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At Greater Baltimore (MD) Medical Center, patient access leaders confidently report that their department operates at a “99% or better” accuracy rate.
“We’ve shared this in meetings with other departments. We do find it helps instill confidence in patient access,” says Cherie Patterson, CHAA, CHAM, patient access operations manager.
The patient access department ensures quality in these ways:
“This type of QA is crucial to preventing claim denials or delays in claim payment,” Patterson explains.
Recently, some registrars were entering self-funded insurance plans incorrectly. This is because the cards looked almost exactly the same as HMOs or commercial plans.
“To prevent these errors, we presented reeducation on self-funded insurance plan entry to all staff at a recent meeting,” Patterson says.
Previously, the department used QA software that provided data on registration accuracy.
“But it was not very accurate for timing,” Patterson laments. Recently, the department used benchmarking data from other facilities using the same electronic health record system to set a 10-minute goal for registrations. “We quickly surpassed that goal within a month,” Patterson boasts. “Our average [registration] time now is five minutes, four seconds.”
The department set a seven-minute goal. If it’s not met, managers look closely at the employee’s practices.
“We see if there is any additional training needed to improve speed,” Patterson notes.
Some staff were taking too long with the registration interview because they were verifying all the information with the patient. This was necessary with the previous registration system, which didn’t show the last time the information was verified. The new system does show this, but staff hadn’t gotten used to the change.
“We provided training to change our staff’s behavior from asking all questions, every time, to verifying only key information,” Patterson says.
Staff always confirm the patient’s address, phone, and insurance information. They don’t confirm data that change infrequently or not at all, such as primary language, country of origin, or patient contacts. “Changing the reps’ mindset and behavior helped improve registration timing,” Patterson adds.
This is especially important for high-volume areas such as the ED. To comply with federal EMTALA regulations, patients are not registered until after a physician performs a medical screening exam.
“As a result, the registration interview can be pushed back to hours after the patient has arrived in the ED,” Patterson explains.
Many patients were arriving in the late evening. However, many weren’t actually registered until the early morning, causing a surge in volume for the two registrars who worked the night shift.
“We found that we definitely needed to add a third person to accommodate the patient volumes we were seeing in the early morning,” Patterson notes.
The department even found a budget-neutral way to add the third registrar to the ED.
“This change was part of a major schedule overhaul that addressed staffing difficulties,” Patterson explains.
Previously, all full-time patient access employees rotated weekends. Part-time employees were hired to work only on weekends.
“This freed up the [full-time employee who] we needed for the ED night shift,” Patterson says.
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