Make staff accountable for registration accuracy

Have employees fix their mistakes

Without staff involvement in registration accuracy, no matter what a manager does, needless errors will occur. "Staff involvement provides a feeling of ownership and empowerment," says Catherine M. Pallozzi, CHAM, CCS, director of patient access at Albany (NY) Medical Center. "It becomes an inclusive process, as opposed to a 'top down' environment."

Currently, Albany Medical Center's patient access department lacks an automated quality assurance (QA)/monitoring application. "We do, however, have a dedicated quality and development team," says Pallozzi.

The organization uses set guidelines for monitoring the accuracy rates of staff. All new team members are monitored at 100% for a period of time. Staff members achieving 95% for a three-month period are not monitored as frequently. 

Pallozzi says her greatest challenge is that the four-member quality and development team also covers the organization's registration fundamentals program, customer service, and medical terminology, among other skill enhancement programs. "So if a priority needs to be bumped due to an identified need or staffing, it usually is monitoring," says Pallozzi.

Recently, a new "unit observation" initiative was implemented. A trainer is assigned to be in a unit for a day or two for the sole purpose of answering questions from staff during day-to-day operations. 

"It is not done for the purpose of monitoring. It is an informal time with the quality and development staff member," says Pallozzi. "It has been a great success, and we have gotten some wonderful feedback from the frontline staff. Staff have asked, 'When are you coming back?,' which is a telltale sign of success."

This concept has strengthened the relationship of the quality and development team and staff. "The quality and development team is being embraced as helpful, as opposed to being seen as the group that 'dings' me for an error," says Pallozzi.

Staff clean up own edits

Currently, Pam Stevens, director of patient registration at Cook Children's Medical Center, has a team of two people who manually do QA for about 95% of registrations. "I think this is the reason the back end is so successful," she says. "Patient financial services wouldn't drop nearly as many clean claims if we didn't do that work. My department is about 97% accurate, which means clean claims are dropping."

Stevens says that the department is implementing a new electronic system for registration QA that "will have scrubbers on it for billing edits. It will send a note to the person who actually did the registration, so they can clean up their own edits."

Stevens says that this will allow her to do more of the facility's QA, not just those who report to patient access but anybody in the hospital system who is doing registration. "That is something that the medical center will benefit from," she says.

Cook Children's has had an incentive program in place for several years, tied to accuracy and collections. Each month, a point-of-service collection goal is set, based on the prior month's revenues. "If staff are not at least at 95% accuracy for their QA, they are not eligible for incentives," says Stevens. "Probably nine out of 10 months, we make our incentive goal."

Teresa R. Drakeford, CHAA, CHAM, manager of patient access services at Carilion Clinic in Bedford, VA, says that one problem she contended with was determining who actually made the error. "With the current ADT system that we are using, anyone that touches the account or makes one change to it has their initials on it," she says. "We implemented charging anyone that has their initials on that account with the error."

For example, if the Medicare as Secondary Payer questions state a retirement date, but the registrar put the subscriber as unemployed, this needs to be corrected to reflect the patient's retired status. "We know this error will get fixed due to anyone touching the account being charged with the error," says Drakeford.

Six staff members check errors daily, including Drakeford and her team leader. "We send the employee what the error was via a communications function within the system, and we give them three days to fix it. If the employee does not fix it, it is counted against them," says Drakeford. "When they do not meet quality standards, they are not eligible for incentives for their upfront collections."

A board posts the name of the person with the best accuracy rate for the month. "Typically, when someone has their name on the board the most times, they receive a little gift," says Drakeford.

Give feedback

At Albany Medical Center, patient access staff receive feedback in written format. Occasionally, the trainer, unit manager or unit staff lead reviews this one on one with the staff member. 

In addition, the department's quality improvement team (QIT) comprises staff lead, managers, and quality and development. "This is a peer program," says Pallozzi. "Through the formal monitoring program, areas that require some additional training are identified."

As for areas identified, Pallozzi says that "address format to ensure no mail return has been high on the list." Other areas include ensuring that a P.O. box vs. a street address are noted appropriately, as the system is sensitive to punctuation. "In addition, the team has created a mechanism for staff to conduct self quality checks of their registration," says Pallozzi.

After QIT members meet with staff individually or in small groups, the information is shared with the team. Results of the training are shared at the bi-monthly QIT meeting.

"Some staff have concerns with being monitored or 'graded.' That has been somewhat of a challenge. But I feel if the results of the monitor are shared in a respectful way — a perspective of 'I want to help you' — then the result is very positive," says Pallozzi.

Pallozzi adds that the same staff members who were unhappy about being monitored have had great pride when they actually see how they've improved. "They have a real sense of accomplishment," she says.

[For more information, contact:

• Teresa R. Drakeford, CHAA, CHAM, Manager, Patient Access Services, Carilion Clinic, 2017 South Jefferson Street, Bedford, VA 24011. Phone: (540) 587-3258. Fax: (540) 587-0494. E-mail:]