Enlist everyone's help for 'cleaner' claims

At Wuesthoff Health Systems in Rockledge, FL, outcomes of the patient access department are measured by various reports and spreadsheets. Of these, two particularly important metrics rise to the top of the list.

"First and foremost is delivering a five-star customer service experience to our patients and visitors," says Jacob Lopez, manager of patient registration. "Second on the list is meeting our financial goals in today's economy."

This is achieved, in large part, by creating cleaner claims so payments are returned quickly and reimbursement is maximized. "This is not always as obvious to the front end as it is to the back end," says Lopez.

To achieve this goal, the department has enlisted the help of its staff, technology, other departments, and administration.

First, it was important to ensure that processes were measured the same way throughout access services. "Our auditing process is unique," says Lopez. "We trained several staff members to become auditors. This way, the audit process is non-biased."

A new eligibility system was just purchased, which is used in access' audit process. "We use this to measure several things, but one in particular is getting correct policy numbers," says Lopez. "We identified that placing a hyphen or asterisk in there can prevent some claims from going out cleanly. By taking this information to the registrars and re-educating them, it helps us get the bills out cleaner."

A recent training effort involved medical necessity, which covered how to screen patients, what to do when the process fails, and completing an Advance Beneficiary Notification. "All of these processes intertwine with each other," says Lopez. "Re-educating registration is a constant thing."

Information also needs to be trended correctly in order for it to be of any use. With the medical necessity screening process, for example, reports were created to do this more timely and efficiently. "But we noticed that with the spreadsheets, certain accounts resurfaced week after week," says Lopez. "The process flow of the work leaving registration to coding to billing was not occurring, and the same accounts would reappear on the list."

The solution was to document notes in a specific location. "These would flow over to coding, allowing them to see exactly what we corrected," says Lopez. "That way, they could code it and have billing send it out timely."

Another goal involved reducing wait times in the outpatient area, which was up to 45 minutes at times. The wait time is measured by the patient's arrival time to the time of completion of registration. "We implemented an acceptable target of 30 minutes or less. We are now averaging less than the targeted time," says Lopez.

First, the process was examined from beginning to end. "We evaluated how we measured this, and realized that the times being noted by the staff were not done consistently," says Lopez. "We then targeted the pre-registration of the early cases and expanded on those numbers."

Not surprisingly, the biggest difficulty was getting staff to buy in to a new process. "The daunting words by the staff to a manager of, 'This can't be done' is something I love turning around in a clandestine manner," says Lopez. "In registration, we know that if we have a nice start at the beginning of the day, everything else flows smoothly."

Reward staff

"For our collection success, we make it fun," says Lopez. Access staff are continually provided with departmental acknowledgements, along with additional recognition items provided by human resources.

For some extra motivation, monthly themes are used, such as "March Madness." During the month of March, if staff members hit a specific amount for the day, they received a prize. In December, several prizes were given for each of "the twelve days of Christmas."

Last year, a selected associate got to show off a "floating trophy" at her desk for the entire month. "We treated it like it was the Stanley Cup. I had it filled with their favorite candies, and a small token of appreciation prize," says Lopez.

Staff members who do especially well in customer service are recognized at staff meetings. "One way to reveal particularly impressive results to higher-ups can be during monthly meetings," says Lopez. "We have a hands-on administration group here. When our goals are met, we are given accolades."

During a recent revenue cycle meeting, upfront collections in the emergency department was the topic of discussion. Targeted goals were created for two of the system's hospitals.

A decision was made to monitor the number of patients who left the ED without checking in with anyone. In conjunction with the clinical staff and security, all staff members were educated to make sure that all patients stop and see a staff person before leaving the ED. "With this simple process, we started to see quick results. We are midway into our fiscal year, and I am proud to say we have hit our targets four out of five months in both facilities," says Lopez.

Lopez feels strongly that accolades from administrators have a "trickle-down effect." "Hospital leaders in my organization have noticed my staff in many ways. They understand we are the frontline of the organization and start the encountering process," says Lopez.

On an organizational recognition day called "Thank You Thursday," administration recognizes an individual or department. When this first started, one of the first people to be recognized came from registration.

"This tells me the significance of how much my department is valued in this organization," says Lopez. "To have your COO and your CFO give you kudos in the board room goes a long way for me. I, in turn, channel that energy to the staff."

[For more information, contact;

Jacob Lopez, Manager, Patient Registration, Wuesthoff Health Systems, 110 Longwood Avenue, Rockledge, FL 32955. Phone: (321) 636-2211, ext. 2823. E-mail: jacob.lopez@wuesthoff.org.]