Marion (IN) General Hospital’s patient access department saw worse quality assurance (QA) outcomes shortly after implementing a QA tool. However, this decrease was expected, because the quantity of data elements being final-reviewed was greatly increased.
“On a positive note, we had coached all users and departments that ‘We can’t fix it if we don’t know it’s a problem,’” says patient access manager Teresa Adams, CHAM.
The percentage of clean claims has increased, which has decreased accounts receivable days. Another advantage is that the patient accounts department can trust that claims are properly “scrubbed” due to rules in place that catch errors that will cause payer rejections. “Timeliness of claims transmissions is improved when staff aren’t manually rechecking claims,” says Adams.
The tool reduces many registration data elements that were being checked manually before billing was allowed to be transmitted. “They can now focus manual front-end efforts on payer challenges,” says Adams. Billing staff are freed to fix difficult issues by working with payer representatives.
“Patient access collaborated with the back-end team of users to come up with rules that needed to be written,” says Adams. For example, Medicaid ID numbers can be tricky to obtain from Indiana Anthem Healthy Indiana Plan (HIP). Only the payer can provide the ID number when patients present without an insurance card, as they often do.
The state of Indiana’s electronic eligibility response only provides the 12-digit recipient ID number used by most Indiana Medicaid plans. Patient accounts billing experts trained patient access users on how to retrieve the actual Anthem HIP policy ID number.
“Patient access enter the patient’s social security number as the policy ID number to prompt Anthem’s response with their specific ID number format required for claims,” says Adams.
