Registration errors used for training
Identify reasons quickly
Mistakes in registration, such as missing information, are discovered by frequent audits done by managers at Gundersen Lutheran Health System in La Crosse, WI. These become part of the employee's annual evaluation.
"We work really hard to try to get that information back to that end user right away, so the mistakes are fresh in their mind," says Penny Schubert, a manager in patient business services. "We've had pretty good success with that."
Accuracy rates average 96.8%, according to the department's weekly audits.
Recently, the audits revealed a problem with denials for high-dollar radiology procedures because required authorizations weren't obtained. Colette Lasack, MBA, executive director of revenue cycle, says, "We have better aligned process and technology, so our staff and the radiology scheduling department will both recognize when a prior authorization is needed. That has had a big dollar impact."
Based on the audits, additional training was given involving type of coverage. When claims involving Medicaid coverage are denied, "we are almost out of luck," says Lasack. "This became another area of focus for staff education."
There are a significant number of Medicaid programs, all with varying levels of coverage, she explains. "We have had to beef up our education on how to accurately read the electronic insurance eligibility," says Lasack.
If a Medicaid patient comes for an urgent care visit for a broken toe, for example, staff might find out he or she has coverage only for wellness examinations. " Mental health coverage is a different coverage than medical," says Lasack. "Staff need to understand the nuances of the different services that are offered."