Making patient access processes as efficient as possible “begs for lean principles,” says Myndall V. Coffman, MBA, system director of patient access and scheduling at Louisville, KY-based Baptist Health.
“These principles can be applied for accurate billing, patient scheduling and pre-registration, and patient check-in, to name a few,” says Coffman.
Patient access leaders at Kaleida Health in Buffalo, NY, recently used lean methodology to improve the accuracy of pre-arrival information, with the goal of eliminating rework and claims denials.
If on the day of service, the paper chart includes a piece of incorrect information such as a misspelled name, “we now have to reprint whatever small component remains on paper, along with the consent forms and wristband,” says Diane Pazderski, RN, director of patient access services.
Wasted time and confusion makes patients dissatisfied with patient access. “It impacts our credibility in the patient’s eyes,” says Pazderski. “They wonder ‘What else did they get wrong?’”
In addition, denied claims often can be traced back to inaccurate information at pre-registration. “Now we have a patient who gets a bill he shouldn’t get, leading to further patient dissatisfaction,” says Pazderski. The department made these changes:
Specific staff members are designated to obtain authorizations.
Physician offices don’t always provide timely authorizations. “We had multiple inbound and outbound calls regarding a single patient’s authorization for a procedure,” says Pazderski. “We have carved out a small set of staff to handle this.”
An initial attempt is made by pre-registration staff to obtain the authorization. Next, the account is moved to an authorization work queue that a separate group of employees handle. “This group stays with the account until authorization is obtained,” says Pazderski.
A quality audit process was implemented.
“We look at the number of times we receive a denial based on pre-arrival information,” Pazderski says. These questions are asked: Was our source of information accurate? How did we determine Medicaid and Medicare eligibility? Do we have accurate databases from our payers?
About 10 registration face sheets are randomly audited per staff member each month by the patient access manager or supervisor at each of the system’s four hospitals. “We look at whether information is entered correctly. We also look at denials by staff member,” Pazderski says.
One unexpected finding was that eligibility often changed because the first of the month occurred between pre-registration and date-of-service. “This happened more often than we thought,” says Pazderski. “We challenge the denial on the backend, but this requires rework and wasted time and effort.”
A new quality management position was included in the 2015 budget.
“We realize the importance of getting it right the first time,” says Pazderski. “In order to eliminate downstream rework and waste, we have committed resources to develop a robust quality position.”
The position will be dedicated to monitoring and addressing quality issues throughout the revenue cycle, including the pre-registration and registration processes. “We are in the process of developing a job description and onboarding this person,” says Pazderski.
Annual reviews of the registration system were made mandatory.
“We identified that once staff were competent in our registration system, they weren’t required to attend a review class,” says Pazderski.
They received email notices of changes, but no further formal training. Experienced staff members often turned to new hires to ask about new fields that were added, such as a pharmacy program allowing patients to obtain medications prior to discharge, with the goal of reducing readmissions.
“That was something we needed to address,” says Pazderski. “Staff are now required to review the registration system annually.”
Frontline staff share every step they take to complete a process.
“Staff will say, ‘Actually, that’s not quite the way we complete that step. There are other steps I do before that,’” Pazderski says. Registrars have missing pieces of information that their supervisors can’t provide about a process, such as databases they routinely use to find information.
“Managers will often tell you what they think their staff does,” says Pazderski. “When you ask the staff, there is much more going on.”