Career Paths: Veteran AM moves to collections, gets results

Impact of registration mistakes are clearer

Martine Saber, CHAM, had something of an awakening when she assumed her current position as director of support services for HCA Healthcare in Palm Harbor, FL. As a longtime patient access director, she was well aware of the importance of "getting it right" at the point of registration, and worked diligently with her staff to foster the creation of accurate claims.

But it was only when she became immersed in the world of "the back end," Saber says, that she realized exactly how far-reaching and time-consuming the effects of the simplest registration mistakes could be.

Transposing figures when entering a patient’s Medicare number, for example, recently resulted in Medicare denying a claim because the patient couldn’t be identified, she notes. "The patient was very angry with us, called us names, and now we have to rebill Medicare. They eventually will pay, but instead of within 45 days, it will be more than 100 days. It was a really simple thing, human error, but it took away from the wonderful care that the patient received at our hospital."

In another instance, a patient gave two insurance cards to the registrar, who entered all of the information for the primary insurance, but left out some of the data on the secondary insurance, Saber says. "We bill the first insurance, but on the second we don’t have everything, so we call the patient, who doesn’t respond. Eventually, we send the bill to a collection agency."

It was only when the unpaid bill showed up on the patient’s credit report, interfering with the purchase of a house, that her department discovered that the patient had moved, changed telephone numbers, and never got the messages pertaining to the secondary insurance, she adds. Remedying the situation involved rebilling the secondary insurance and removing the bill from the patient’s credit report, Saber explains, not to mention the time it took to get to the bottom of the problem.

Even more problematic was a case in which the registrar inadvertently enters the medical record number of another patient who happens to have the same name as the person being registered, she says. All the charges go under the wrong person’s Social Security number and eventually make their way to a credit report, which again surfaces when the person is trying to buy a house.

That mistake necessitated the wrongly billed person having to come to the hospital and prove she did not receive the care cited on the bill, Saber says. "She had to give us her signature three times, show her driver’s license, and we even had to go so far as to look at the medical histories of the two different patients."

"I know how these mistakes happen, but I never realized how much of an effect they have," she adds. "Now I work with our patient access directors and try to feed back to them these kinds of errors. If not, they never know."

One of the biggest errors has to do with constantly changing insurance plan numbers, Saber says. "Sometimes it’s because the registrar chose the wrong number, sometimes it’s because we put in the wrong number. There are a lot of things that can also go wrong on the back end."

"When we do identify that it is a registrar error, we tell the patient access director so he or she can start trending," she adds. "I’m seeing a reduction in errors. It’s wonderful to see how they want to work with us, how we can help each other, when we feed back to them in a nice way."

A different way of helping’

The switch to patient accounting was "a wonderful career move for me," Saber says, partly because it makes her work experience better rounded. "I have to know a little bit about everything, about billing, collections, refunds, overpayments, underpayment."

The change suits her desire for less stress, fewer hours in the car, and more regular work hours, she explains, but it also offers a new kind of job satisfaction.

"It’s a different way of helping" patients, Saber says. "On the front end, the patients are in front of you and they’re sick, and you want to hurry and get them into a bed. On the back end, you still have to have compassion. Sometimes we screw up for whatever reason and we want to make it right. Sometimes it’s not us, but the insurance company moving so slowly, and you can’t leave it up to the patient to fight it."

As director, she usually fields the toughest patient complaints, Saber says, often pulling cases from the collection agency or getting bills removed from credit reports.

"I never realized customer service was so wonderful," she adds. "I can’t tell you the wonderful thank-yous I get. It just feels good to help somebody, clean up something, and then look at what we could do better to keep that from happening again."

All of the department’s new employees go through a class based on the tenets of the best-selling book Who Moved My Cheese, Saber notes. "If you stay stagnant, the cheese disappears. We should be looking out for change coming, taking the initiative. We talk about it all the time. What are we going to do to make this happen?"

"We need to run ourselves out of business," she adds. "That would be the perfect world, but wouldn’t it be nice if we can at least improve the things we can control in our own facility?"

One of the toughest things about the job initially, she notes, was the high turnover rate in her department. Although her first reaction was, "No, that’s not going to happen," Saber says, she came to realize it simply comes with the territory.

"The staff answer the phone all day long, mostly calls from angry patients," Saber says. "Right or wrong, they eventually get tired of that." Now, she says, what she promotes with her staff is, If I taught you something and you move on to another department, that’s OK. It’s the nature of the beast."

There is an ongoing exchange between Saber and her boss, she says, that illustrates her own frame of mind. "Every Friday, I meet with her one on one and I always end by saying, I love my job. You don’t know how much I mean it. It’s so rewarding and satisfying.’"

Now her boss, the chief operations officer for one of HCA’s central business offices, will laughingly ask her if she still loves her job. "It’s like a joke, but it’s not," she says. n