Health System in Portland, OR, points out that although the CHAM certification is recognized within NAHAM circles and in the access marketplace, outside that group not everyone knows what a CHAM is. "It doesn’t have that wide recognition that, say, CPA has," Hughes notes. "It would be pretty hard to have a [credential] that is widely recognized, especially since in most organizations, there are just one or two managers."
In addition, she says, "we have such a strong curriculum that I don’t have a desire for [getting national certification for access employees]. We are so fortunate to have a QA [quality assurance] and training department with six people in it. I might feel differently if we were a stand-alone hospital that didn’t have a comprehensive training program."
A national curriculum would be of limited value, Hughes suggests, for access employees at Providence and other organizations in the Northwest, where managed care is pervasive. The training focus there, she says, must be on the differences in health plans and their requirements. "We could have a high-level discussion [nationally] of what is an HMO, and what is a PPO, but couldn’t go much beyond that," she says. "Plus, for us, what I really want to see is outstanding customer service skills, and there’s not a test in the world that can show me that. I will take someone from a different industry and train them for access if they have those public relations, customer service skills. I really believe you either have them or you don’t, although you can enhance them with good training."
At Providence, Hughes points out, "we don’t view registrar as an entry-level position, and we haven’t for a while. For those [organizations] that still do, some recognition and national certification might help [those employees] advance." What she’s excited about at present in the world of training, Hughes adds, is web-based delivery, which she is exploring for possible implementation at Providence. (See "Web training offers flexibility, efficiency," in this issue.)
Farrington points out, however, that while the CHAA certification does not provide any recognition of the skill set related to specific contracts, it acknowledges a more sophisticated understanding of the fundamentals that are common to the vast majority of access departments. The CHAA exam promotes, for example, the understanding that managed care contracts in general require a copay or require a referral from a primary care physician, she notes, and covers a variety of subjects ranging from JCAHO requirements to customer service to patient rights and responsibilities.
As the privacy and transaction standards called for under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 go into effect, Farrington says, standardization within the access field will increase. "Two of the things the government wanted to accomplish with HIPAA were portability and accountability, and under the latter came administrative simplification," she adds. "In order to do that, it makes sense to use [electronic communication] and to do that means no deviation from the rules."
One change under HIPAA, Farrington says, is that every insurance plan will have a number, a unique identifier, as will all employers that offer health insurance. "This links back to the idea of a national certification program," she notes. "As more and more [information] is standardized, we will continue to build it into our programs."