Revenue Cycle

Identify registration errors

Patient Access Weekly Advisor, January 30, 2008

From Paul Shorrosh, MSW, MBA

As a newly installed business office director at a 250-bed hospital with decentralized registration, I was astounded by the number of complaints I got each week from billing, collections, health information management, and IT departments, all pointing to data quality errors that the patient registration department made.

I needed a way to monitor and track accuracy, and somehow bridge the divide between front and back. Soon I began to envision a way for patient access employees to self-correct and learn from their mistakes. I started by analyzing the complaints and ranking them by frequency and impact. I studied remit denials, billing system reports, and interviewed billing staff to identify the top five registration errors, then the top 10, until I understood what was going on.

The errors fell into three categories: financial, operational, and compliance. Financial errors, such as missing guarantor or subscriber information, invalid policy or group numbers, or missing authorizations, would stop or deny the claim.

After months of testing, we finally developed a model that automatically identified 15 common registration errors and reported them back to each patient access employee for self-correction. It was easy to use, and registrars immediately began self-correcting their errors prior to bill-drop.

Now that we could track error rates with relative ease, we watched them drop from 35% to 10% in the first six months. That year, we hit the lowest accounts receivable days in five years, and denials dropped by 20%. Our clean claim rate was higher, and the number of complaints from other departments trickled to almost nothing.

My patient access manager and supervisors recovered three to four hours per day previously spent on manual quality assurance (QA) to manage processes and train employees more effectively. Patient access employees appreciated being able to learn about and correct their own errors before anyone downstream had a chance to complain. Soon our patient access staff members began competing to see who could have the lowest error rate in the department and who was registering the most patients per day.

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