Correct reg errors with real-time QA
Inaccurate demographic information at registration occurs for many reasons, but is the mistake fixed before the claim goes out the door? Or is it discovered months later, when the claim has been denied and the patient has received a bill?
“Our biggest challenge with improving accuracy is giving quick feedback on errors so they can be corrected in real-time,” says Nikki Taylor, CPAR, assistant director of patient access services and patient accounts at Georgia Regents Medical Center in Augusta.
The department invested in a real-time quality assurance system, which flags inaccuracies on an account at the time of registration, such as incorrect characters in an insurance ID, the wrong amount of characters for a Medicare number, invalid patient address format, missing required information on the registration, and minors registered as their own guarantor.
“This helped each registrar be more accountable for their own errors at the time of working the account, as opposed to getting feedback potentially months later,” says Taylor.
The system runs reports on each registrar and the error they did not correct. “Management can see who is truly working their errors timely,” says Taylor.
Previously, managers discussed registration errors with employees only in a general sense. “We would sit in staff meetings and say we were receiving complaints from another area, indicating we had errors on accounts,” says Taylor. Now, statistics and feedback goes out to each registrar on a weekly basis. “Until staff see the error for themselves and can make their own corrections, it is hard to change a pattern or learned behavior,” says Taylor.
Managers hold quick monthly meetings with each staff to show errors that have occurred throughout the month.
“Each area is assigned to work specific root cause denials on the monthly reports,” says Taylor. “We check for trends, issues, and miscommunications.”
Managers also review accounts in which patients have called customer service with questions on accounts that could have been avoided if mistakes were fixed at registration.
Monthly denial meetings are held, with patient accounting, outpatient clinic registration staff, utilization management, and registration staff for day surgeries, observation and inpatient stays. “We pull denials specifically related to registration errors to review with staff,” says Taylor.
At the Patient Accounts and Access Center at OSF Healthcare in Peoria, IL, the computer system places accounts into work queues if any piece of information is missing that is necessary to send out a bill.
“We have several work queues for each area of our hospital. The staff that work in those prospective areas fix whatever needs to be corrected on the account,” says Jacqueline Doerman, MBA, patient access services manager of offsite registration. “If those accounts do not get fixed or need additional information, they go to our designated work queue specialists to work.”
Patient access managers continually monitor work queues that hold accounts with missing information or rejected insurance. “Our staff and management team work them consistently, and our two work queue specialists work on them all day long,” says Doerman.
The specialists and patient access managers share information on anything that was not done correctly, such as plan codes that were billed inaccurately, addresses in the wrong format, and claim information that was not filled out accurately.
“We are then able to take that feedback, and present it to our staff,” says Doerman. (See related story on training to improve accuracy, below.)
Want better accuracy? Training’s the answer
Inaccurate demographic information can sometimes occur because patients aren’t truthful or because they don’t have certain pieces of information with them at registration.
However, more commonly, errors result because members of the patient access staff fail to follow the correct process, according to Jacqueline Doerman, MBA, patient access services manager of offsite registration at OSF Saint Francis Medical Center in Peoria, IL.
“To improve this, I have tried real-time coaching, auditing accounts, and analyzing our feedback surveys that patient fill out,” says Doerman. “This has been helpful, but has not resolved the problem in all staff members.”
Staff members don’t always ask all of the questions that are necessary for a complete registration. “As a result, there are accounts that come back incomplete or inaccurate,” she says. Here are some solutions Doerman uses:
• She gave a presentation to staff to show why it’s necessary to enter each piece of information into the computer system and how this information affects billing.
Staff members enjoyed the presentation. “It helped them to see why they were doing certain things and how crucial it really was to complete that information,” Doerman says. “When staff do things day in and day out, it becomes monotonous. They don’t really even know why they are asking certain questions.”
Registrars realized that everything they enter into the computer system has value. “They were able to connect the dots and see that is should not only be completed, but completed accurately,” says Doerman.
• Managers give staff yearly competencies to be sure that they are following the correct process.
The competencies cover customer service as well as asking the correct questions, transcribing and scheduling patients accurately, collecting co-payments, and scanning documents. “During competencies, staff will ask process questions if they are unsure about certain things,” adds Doerman.
• Managers observe employees registering patients.
“If we notice something is being done incorrectly, we are able to coach staff real-time,” says Doerman. During observation, Doerman noticed that staff members sometimes were “feeding” the patients registration information instead of obtaining it from the patient, such as saying, “Do you still live at 123 Main St.?” instead of saying “Could you please verify your address for me?”
“We have concern for identity theft, as well as patients not accurately listening to what we are stating and verifying the incorrect information simply because they weren’t listening attentively,” she says.