New call center brings service up, errors down

Mistakes are gone before bill drop

A new call center — consolidating precertification, preregistration, and scheduling for four hospitals — is sparking dramatic changes for Cincinnati-based Mercy Health Partners, says Jane Lach, RRA, MBA, regional director of access.

Since December 1998, when preregistration and precertification staff moved into a new geographically central building near the health system’s headquarters, the registration error rate has dropped from 15% to 5% for one facility, and to 7% or 8% for the remaining hospitals, Lach says. The goal is 5% or fewer errors, she adds.

The goals for the center — which Lach was hired to establish — included the following:

• provide better customer service;

• make scheduling more convenient for physicians and patients;

• increase and improve preregistration;

• improve the rate of precertification to decrease payment denials.

The most important result of the new center — which added scheduling staff to its mix in February 1999 — has been to centralize the management of its functions, Lach notes. Error reports, for example, which formerly went to four different registration managers, now go to the call center manager, she says, and a new database tracks performance by facility and employee.

Four employees make up a quality assurance (QA) team that is a subunit of the call center, Lach explains. Team members check for registration errors during the pre-bill stage and make corrections on the mainframe computer prior to bill drop.

"We keep track of those mistakes in our database, so feedback can be given to the registrar that made the error," she says. "It’s very helpful, an educational process."

Monthly reports are provided to on-site registration managers, and the QA team prints and publishes a monthly newsletter that informs staff of common mistakes and changes in insurance requirements, she says.

The challenges involved in making the center a reality, Lach explains, can be broken down as follows:

1. People issues.

Employees had to be transferred out of the individual hospitals into the call center, Lach points out, and some did not want to make the change. "They were converting from an environment where they felt comfortable to a larger work environment where productivity is monitored."

To aid in the transition, Lach gave early notice of the upcoming move and offered staff the opportunity to transfer to other departments in the hospital before the call center implementation. In the end, very few chose not to make the move, she adds.

There are 35 employees in the call center at present, and capacity for 52, Lach says. "I believe we’ll be at that next year."

2. Designing the telephone system.

"At first, we thought we would have one telephone number, but we ended up with two," Lach says. "One is given to the physicians internally, and the other, which is considered the patient number, is in the telephone directory and on television." The reason, she notes, is faster service for physicians, who make the majority of the calls. The call center handles as many as 700 calls per day, with 500 on a slow day, Lach says.

The beauty of the automatic call distribution system is that it monitors staff productivity and evens out the workload, she says. If one employee is busy, the call goes to the next person, Lach adds. "The system looks at how long [an employee] has been on the phone and assigns the next call to [that employee]. Not every physician’s office calls and schedules one patient. Some call in 12 at once."

3. Communicating with physicians.

"We were on a fast track, and communicating [the call center operation] to physicians was a real challenge," Lach notes. Rather than advertise a new phone number right away, Mercy left the existing numbers for each facility in place for the first four months of operation, she says. Physicians continued to call the same numbers they had in the past and reach employees responsible for one particular facility.

"During that period, we cross-trained all of the schedulers to learn the other hospitals’ scheduling [requirements]," Lach says. "When we felt they were ready, we did a new marketing campaign and, in June, implemented the same number for all the facilities." The timing also was geared to the date the Yellow Pages come out, so the new number could be listed there, she notes.

There was some initial resistance to the call center from physicians, Lach says, primarily because they were "clinging to old ways. The radiologist, for example, liked knowing the scheduler was down the hall and he could poke his head in the door and make changes or inquire about his schedule for the next day."

The feedback from physicians has been positive, however, mostly because of the expansion in service hours, she notes. Before, scheduling took place five days a week, between 7:30 a.m. and 5 p.m. or 5:30 p.m. The call center is open from 7 a.m. to 8 p.m. five days a week and from 8 a.m. to 4:30 p.m. Saturday.

4. Cross-training.

Different services are provided at the various Mercy hospitals, and some more complicated services are done only at the larger facilities, Lach says. Not all the hospitals own a magnetic resonance imaging (MRI) machine, for example, so some employees had to be taught what questions to ask when scheduling an MRI, she adds.

A three-inch manual was created to explain the different services, she says, and to facilitate the training, she hired an experienced health care manager to serve as access educator.

The call center implementation became more complicated in April 1999, when Mercy Health Partners acquired two more hospitals, which are now in the middle of reorganizing the admitting department, she notes. "We will be training [employees at those facilities] and bringing them into the call center in mid-2000."

So far, the call center has been improving service and accuracy, not reducing staff, she says. "In the future, we might be able to do that."

5. Reasons for denials complicated.

The consolidation is helping the health system get a handle on payment denials, but that takes time, she explains. "There are a lot of reasons for denials, but we’re starting to identify patterns so we can change processes as needed."

Although the jury is still out, Lach says she suspects there is a high denial rate on "special" procedures that are not scheduled at the call center but still handled at the individual hospitals. One such procedure, for example, is a needle biopsy that must be done in the radiology department under computerized axial tomography scan guidance, she adds. "Radiology wanted to maintain control of certain procedures that require more resources, such as a physician in attendance."

With such cases, Lach says, there is no coordination of preregistration and precertification, which she thinks is causing a high denial rate. "If I can identify that, I can make a business case for our CEO and CIO saying the call center needs to schedule those patients."

Although no concrete data are available — primarily because no figures were kept in the past — the percentage of preregistered patients clearly has increased, she notes. That is particularly true for one facility, which was so short-staffed there was never time to preregister. "There were also long patient wait times in the admitting department."

Despite the progress made so far, there is much more to come for the call center, she points out. Key elements in the works include:

A Windows-based scheduling system, Pathways Healthcare Scheduling by Atlanta-based HBOC. All schedulers will be trained on the new system, which can load preparatory information for outpatient testing, generate appointment reminders if needed, and perform appointment conflict resolution. The system also allows "scheduling sets," such as coordinating a test that requires a specific injection followed by a scan two or three hours later.

A predictive dialer, which will add efficiency to outgoing calls. This will be used by the call center staff to make preregistration calls to patients and precertification calls to insurance companies.

Future plans include an on-line eligibility system to allow real-time insurance verification, and new technology for precertification, Lach says. The "voice mail" precert system would require the cooperation of third-party payers and physicians’ offices, she notes. That technology allows an employee in the physician’s office to dial in to a voice mail system and give all the information required for a precertification, just as if the caller were talking to an insurance company representative, Lach explains.

"It’s a real timesaver," she adds, because instead of waiting on the phone, the access employee can move on to the next account.

(Editor’s note: Look in future issues of Hospital Access Management for more information on implementing the scheduling system and transitioning employees from the two new hospitals into the call center staff.)