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Quality assurance (QA) in patient access is often “time-consuming, expensive, inaccurate, and incomplete,” says Tim Holland, MPA, CHAM, regional director of admission services at CHRISTUS Trinity Mother Frances Health System in Tyler, TX.
The main problem is that directors only see a tiny sample of the total patient population. “Decisions and process changes can be misleading and incomplete, at worst, and a Band-Aid fix at best,” Holland explains.
Slow reaction times hinder progress. By the time leaders can react to the information gleaned from audits, it is already outdated. Incorrect processes continue for weeks or even months. “This leads to denials, reworks, and appeals,” Holland laments. “It all costs time and money that could have been saved if the process was correct the first time.”
The patient access department now contracts with a vendor that allows the department to QA 100% of its data in near real time. The first major change: Make QA scores for individual associates transparent for everyone in the department to see. “This pushes accountability to the individual user level,” Holland explains. “A team begins to hold an individual responsible for lower QA before a leader ever has to.”
Leaders intervene when needed. Sometimes, a registrar refuses to accept the help offered, exhibiting no interest in improving accuracy. “But it has drastically cut down on the amounts of time where a leader was required,” Holland notes.
Most employees take great pride in the quality of their work and turn to their more successful counterparts. “These employees are able to keep conversations positive with struggling associates and help them improve over time,” Holland adds. Pride in your work is one reason to produce highly accurate registrations. Extra cash also is on the minds of patient access employees at Riverside Walter Reed Hospital in Gloucester, VA. Highly accurate registrars are rewarded with incentives after quarterly audits. “It is a strong motivator. They have the ability, based on hours worked and outcomes, to earn a nice increase in pay,” says Sherri D. Hamm, CHAM, manager of the revenue cycle.
The amount of the payout is determined by accuracy and point-of-service collections. “Staff have no idea which accounts will be selected for auditing purposes. They have to ensure the accuracy of each registration,” Hamm explains.
Fifteen accounts are audited each quarter. When errors that prevent either “clean” billing or pose compliance concerns occur, they are flagged in the system. Staff are required to fix these before the claim goes out the door — and their colleagues are in the loop, too.
“We do not show individual incentive results, as that is tied to pay,” Hamm notes. However, all employees can see who made errors and whether they were fixed. Struggling employees know exactly who to turn to if they are struggling with inaccurate registrations.
“They know who the shining stars are within the team, and they seek guidance and direction from those employees,” Hamm says.
The same is true of struggling collectors, who often turn to top collectors for advice. For some, it is as simple as changing the way patients are asked.
Struggling collectors typically say, “We can bill you if you are not prepared today.” In contrast, successful collectors say, “X amount is due. How do you plan on taking care of that today?”
A recently implemented QA module dramatically improved registration accuracy at Mosaic Life Care in St. Joseph, MO. The tool alerts registrars about any problems with a registration. While the tool prompts the user to fix mistakes, it goes even further by recommending training for struggling registrars. “It will assign re-education to the access rep based on recurrent registration errors,” says Deborah Vancleave, vice president of revenue cycle.
Recently, patient access added quality scores to the goals for individuals, clinics, departments, and divisions. In fiscal year 2018, the overall goal for registration accuracy was 85%. “We achieved 87%. This was a monumental task,” Vancleave says. “Prior to fiscal year 2017, we did not have any form of registration QA in place.”
The department had tried offering incentives previously, but without much success. “We had moved away from incentives because we had no way of tracking productivity,” Vancleave explains. This issue is going to be reconsidered as the department begins tracking data on its point-of-service collections and missed collection opportunities.
Already, better registration QA “has been extremely beneficial to our bottom line,” Vancleave reports. “We have slashed our patient access final write-offs by half.”