ID costly accuracy problems sooner rather than later
ID costly accuracy problems sooner rather than later
Get it right the first time
A seemingly minor problem with registration accuracy can cost a hospital tens of thousands of dollars if it's not fixed quickly. Staff may make the same error over and over, resulting in a multitude of claims denials. That is why you'll need strategies to identify errors as soon as they happen, so staff can be re-trained and the errors stopped.
Betty McCulley, CHAM, access director in the centralized business office at Baptist Health System, a four-hospital system in Birmingham, AL, says that the top goals for her patient access department are: excellent customer service, the quality of financial and demographic information, compliance with all state and federal mandatory regulations, and point-of-service collections.
"To provide excellent customer service, it is our responsibility to obtain and enter accurate information into our system the first time," says McCulley.
Employees view their own reports
To attain data accuracy, Baptist Health provides a structured training program to its new access employees. In addition, continual training is done through a combination of methods. These include a monthly access newsletter, onsite training, Internet-based training, and training workshops for access supervisors as well as frontline staff.
Documented intake assessments are performed throughout the year at each facility, with feedback provided to the VP of revenue management, the hospital's CFO, and the access leadership team.
The department also uses an automated quality assurance system, implemented in October 2005. This allows errors to be corrected in real time as workflow allows. "Reports are provided for high-volume areas, such as the emergency department, where real-time correction is not an option," says McCulley. "Errors must be corrected within three days, before bill drop. Supervisors work reports to ensure this is done."
Employees can review their report cards on demand. "This instills pride and a sense of ownership related to their individual impact on quality," says McCulley. "Reports are available with indisputable results for use in recognizing high performers, coaching, and in some cases, disciplinary follow up."
Give staff the tools they need
"To expect access to perform their job with accuracy, we are obligated to provide the necessary tools," says McCulley. The department has documented insurance manuals describing information specific to each of the major payers.
"Using best practice/industry standards as a benchmarking tool is an excellent way to compare your results with same-type services in the health care industry," says McCulley.
Here is how the department compares to industry standards from the Revenue Cycle Best Practice Standards Healthcare Financial Management Association, tracked by the hospital's access dashboard:
industry standard for data quality: 98%;
industry standard for unverified benefits/inpatient accounts: 0.5 days;
industry standard for medical record errors: 1%;
industry standard for patient account quality performed by financial counseling staff: 95%.
Prior to the release of the dashboard report, McCulley covers the results with the access managers and training team.
"We learned where our weaknesses were by running reports of the highest number of errors prior to correction. By identifying the specific error, we would build additional edits to catch the error when possible," says McCulley. "The majority of the time, we can write an edit to cover almost every situation."
McCulley found, not surprisingly, that the most common area for errors was the ED. "This is to be expected due to the high volume, fast pace, and often the lack of good information due to the circumstances of the ED visit."
McCulley also discovered that certain payers were causing staff to create errors, such as with confusing insurance cards with both HMO and PPO printed on the front of the card, and one card that had 17 logos on it. "This gave us the opportunity to build edits if appropriate. And if it was a situation where an edit could not be worked out due to an unusual situation, we provided training and coaching."
Within three months of implementation, the department was meeting industry standards for quality assurance (QA). "We also have incentive program, and QA scores factor into their payout," adds McCulley.
Each access manager is responsible for completing an assessment for any monthly goals he or she may not have met for the facility. The assessment includes information that led to the results, as well as an action plan to meet or exceed the goal going forward. McCulley then shares this information with the hospital's VP of revenue management, who reviews the dashboard results on a monthly basis. These are shared with the facility's CFOs and corporate-level financial officers.
The automated QA system provides a variety of reports to break out errors identified by individual user, by department, by areas reporting to specific supervisors, and by payers.
"The reporting capabilities are excellent tools for fair and unbiased reporting and documentation of employee performance to be used in their annual appraisals," says McCulley.
Some manual audits needed
Although the automated QA system is capable of auditing 100% of accounts, there are some indicators that cannot be measured through this system. For this reason, patient access staff manually audit a small sampling of accounts each month. These manual audits are reported on the dashboard and include account reviews to assess performance specific to financial counseling.
A team made up of both business office and access staff reviews insurance errors together. "Significant progress has been made to date through these combined efforts and processes," says McCulley. "We have found the automated tool, along with a limited manual review, is giving us a true accounting of our quality."
Rose Jeanfreau, director of patient access services at Swedish Covenant Hospital, says that her department made the following changes to improve accuracy:
A lead ER registrar position was created.
"This improves efficiency and effectiveness in the department, by performing quality assurance checks on ER patient accounts," says Jeanfreau.
A four-step process was implemented for identifying out-of-network patients.
The patient access department collaborated with the emergency department, the information technology (IT) department, bed managers, and case managers to accomplish this. "This ensures that the ED physician is notified, the patient's primary physician has been contacted, and the patient is cleared for admission," says Jeanfreau.
A process was developed to allow the authorization number to cross over to the patient claim form.
Patient access staff collaborated with patient finance and the IT department to develop this new process. "This eliminates multiple steps and significantly reduces the number of inpatient and outpatient denials due to lack of referral or authorization," says Jeanfreau.
Trends are identified.
Patient access attends bi-weekly meetings with patient finance and the IT project manager to identify trends in registering errors, modify or implement automated processes, and improve overall operational efficiencies.
Key indicators are tracked.
Reports and monitoring tools were created to track several key indicators for identifying overall performance of front-end and point-of-service staff. These indicators are tracked:
insurance referral/authorization numbers;
Blue Cross/Blue Shield coordination of benefits questionnaire;
physician NPI numbers;
copay, deductibles and self-pay collections;
duplicate patient registrations.
Swedish Covenant's patient access department is currently automating the process of address verification. The address entered is matched against the U.S. Postal Service database, which returns the address along with error messages identifying any problems, such as a non-deliverable address, a missing apartment number or invalid street name.
Another change that the department has in the works is to incorporate the quality assurance coordinator's responsibilities into the ED registration manager's role. The goal is to increase registration accuracy rates within both access services and departments that utilize registration functions. "By identifying potential problems, action can be taken ahead of time, as opposed to being reactive, where the issues are not identified until after the fact," says Jeanfreau.
[For more information, contact:
Rose Jeanfreau, Director of Patient Access Services, Swedish Covenant Hospital. Phone: (773) 878-8200 ext. 6670. E-mail: [email protected].
Betty McCulley, CHAM, Access Director/Centralized Business Office, Baptist Health System, Birmingham, AL 35211. Phone: (205) 599-4122. E-mail: [email protected].]
A seemingly minor problem with registration accuracy can cost a hospital tens of thousands of dollars if it's not fixed quickly. Staff may make the same error over and over, resulting in a multitude of claims denials. That is why you'll need strategies to identify errors as soon as they happen, so staff can be re-trained and the errors stopped.Subscribe Now for Access
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