New patient access employees’ training was cut by two weeks with expanded use of online training modules. The following strategies can be used to tweak training:

  • Ask new hires for feedback on training.
  • Ensure modules are challenging but not impossible to pass.
  • Cover all aspects of registration before department-specific training.

Onboarding training for new patient access employees was cut from seven weeks to five weeks at Los Angeles-based Ronald Reagan UCLA Medical Center, mainly because of expanded use of online training modules.

“The modules range from beginner to moderately advanced and can be modified at any time,” says Drew D. Totten, principal administrative analyst for patient access services.

Initially, employees took all the modules over a two-day period. “We found this was ineffective, particularly with new hires,” says Totten. “They didn’t retain the information.”

Employees now take a single module at a time. First, they demonstrate the relevant skills on the job. “Once they’ve mastered that, they take another module,” says Totten. “They get a better grasp of the material that way.”

The previous practice was for UCLA’s new hires to shadow employees. This gave them exposure to their actual job duties. “But due to inconsistent training, we made the change to our current practice. We have seen positive gains,” says Totten.

The online training saves resources and time. Productivity is higher, since most employees take the modules during downtime at work. “It also frees up the manager, who previously had to cover everything that’s now in the online modules,” says Totten. Another advantage: Every patient access employee gets information in the same exact way.

Online training doesn’t always translate well to face-to-face encounters, though. “It’s like becoming a police officer. You go to the training academy, but when you hit the streets it’s completely different, due to the different scenarios the employee will encounter,” says Totten. He names these as some of his biggest training pain points:

  • Properly entering the patient’s primary care physician.

“This was often done incorrectly, but the online training has made it a non-issue,” says Totten.

Often, entering the primary care physician information was overlooked. Registrars viewed it as an unimportant piece of data. “The online training and hands-on reinforcement has cause our department error rate to drop from 30% to 8%,” says Totten.

  • Medicare Secondary Payer questionnaire (MSPQ) completion.

Prior to online training, the form was completed incorrectly “nine out of 10 times,” says Totten. “We’re really stressing hard the proper steps of completing that properly.” Covering every possible scenario is impossible. “So as new scenarios come up, instead of having staff retake the entire MSPQ training, we just have a huddle to cover the minor tweaks or finer points,” he says.

  • Third-party liability.

If an ED patient comes in after an automobile accident, the insurance of the person who hit them may pay the bill, instead of the patient’s primary insurance. “Those type of scenarios have been integrated into the training and are closely monitored to be sure they are effective,” says Totten.

  • Point-of-service collections.

“Most of the people we hire for pre-registration have never done it.” says Totten. “If employees simply follow the scripting, they’re successful. It’s that simple.”

Online training modules for collections have helped many reluctant collectors. “These have affected our collections, at least in our pre-registration department, substantially,” says Totten. “We are breaking records in that area.” Pre-registration collections have increased about 40% because of improved training and monitoring.

If an employee is having difficulty with collections, two things are done:

1. Managers listen to recorded calls.

“These calls are also reviewed with the employee to identify successes and areas of opportunity,” says Totten. They look to see that the employee is following the scripting for collections.

“In regard to scripting, we are looking for consistency and urgency,” says Totten. An example would be that immediately after the liability is discussed with the patient, the employee must always ask, “How would you like to pay for that today?”

“If the patient is somewhat hesitant to provide credit card information over the phone, our secure online payment portal is an option,” says Totten.

2. The employee does role-playing with a manager who pretends to be a patient.

“We want the employee to sound natural and not scripted,” says Totten. “It’s all about making sure the employee is comfortable in their verbiage.”

Many employees get results after the role-playing, but for some, the improvement doesn’t last. “We are still looking to shore up our processes for training, to get everybody at the same level with collections,” says Totten.

Evaluate Training Approaches

Totten continually evaluates his own training approaches. He always asks new hires what they thought was good and bad: “If the training is flawed, it must be fixed.” Here are some recent tweaks made to patient access training at UCLA:

  • Several questions were reworded because they were unintentionally tricky.

“Some of the fill-in questions could have had multiple answers,” Totten explains. “The test has been modified to identify all possible answers.”

  • A module was made less difficult because few patient access employees were passing it.

“Modules should be challenging, but not so much that no one can succeed,” says Totten. Initially, the patient access coordinator module took four hours. “That is too much material to retain in just one exposure session,” says Totten, who broke it up into three smaller trainings. “This ensures the user is engaged and not overwhelmed. This also allowed me to shorten the assessments.”

  • The number of acceptable answers was expanded for some “fill in the blank” questions.

The correct answer for the question “In securing patient valuables, you must have a ________present whenever the safe is open,” is “security guard.” However, “guard” or “witness” are also acceptable answers.

Similarly, for the question, “The COA informs patients that UCLA is a ________ hospital and that their case may be reviewed by medical students,” there are multiple acceptable answers. These include “teaching,” “instructional,” and “research.”

Patient access leaders at Riverside Regional Medical Center in Newport News, VA, recently made an important change to initial training for new hires. The department switched to a structured classroom training environment.

“This has proven effective with our new hires, and can be shown in their progress once in the department,” says patient access director Melanie Stanius, CHAM.

Previously new hires were trained exclusively in the department. They were paired with an experienced registration representative and observed actual patient registrations. “The change to a standardized classroom training has allowed the new hire to come in with a solid foundation for us to build upon during the department training,” says Stanius.

New hires now complete three days of classroom training with a patient access trainer. This covers all aspects of registration — compliance, rules and regulations, and workflow. “This results in less frustration and confusion for the new team member as they begin their department-specific training,” says Stanius.


  • Drew D. Totten, Principal Administrative Analyst, Patient Access Services, Ronald Reagan Medical Center, Los Angeles, CA. Phone: (310) 481-9759. Email: DTotten@mednet.ucla.edu.
  • Melanie Stanius, CHAM, Patient Access Director, Riverside Regional Medical Center, Newport News, VA. Phone: (757) 594-4211.
    Fax: (757) 594-4495. Email: melanie.stanius@rivhs.com.