Give assessment tests if these errors occur

Registrars are given two assessment tests each month, covering updates to policies or payer requirements, at St. Anthony Central Hospital in Denver. If someone fails a test, the department's patient access coordinator does a one-on-one educational session, and the test is retaken. Here are items that staff have been tested on:

• The hospital's stroke alert process.

The steps that occur when the emergency department receives the call that a stroke patient is on the way were reviewed. First, a "John/Jane Doe" visit, because the patient's name is not yet known, is created with an account number medical record attached. "Once the person rolls in, we can update the time they arrived and collect demographic information," says Tammy Casados, patient access manager. "If the patient has been here before, we will contact medical records to combine the new medical record number to their old medical record number."

• Police/state patrol registration.

"The registration staff were automatically billing the police or state department," explains Casados. "We needed to ask the police and state patrol office some key questions, to see if the patient or the police or state department needs to be billed."

• Acquiring physician information and data entry.

The importance of collecting the primary care and referring physician's contact information was explained to staff. "This is very important for the patient's care, just in case the ED or admitting physician needs to talk with the patient's primary care or referring physician about their plan of care," says Casados. "This also helps case management on placement."

• Correctional facility registrations.

A PDF file was put together on how to handle correctional facility inmates. Staff were reminded to follow all processes for their safety and to avoid giving out personal information.

• Insurance payer codes.

The most common errors received back from the central billing office were reviewed. "Some of these involved updated insurance changes. These can be reviewed with the registrar or financial counselor to find out why they used a particular code," says Casados.

• Duplicate medical records.

When it's necessary to create a duplicate medical record, such as a stroke alert that starts off as a "John/Jane Doe" visit, an e-mail is sent to health information management (HIM) to let the department know why the duplicate medical record was created. "This will prevent the registrar receiving a error," says Casados. "No notification to the HIM department will lead to an error."

Feedback on errors

Coordinators were hired to do daily audits on registrars based on their daily activity log. "They can address errors or go over a process that isn't being followed," says Casados. "They can give feedback to the registrar during their working day on their work activity." The coordinator is able to work with the team on any issues that occur in the department.

Recently, the coordinator had to correct an incorrect entry for the "reason for visit" field for an admitted patient. "Our super census team was trying to get the authorization for the patient's visit and needed a correct reason for visit, chief complaint, or diagnosis," says Casados. "We can run a report to see if we have a valid reason, update the field, and educate the staff."

The coordinator can run a pre-edit bill at any time showing all errors that would hold up a statement, such as incorrect Medicare information. "We can remove the Medicare from the patient's visit and educate the staff on what they did wrong," says Casados. "For failed ABNs, we can see if the registrar completed the form, if the patient signed and dated the form, and if they updated the pending code," says Casados. "Also, we can check to see if they added the occurrence code."

A productivity report is run for each registrar. This tracks each patient checked in for the day, to ensure all demographic and insurance information was collected. "We run a consent audit daily on all registrars. We look to see if the HIPAA box is marked, if the name is printed on the form, and that the signature, date, and time are listed on the form," says Casados.

Payer code corrections may involve use of a generic payer code instead of a specific payer code. "This shouldn't occur, but we can find out why," says Casados. "The reason could be they saw an out-of-state address that didn't look familiar and chose the generic payer code, when in fact we do have a payer code for out-of-state coverage for the insurer."

Recently, Casados noticed that the incorrect payer code was being used 99% of the time for a certain insurer. "I put an assessment test together, with all payer codes attached," she says. "Now, they can go to the share drive folder under 'insurance,' and match up the card they are looking at to the correct payer code."

Missing scanned orders was another issue. Staff were educated about the key elements for a valid order and told that the patient isn't to proceed to the department of service without a valid order. "We made changes at our central scheduling department to ensure that there is a valid physician order when booking appointments," says Casados. "If the office didn't get us an order, the scheduled booking would stay in a pending status until the order was received."