Manual processes are no longer enough to conduct the kind of quality assurance (QA) patient access leaders need at Winston-Salem, NC-based Novant Health.

A team of 15 representatives handles QA duties. “But as good as they are in their work, it is not enough to really give us what we want,” says Craig Pergrem, senior director of preservice and onsite access for Novant.

Patient access is a multifaceted division in the revenue cycle. “QA can be challenging due to all of the different touch points patient access has,” says Elkin Pinamonti, MHA, assistant director of onsite access for Novant Health’s greater Winston-Salem and northern Virginia markets.

Many people in the patient access department view a patient’s account before it even gets billed out. “This means that multiple team members have ownership of the account,” Pinamonti notes. With any QA system, there’s always the possibility that data can get “muddled and skewed,” Pinamonti says. For instance, some team members may be included in a QA audit, even though their function with the account was very minimal. “Therefore, they would need to be excluded from the audit. Depending on your system, this delineation can be very difficult,” Pinamonti explains.

The QA team examines about 10% of monthly volume. “When we went live with Epic, we determined that it would provide us with the data we needed. We cancelled our QA vendor,” Pergrem says. Soon, patient access leaders encountered a problem. “We could not maintain the same level of clean data with just work queues,” Pergrem says.

Now, Novant’s Epic revenue cycle team is attempting something new. “We are creating a QA process within the system by bringing work queues and other reports together on a dashboard,” Pergrem reports. This information goes directly to team members.

The department’s analyst, who is a former patient access manager, created the new QA dashboard. “It is like a reboot to QA for us. Each individual can see where they are having issues,” Pergrem explains.

The department always watched closely for errors. The problem was that the information did not always make its way to the person who made the mistake. The dashboard allows leader to put patient access processes under the microscope.

“We want to see what patient access causes when it comes to a bill dropping or not,” Pergrem says. Patient access staff are more aware of how their role affects the “big picture” of the revenue cycle.

“We will then build those key items into the scoring,” Pergrem says. “It has been a process, but we feel we are getting closer.” Accounts randomly sampled for monthly audits give only limited information. “It will not give your team members or your leaders specific data drilled down to individuals,” Pinamonti says. The best QA system “needs to start at the end user level and it needs be in real-time,” Pinamonti offers. The goal is for registrars to readily access information to address issues head on.

“Although monthly QA can be helpful in identifying departmental trends, it doesn’t dig deep enough into what our individual team members may be missing on a day-to-day basis,” Pinamonti says.

Novant wants to give employees a QA system they can use throughout their day. If an employee makes an error, he or she finds out so it can be fixed. Employees also receive an overall accuracy score. Pinamonti expects to see “big improvements” from the new QA system. “It is vital to set expectations for what a team member’s role will be in the QA process, or it will lose its value.” Employees are expected to ensure their accounts are error-free before they move to the billing phase of the revenue cycle. “We are continuing to see an increase in the importance of front-end registration’s role in the billing cycle,” Pinamonti notes.

Most employees really want to know how they can improve. “One of the biggest benefits of a great QA process is that it allows them to take control of their day-to-day work,” Pinamonti says.

Employees identify their own needs for training, instead of leadership telling employees. “Delivering cleaner, more accurate QA allows for more trust in the system,” Pinamonti says. “This increases utilization and buy-in.”

The new ability to fix errors in real time positively affects revenue in three key ways, according to Pinamonti.

“It allows for registrations to be cleaner, decreases rebilling of accounts, and ultimately assists with your overall A/R.”