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To increase collections, you need accurate information at registration. "Billing accuracy affects your ability to collect," says Cathy Foster, director of revenue cycle at St. Joseph Medical Center in Towson, MD. "If we don't get accurate insurance information, then we can't check the benefits and copay. And if the patient doesn't find that information out ahead of time, they are less likely to pay."
Last fall, Foster's department implemented an automated system to improve registration accuracy. "We are getting prepared for electronic eligibility, which will help with registration accuracy also," she adds.
With the new system, when registrars enter insurance data, it will come back saying the insurance is either good or bad. Currently, registrars have to either call the payer or go on the web site to check, which delays the registration process. "But on the flip side, this technology also costs the hospital something," Foster acknowledges.
These factors trigger quality review
At Palmetto Health Richland in Columbia, SC, patient access uses a manual process for tracking registration accuracy. "The manual process works well it just does not give us the opportunity to identify the errors and correct them earlier in the revenue cycle," says Charlene B. Cathcart, CHAM, director of admissions and registration.
The department's goal is to have all registration-related errors identified and corrected prior to the billing process normally by the fifth day after the discharge date. "There are several excellent quality systems available. We are considering purchasing one once capital funds are available," says Cathcart. "We have delayed because there are other systems that we wanted to implement to help us provide better care to our patients."
A quality review is done by one of the department's two education and training specialists, triggered by any one of several factors a failed billing report, a failed claims report, work lists from the Financial Clearance Workstation product, or feedback from the patient account department. For failed bills or claims, the below items are reviewed:
employer name and address;
Medicare Secondary Payer Questionnaire;
information received from the electronic verification system;
no insurance loaded;
ethnic origin (reported to the Department of Vital Statistics);
relationship to insured.
Also, 20 accounts are manually reviewed per month, checking the accuracy of employer name and address, the Medicare Secondary Payer Questionnaire, occurrence codes, patient demographics, relative/emergency contact, social security number, insurance plan/policy number, whether the second insurance was not loaded, and information received from the hospital's electronic verification system.
"The most common error is missing occurrence codes, specifically related to the patient and spouse's date of retirement," says Cathcart.
All of these data are entered into an access database, and at the end of the month, each employee is given a quality review report, which they call a "report card." If the employee has 97% quality or greater, they are recognized with a meal ticket. If the employee has less than 97% quality, they are referred back to the education department for a refresher course.
"If average quality year to date continues to be below our expectation of 97%, corrective action steps are taken," says Cathcart.
At. St. Joseph, errors made by registrars are routinely monitored by a patient access trainer.
"Also, registrars are able to sign in themselves and see what their errors were for the day," says Foster. "They are required to go in and do this. Our trainer can tell whether they have looked or not."
The monitoring has markedly improved registration accuracy, says Foster, partly because the registrars know somebody is looking at their errors. "For the most part, they want to do a good job and the trainer doesn't have time to look through every single registration and find errors on a daily basis. This way, the system finds them for them."
For example, the system will pick up errors such as a Medicare number without enough digits or missing the prefix or suffix. "These typo errors occur because they were trying to get the registration done quickly. Now they can go in and correct it before the bill drops, because we have a four-day bill hold," says Foster. "So it has not only impacted registration accuracy, it has also impacted billing accuracy."
Currently, registrars are not incentivized in any way. "So we are relying on pride in doing a good job. And our trainer is very good about giving positive feedback," she says.
Instead of giving registration staff feedback only when errors were made, the trainer also lets them know when their accuracy is very good, often by sending out a group e-mail. "And they appreciate that," she says. "She lets everyone know if someone has been outstanding, and congratulates them."
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