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Audit patient access proactively

Patient Access Weekly Advisor, October 17, 2007

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As a patient access manager, you know that improving your hospital's front-end operation is your primary responsibility and biggest challenge. Errors in registration can ripple throughout the revenue cycle. That's why it's imperative to take a proactive approach toward auditing patient access.

Don't take this job lightly, says Yvonne Focke, RN, BSN, MBA, CHAM, former director of access and care management at TriHealth, Inc., in Cincinnati. "Little things make a big difference," she says. "The auditing process is very important."

TriHealth began its auditing reconstruction with a 20% registration inaccuracy rate. Today, that rate is down to 1%-2%. But it was a long road to arrive at near perfection. "Knowing that increasing variations are only getting more complex with consumer-driven health plans, we know we needed more technological help," says Focke, who is now Senior Regional Director of Revenue Cycle Management at Mercy Health Partners.

In 2005, TriHealth partnered with Cincom, an international provider of software solutions with domestic offices in Cincinnati, to develop a system that could provide a decision tree to overlay on its platform system (Meditech) to help navigate staff through the formal registration process. The system, which the group calls Intelligent Guided Registrations, went live in 2006.

It walks registrars through the registration process, step-by-step, and prompts them with messages if information is missing or questions and prompts them when there are multiple choices.

"It's like TurboTax," Focke says. "It helps tremendously." The software enables registrars to catch about 50% of the mistakes they make before the claims reach their registration auditor.

The software greatly limits the amount of work the auditor must perform. And because of the increased efficiency, TriHealth went from three auditor full-time equivalents to two last year. "We audit each person each month and base their performance [reviews] on their scores," Focke says. "But the accuracy level has improved dramatically, and most people are now in the 'good' to 'very good' category."

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