Adventist manual aids registrar, manager

Directions are concise and consistent

A new best practice registration manual, jointly written by an eight-member team at Adventist Health, has been "very useful" for both new registration hires and admitting managers throughout the hospital system, says Ken Mitchell, MM, CHFP, director of patient financial services at Adventist Medical Center in Portland, OR. The project was initiated by corporate admitting manager Susan Baxley after she visited the organization’s 20 member hospitals, which are spread across Washington, Oregon, California, and Hawaii.

"She saw a need for a document that would provide concise and consistent direction for registration personnel, so she gathered a group of individuals from several hospitals to write he manual," Mitchell adds. "Over a period of months, that’s what we did."

Team members met once a month, sometimes more, to develop ideas and agree on content, he explains. "Different individuals took different chapters and did the original draft. As a group, we would work through the draft and update it."

His role, Mitchell says, "was as the typist who, in the meetings, did the word crafting" while the revisions were being done. "It was a smooth process, the group worked very well together, and we had lots of fun at the same time we worked on it," he adds.

While functions needing particular attention varied from hospital to hospital, Mitchell notes, "one consistent issue in registration is turnover, so there is always a great need for training."

New registration employees sometimes don’t receive adequate training, he points out, "because the person they’re replacing is not there anymore. Some of the facilities are small, so it’s challenging to have enough individuals to provide ongoing training. We needed some documentation that was other than word of mouth."

With the registration manual, Mitchell says, "[employees] get the benefit of having somebody provide the [relevant] documents. We make sure they read it, then we have someone do hands-on training."

While much of the information in the manual is applicable to any hospital, much of it is geared to Adventist facilities, he notes. "We did include very specific things that are requirements for our hospitals — our expectations, things that are supposed to be recorded and tracked."

Chapter 1 is the manual’s introduction, Mitchell says, and Chapter 2 deals with "return on investment" from a registration perspective. "It isn’t a technical chapter and doesn’t define a return on investment model," he explains. "The focus was analyzing what the effect would be of having proper policies and procedures that were consistent across the organization. It gives registrars some financial information that shows the value of doing it right."

The rest of the chapters deal primarily with various aspects of registration, Mitchell adds, briefly outlining them as follows:

• Chapter 3: Registration standards, and expectations for quality performance.

• Chapter 4: Job descriptions, including sample job descriptions for 14 different positions within the department, from registrar to financial counselor to scheduler to admission manager.

• Chapter 5: Emphasizes the value of a strong training program. Provides a great list of items that should be included in training. Subjects include systems, customer service, compliance, primary registration functions, etc. Suggests web sites that may be helpful.

• Chapter 6: Account workflow — the process that an account follows from the point of preregistration to the billing department "so a new person gets the idea of what happens to their work. A lot of times [registrars] just see what they do and have no idea how it affects somebody else."

• Chapter 7: Briefly discusses theories of motivation in the context of providing incentives for employees. It talks about money as an incentive, and then describes other possible financial and nonfinancial ways to reward and motivate employees.

• Chapter 8: Denials — "Organizationally, we log denials, keep track of them, so this chapter provides information about how we do that, how statistics are reported and outlines some of the cost of having denials and why we want to prevent them."

• Chapter 9: A summary of the preceding chapters.

• Chapter 10: An appendix with some documentation requirements, Internet resources, more on incentive plans, and an assessment tool for registration departments "that’s useful if you’re a new manager and want to assess how well the department is meeting objectives." (See excerpt from the Best Practice Registration Manual’s assessment tool.)

Such resources make the manual effective at both helping managers and educating employees, Mitchell points out. "It’s a reference — a guidebook that says, Here’s the standard.’ Managers should review it once in a while to make sure they stay focused on their goals."

Upon completion, the manual was presented to the top leadership at Adventist, approved, and then rolled out at a corporate meeting of patient financial services directors and admitting managers from all the hospitals, he says. "Each site got copies," Mitchell adds, "and the information is also on the web site within our intranet for use electronically by all of our 20 hospitals and numerous clinics throughout the system."

(Editor’s note: Ken Mitchell can be reached at