Are registrars accountable for registration mistakes?

Without question, the mistakes made by front-end staff can make or break the success of your patient access department. "Registration is one of the important components of patient care," says Debra A. Artwell, manager of outpatient access at Pennsylvania Hospital, part of the University of Pennsylvania Health System. "The patient demographics and financial information are data that follow the patient throughout our entire health system."

In some cases, though, registrars may be completely unaware of the costly mistakes they're making. If this is the case, it's a safe bet the mistake will be repeated again and again.

"If staff are not aware of the errors they're making, they can't impact their own performance. They can't attain the goals for performance that are set for them," says Tammy Casados, patient access manager at St. Anthony Central Hospital in Denver.

"In most instances, registration staff have first contact with our patients," says Anne Goodwill Pritchett, vice president of patient financial services at Hackensack (NJ) University Medical Center. Their responsibilities include capturing patient demographics, verifying insurance eligibility and benefits, and obtaining pre-certifications and authorizations that may be required to obtain payments from insurers or third-party payers.

"If any of these data are incorrect or inaccurate, it creates a negative rippling effect throughout the revenue cycle," says Pritchett. "Inaccurate data can results in denials, payment delays, bad debt, and patient dissatisfaction. Hence, it is imperative to hold registration staff accountable for their own errors."

Pritchett says that the biggest challenge is the lack of user-friendly, real-time technology to do this without manual intervention. "While there are some online tools available, most that we have seen are not comprehensive and require some manual manipulations," she says.

Get fewer denials

When staff are held accountable for errors, there is less likelihood of denials and lost revenue. "Clean claims go out the door on the first attempt. That will decrease our A/R days and help our cash flow," says Casados. "Regulatory compliance is achieved, which contributes to accreditation of the facility during reviews."

These changes were made by patient access managers at St. Anthony's:

• Staff make their own corrections to their work, so they can learn from their mistakes.

This way, the ramifications of incorrect demographic and insurance information entered at the beginning of a registration become very clear. "This decreases correction at the back end and results in timely filing with the insurance companies," says Casados.

If the staff person who made the error happens to be off when it's discovered, it's corrected by a manager and reviewed with the registrar later. The same process is used if there is not enough coverage in the registration area and the staff are too busy with patients to correct the error in real time.

• Registrars are audited on their performance in the department.

A goal is set for each registrar that the error ratio needs to be less than 5%. Statistics are posted on the department's monthly collections and registration accuracy rates. "The staff see how well we're doing as a unit and what we need to improve upon," says Casados.

• The staff meeting area was converted from a conference room setting to a training room setting.

"Now, instead of booking a conference room for our meetings, I place a request for one of our training rooms," says Casados. "We have a classroom set up with computers in the room and access to overhead projectors for PDF file viewing."

A recent staff meeting covered Advance Beneficiary Notice of Noncoverage (ABN). Each registrar was given material on how to enter the ICD-9 procedure code. If they made a mistake, they were asked to correct it on the spot.

"On their failed ABNs, they had to follow the process. They had to explain the ABN form to the patient, enter the ABN code showing the patient was provided the form, enter the occurrence code that the ABN failed, and scan in the failed ABN," says Casados.

Staff have access to training modules on computers and can create registration scenarios anytime. Share drive folders were created for patient access staff, so they can review policies and procedures and updated changes on payer requirements.

"Any information that pertains to patient access can be found in our share drive folders," says Casados. "During our staff meeting, when discussing any new changes, we can pull up the policies or procedures. Staff are engaged, and the changes can be discussed in that setting."

Give specific goals

The expected accuracy rate for all of Pennsylvania Hospital's patient access staff is 95%. "Our registrars are continually reminded that system entry affects patient safety and the revenue cycle of the health system," says Lurie V. Forney, manager of quality and training.

Managers critique a percentage of each registrar's accounts. Their accounts also are evaluated by their colleagues using a peer review process.

In addition, accounts are monitored to check for duplicate medical record numbers, misidentified patients, and the inclusion of universal index numbers, which are unique patient identifiers.

"Some of our challenges are the increased number of patients we are seeing, and the registrar's increasing responsibilities as we continue to expand our services," says Forney "Also, there are language issues, the limitations of patients as historians, and the patient's willingness to divulge information."

The patient may not even be present to confirm all the information. "The staff are relying upon information that has been sent by physician offices, which may not always be accurate," says Artwell. "Our registrars possess exceptional investigative skills. The focus is reimbursement and accuracy," says Forney.

To motivate staff, incentives are given for the least amount of duplicate medical record numbers created and the most copays collected. The department has found that holding staff accountable does more than just reduce mistakes; it also increases their independence and self-confidence. "Also, self-reliance and respect for managers improves," says Forney.

[For more information, contact:

Debra A. Artwell, Manager of Outpatient Access, Pennsylvania Hospital/University of Pennsylvania Health System, 800 Spruce Street, Philadelphia, PA 19107. E-mail: Debra.Artwell@uphs.upenn.edu.

Tammy Casados, Patient Access Manager, St. Anthony Central Hospital. 4231 W. 16th Avenue, Denver, CO 80204. Phone: (303) 629-3753. E-mail: tammycasados@centura.org.

Lurie V. Forney, Quality and Training Manager, Pennsylvania Hospital/University of Pennsylvania Health System, 800 Spruce Street, Philadelphia, PA 19107. E-mail: Lurie.Forney@uphs.upenn.edu.

Anne Goodwill Pritchett, MPA, FHFMA, Vice President, Patient Financial Services, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601. Phone: 201-996-3364. E-mail: AGoodwillPritchett@humed.com.]