Is your policy doing enough to improve QA?
Produce a "clean claim"
Consider the old adage, "garbage in, is garbage out." "This truly has a distinct meaning where upfront errors are concerned," says Jackie Mitchler, a revenue cycle analyst in the patient business services department at Affinity Health System in Menasha, WI.
Mitchler emphasizes that if you want to improve accuracy, the key is your policies and procedures for your patient access department and for those areas creating registrations within their departments.
"One of the main components of the revenue cycle is patient access," says Mitchler. "The best chance to improve the revenue cycle is at the beginning of the process, when you are first capturing data while registering and scheduling patients." Here are four ways the department does this, according to Mitchler:
1. Staff receive comprehensive training.
The patient access coordinator oversees training, with yearly competencies performed.
2. The quality of work produced by patient access and departments performing patient access functions is monitored.
Denial reason codes specific to patient registration are reviewed each month in detail, with report findings submitted to the denial management team.
"Corrections and process improvements are implemented," says Mitchler. "A monthly denial report is posted on the communication boards of departments that do registrations."
3. Random audits are performed.
"We are looking at software options to create staff report cards," says Mitchler.
4. To ensure that patient information is accurate and complete, corrections are processed prior to billing.
"Many of the errors are reviewed from audit reports, such as termed insurance or Coordination of Benefits," says Mitchler. "If this information is accurately entered at the time of registration, you produce a clean claim for payment."
Find weaknesses
Overseeing the quality assurance program, ensuring consistency, and developing appropriate reports ultimately is the patient access department's responsibility, says Mitchler.
New employees' accounts are reviewed until the employee attains and maintains the standard of 95% accuracy for at least three audits. For established employees, a minimum of 10% of one month's work is reviewed for each employee a minimum of three times per 12-month period.
"Because we found this to be so time-consuming, we opted to use the spreadsheet," says Mitchler. "Errors of screen shots were displayed at department meetings. There is some really nice software out there that you can use for registration errors, as well. We have not purchased this software to date."
Failure to meet a 95% accuracy rate will result in 100% review, until the employee attains and maintains the standard of 95% accuracy for three audits.
"Using your tracking tool congruently with your registration process should show you where the weakness lies where denials are concerned," says Mitchler. "By outlining and drilling down on these errors for each registrar, you can take the data and incorporate your findings in their performance evaluations for future improvement."
[For more information, contact:
Jackie Mitchler, Revenue Cycle Analyst, Patient Business Services Department, Affinity Health System, Appleton, WI. Phone:(920) 628-9221. Fax: (920) 628-9108. E-mail: [email protected].]
Consider the old adage, "garbage in, is garbage out." "This truly has a distinct meaning where upfront errors are concerned," says Jackie Mitchler, a revenue cycle analyst in the patient business services department at Affinity Health System in Menasha, WI.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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