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Clarian Health in Indianapolis has launched a major patient access training initiative that includes the annual certification of all registrars, an aggressive data quality program, and a corrective action policy for weeding out poor performers. The new training and data quality team also is responsible for training new registration hires and providing continuing education for about 400 registration employees throughout the health system, says Sue Underbrink, who manages that team in addition to serving as manager of patient access services for Indiana University Hospital, one of Clarian’s three acute-care facilities.
Since April 2000, when Underbrink added the first full-time equivalent (FTE) to her team, the training and data quality staff have grown to include two trainers and a system and data analyst, she notes, and have an ambitious agenda under way for 2001. Programs that are ongoing or in the works include:
• The annual certification of registrars.
The team attempted to certify all Clarian registrars last year, Underbrink says, evaluating the employees on whether they were following approved processes, utilizing available tools, such as on-line insurance verification and entering accurate data. "As is true everywhere you go, there are cost restraints, so this year we’re looking to be a little more creative, to make the best use of our resource," she adds. "To facilitate the large number of registrars requiring certification, we’re planning to host a competency fair in 2001. All Clarian registrars will be required to attend the fair, where competency for the registration process will be validated."
The fair probably would be held several times, Underbrink says, including on the weekend and evening to accommodate the people on those shifts.
• Continuing education for registrars.
The training and data quality team will provide quarterly educational offerings, including soft-skills training. Service excellence, Underbrink notes, is a major focus at Clarian Health Partners. Other topics will be drawn from the results of manual audits and system reports. The training and data quality team is providing feedback to registration management on duplication of medical record numbers, account duplication, returned mail, and missing registration data, she adds.
• Back to basics.
Because the patient access staff are made up of long-time employees who’ve never been through the formal registration training and newer employees who have, Underbrink says, there are plans to conduct back-to-basics training for the entire staff. "Those newer employees sometimes pick up bad habits from those who never had the formal training," she points out. "We want to hit the [problems] we see through the reports and audits, and then continue with the quarterly education meetings.
"Some of the areas we know we’re having problems with are missing authorizations on managed care Medicaid and insurance errors, such as the wrong plan code, or missing information that can cause the [bill] to be denied."
• Implementation of a registration data quality policy.
The goal is for the team to look at 20 registrations per month for each registrar, assigning a point value to various components and averaging the scores of the registrations to come with a monthly score for each registrar, Underbrink explains. There also will be an overall score for the unit to which the registrar belongs.
"We’ve been doing this within our own [patient access] departments," she notes, "but not every registrar reports to patient access services." Various clinics owned or operated by Clarian handle their own registrations, Underbrink says. The registration data quality will be a companywide policy to ensure consistency throughout the organization, she adds.
The goal is for registrars to score 95% or better on the audit and, if they do, they will be recognized through mention in the system’s patient access newsletter and with individual and/or departmental awards, she explains. Those who score 85% or below will be placed on corrective action, a four-step process that can include oral counseling, written counseling with documentation in the employee’s record, suspension, and finally termination.
In addition to rating employees through the face sheet audits, the team "will take it very seriously if [a registrar] creates a duplicate medical record, or looks someone up and registers the wrong patient," Underbrink says. Employees who make those mistakes will go directly to the written-counseling step, and will remain in corrective action for six months, as opposed to the three months required for scoring below 85%. If there are no further errors, the employee drops out of corrective action, but if the problems continue, the process will be followed to its conclusion.
Accurate completion of the Medicare Secondary Payer questionnaire is one of a number of registration components her team will monitor, Underbrink notes.
• Registration and the bottom line.
At the beginning of this year, the denial management group within patient access became aware of significant write-offs that were due to eligibility and certification issues, Underbrink says. "Based on that information, we have undertaken an aggressive initiative. Two data quality teams have been deployed to observe registra-tion throughout the organization. The teams are observing processes, checking for accuracy, and providing immediate feedback, allowing registrars to make corrections on the spot."
The results of this effort will be shared with registration management, she notes, and continuing education will be provided based upon the results. A second observation period will follow in approximately three weeks to determine if improvements have been made, Underbrink adds.
• A training and data quality Web page.
"We’re developing a Web page for the training and data quality group that will have hot topics, frequently asked questions and answers, and a training schedule," she notes. It will give information on upcoming events, and provide an on-line registration form for classes.
• Initial training of new registrars.
Her staff currently conduct three days of intensive training on registration pathways for new employees, but have plans to extend that to 10 days, Underbrink says. "We want to incorporate more of the soft-skills and customer service training, and have more time for registrars to practice." New registrars do receive on-the-job training when they report for duty, and future plans are to include a train-the-trainer class to the data quality group’s repertoire, she notes. "We want to provide on-the-job coaches some education in an effort to provide consistent training."
The training efforts under Underbrink’s direction are making a substantial difference in registrar performance, notes Marne Bonomo, PhD, RN, Clarian’s director of patient access. "Managers in all areas of the organization have user-specific error reporting for the first time ever. All areas are eager to improve and teamwork is at an all-time high. "We all want to be successful," Bonomo adds, "and the efforts of our training and data quality group are helping us to make that difference."