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A new revenue integrity specialist (RIS) team at the University Hospital of Arkansas in Little Rock is on a mission — extend to the outpatient arena an initiative that has dramatically improved the accuracy of inpatient registrations, says M. Holly Hiryak, director of hospital admissions.
Four employees have been hired to audit registrations and act as a resource for all frontline hospital and clinic staff who perform registrations, adds Hiryak. The former emergency department (ED) manager supervises the team, she says. "She is responsible for auditing, but also is the central point for gathering information and trending errors, identifying education needs, and assisting the training center in terms of what we need to educate new hires. She also will give feedback to individual employees and clinic managers and directors, so they will know where the problems are."
The hospital’s 30 or so clinics, she notes, handle more than 250,000 visits annually.
The RIS team took over the inpatient auditing function from the registration manager, who had performed it in addition to myriad other duties, explains Hiryak. Although the hospital administration made the decision to add four full-time equivalents for the team, she notes, "the idea is that once we clean up the process, we will not need as many [employees] on the back end. Eventually, we will be able to eliminate some positions there."
When the inpatient auditing effort began about a year ago, Hiryak says, the accuracy rate was about 80%. Including ED registrations, which also fall under her purview, it now ranges between 93% and 96%. "Our feedback from the [billing department] is that very few inpatient accounts get stopped on the first go-round."
Because of the inpatient success story, Hiryak — who does not oversee outpatient registration as part of her normal duties — was asked to put together a team to clean up registrations in that arena.
The outpatient auditing process is a work in progress, she says. "We are defining the source documents they will use to audit against. Those include the copy of the insurance card, the driver’s license, [or] another picture ID. There may be a physician’s order."
With inpatients, Hiryak adds, the source documents include the admission request.
While 100% of inpatient registrations are audited, the goal is to do 20% of outpatient registrations, she says. The RIS team will use the source documents to check demographics, spelling, third-party payer information, financial class, and coordination of benefits, Hiryak explains. "They’ll also look at the effective dates of insurance, and whether the Medicare Secondary Payer questionnaire is completed correctly based on the information put into the system."
Predictions are that once the RIS team gets up to speed, she says, each member could audit up to 100 accounts a day, she says, depending on the other duties they are called on to perform. "They may do some one-on-one instruction [for registrars]."
"The team will identify a registrar or clinic to audit and [the target of the audit] will be responsible for compiling the source documents," Hiryak adds. "We’ll target [first] the areas we know are particularly bad." The team also will respond to requests from managers who desire a focused audit for their area, she says.
Any person or area that conducts registrations will eventually be audited, Hiryak says, including departments that perform only one or two registrations a day and employees that occasionally fill in for regular registration personnel.
When the auditing process began for inpatients and the ED, there was "a huge turnover" of employees, with some being terminated and some choosing to leave the department, she says. There is likely to be some degree of staff replacement with the outpatient program as well, Hiryak predicts.
"We have asked the clinic directors to develop policies and procedures to support this review process, so if it gets to the point of disciplinary action, we have something in place to manage it," she adds. "If registrars continue to make the same errors with no improvement, there will be a process for putting them on warning and eventually terminating them."
In addition to the more negative role of pointing out errors, RIS team members will provide support for front-line personnel who in the past have had no one to call on when they had trouble with registrations, Hiryak points out. A mix of clinics — better performers as well as those that are less efficient — will be assigned to each auditor, she says. "Each team member will carry a pager and become a resource for that clinic."