Do audits: ID why mistakes were made

Lessen auditors' workload

Previously, registration errors were sent to individual access employees, who were required to correct the error, says Stacey Bodenstein, general manager of admitting and registration at TriHealth in Cincinnati, OH. However, corrections weren't being made quickly enough due to varying shifts.

"We now have a very intensive auditing system in place," says Bodenstein. "We use a homegrown auditing system called Redeeming Audit Engine System."

If the system finds a potential error in a registration, an e-mail is automatically sent to the registrar who entered the information so that necessary corrections can be made before the claim is sent out. This system has lessened the workload of auditors enough to allow for the decrease of FTEs, says Bodenstein. "The auditors now have time to make corrections to the accounts," she adds. "In the past two years, the global audit score of all registration departments has decreased by nearly 50%."

Ensure accuracy

"Registrations should be audited on an ongoing and consistent basis to ensure staff are provided feedback on their registration errors," says Tracy Abdalla, hospital access services supervisor at University of California — Davis Medical Center Hospital.

Abdalla performs random audits by day and by time, with each audit including a wide range of payer mix, taking these steps:

1. A billing folder is assembled containing original documentation related to the registration, insurance verification, and copies of patient identification and insurance cards.

2. The documents are randomly pulled throughout the day on any given day, several times a week, to review the registration quality.

3. Errors are copied and given back to the staff for correction, with a focus on insurance eligibility, subscriber details, and registration data. Auditors check for the following:

• If the patient is listed as disabled, did the registrar check eligibility for Medicare and Medi-Cal, along with any private insurance?

• If the subscriber is listed by the insurance as the spouse of the patient, did the registrar also list the patient as a married person?

• If the patient is part of a county contract, such as a prisoner or child protective services, did they obtain the necessary documents to bill for services?

• Did the registrar accurately reflect the guarantor of the account?

"We discovered that we needed to redirect our registrars to thoroughly review the insurance eligibility responses," says Abdalla. "These responses will also help to verify some of the necessary demographic details." For instance, subscriber details such as date of birth might be missing from the registration screen, but available on the insurance response.

"We have to show the registrar how to be a detective, when faced with trauma or medical situations," says Abdalla. "The patient may not be able to provide the necessary registration information for themselves."

This month: Best practices for education and training

This month's Hospital Access Management is a special issue on education. Inside, we give solutions to provide training at low cost; evaluate registrars' skills; keep staff updated on payer requirements; and educate to dramatically improve collections, customer service, and results from new technology.

Next month is the 30th anniversary of Hospital Access Management. We'll give in-depth coverage on the quickly changing role of patient access, including updates on crucial developments in technology and healthcare reform. Don't miss this special issue!