2 new tools combat denials

Until recently, patient access managers at University of Iowa Health Care in Iowa City performed all quality assessments manually, says Susan Newton, who is the revenue cycle manager for patient access management and patient financial services.

"The process was labor-intensive, and we made random checks on less than 1% of registrations," she adds.

Ten patient accounts were reviewed on a monthly basis for each member of the staff using established criteria. The managers were looking for incorrect patient addresses or incorrect policy numbers and incomplete Medicare Secondary Payer questionnaires.

The department recently purchased a registration quality assurance (QA) tool with edits focused on preventing claims denials due to front-end errors, such as invalid mailing addresses, incorrect ID numbers, or omission of Medicare for a patient over age 65, says Newton. "There will always be some manual quality checks we will have to perform, but we hope the product will decrease that significantly," she says.

The product will reduce manual checks on patient address accuracy, specific financial classifications, policyholder accuracy, and employer groups and insurance formatting, says Newton. "Each staff member signs into our QA system daily to check for their registration errors," says Newton. "Edits are done either through real-time interface or batch if complete evaluation is needed."

The tool identifies errors due to staff "shortcuts" such as copying patients' demographic information into the policyholder's information on the billing system when this might be a different person, adds Newton.

More frequent checks

Insurance eligibility is verified about 20 days before the patient is scheduled to be seen, but the insurance status sometimes changes in that time window, says Newton.

"We want to check for active coverage much more frequently," says Newton. A new eligibility system was implemented that will check eligibility at the point of scheduling, 20 days out, and several days prior to the date of service.

Approximately 5% of claims are denied, says Newton, and of these, 13% involve the front end.

"Some of the front end denials include coverage terminated, patient not eligible, and ID not found," says Newton. "We expect to see a decrease of approximately 1-2% with the QA registration product."