Access Management Quartertly

Hospital averages $6M in front-end collections

New system is 'lifeline'

An enterprisewide master patient index is used at Methodist Le Bonheur Healthcare, a system of six hospitals, several off-campus diagnostic and treatment centers, free-standing surgical centers, and urgent care centers.

Access managers provide all registration services, verify insurance coverage, calculate appropriate copays and coinsurance, counsel patients regarding insurance issues, handle requests and applications for charity care, coordinate incoming orders for surgery and other outpatient services, manage a staff of pre-certification nurse specialists, verify and document provider licensure and sanction status, and collect front-end payments for all services when appropriate.

"We average 45,000 registrations per month, and find now that technology is our lifeline. It is essential to our success," reports Jessica Murphy, CPAM, corporate director for patient access services at Methodist Le Bonheur in Memphis, TN.

About five years ago, Methodist Le Bonheur took a necessary step: investing in an enterprisewide, single-vendor software solution, which encompassed all clinical service needs as well as scheduling, admissions/discharge/transfer, health information management, and coding.

"Using this technology, we have developed at least 35 quality management reports to use as monitoring and accountability tools for registration accuracy and regulatory compliance auditing," reports Murphy.

The system's scheduling application directly feeds into a "work-to-be-done" queue for registrars. "We have direct and/or indirect access to virtually all payer web sites at each registrar workstation," says Murphy. "We developed our own patient online pre-registration product."

An electronic front-end payment handling system was installed to process all approved credit cards and electronic checks. In addition, a fax tracking system is now used on all incoming documents, with specific emphasis on physician orders, indexing, and retrieval.

Murphy points to only one downside: "Needless to say, if the system 'crashes' or is set for planned downtime, we experience the pressure of stress we would never have appreciated before these changes."

Training classes for new associates cover operating in a downtime environment. "We then caution the associates to go back into the workplace and get their supervisor to walk them through the process and location of necessary supplies," says Murphy.

Downtime patient labels can be printed during the registration process, which capture the bar code for Downtime Financial Number (FIN). For any scheduled downtime, access managers receive a reminder e-mail to check their supplies and ensure they have adequate levels of needed product.

A simple "patient tray" system was devised, to allow access associates to stay organized in the midst of chaos. One tray is used for labels and patient records for patients who were already "quick-registered" at the time the system went down. Their FIN already is system-generated and is captured on the labels and documents that would have printed prior to downtime.

The second tray is used for patient documents that would have been generated on patients who had been "full-registered" but are still located in the ED. The third tray contains any printed documents for patients who are being registered during the downtime and will need to be registered into the live system when it is restored.

"The only hope any of us has is to get organized in advance, use all the technology your systems offer in an off-line downtime setting, and put your experienced staff in charge of running the operation," says Murphy.

Registration accuracy has "improved tremendously," reports Murphy. "We are averaging in excess of $6 million in front-end collections each year for the past 2½ years."

In October 2005, goals were set for accuracy and quality for patient access services. The errors attributable to patient access services are system calculated by patient financial services. Two kinds of claims are flagged: those that hit a front-end edit, which designates a "fix" is required prior to sending the claim to the payer, and an actual denial from the payer for a submitted claim.

"Obviously, that doesn't capture every error that can be committed in a registration process," says Murphy. "We review all our systems to look for additional issues that can be captured electronically and reported back, so that we are in a continuous improvement process mode."

The "goal" agreed upon by all players in the corporate revenue cycle task force, which is chaired monthly by the CFO, is a total of 500 attributable errors per month, systemwide. "That places us at an approximately 1% acceptable error rate," says Murphy. "We are looking for ways to capture and report errors in other areas, but between claim edits and payer denials, our significant problem areas are identified and keep us focused."

Of the 500 edit/denial codes, 106 codes are attributed to errors that could have been prevented at the time of registration or verification. Key performance indicators for this category are reported monthly by facility and for the system. These are directly tied to the annual performance evaluation. The number of errors decreased from 1,061 in January 2006 to 424 in January 2008.

Customer service scores now meet the system's standards and stay in that range, and staff also are more satisfied. "We have significant longevity in our registration/access areas with surprisingly limited turnover," reports Murphy.

(For more information, contact James Hicks, CHAA, CHAM, CAM, patient access manager, Southeastern Regional Medical Center, e-mail:; Julie Johnson, CHAM, director, health information management/HIPAA privacy officer, Mt. Graham Regional Medical Center, Safford, AZ, e-mail:; Jessica Murphy, CPAM, corporate director for patient access services, Methodist Le Bonheur Healthcare, Memphis, TN; e-mail: