t oday ’ s a pproaches t o r egistration q uality what you need to know when selecting a...

TODAY’S APPROACHES TO REGISTRATION

QUALITYWhat You Need to Know When

Selecting a Registration Accuracy Solution

MD AAHAM Patient Access Meeting

May 15, 2015

Learning Objectives

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LEARNING OBJECTIVES

Learning Objectives:

Understand the cost of poor quality registration

Learn why some forms of “quality control” don’t work

Review the terms vendors use to describe quality application features and functions

Learn the difference between rule-based process automation and business rules

Poor quality registrations cost money.

According to Mikel J. Harry in his book Six Sigma, The Breakthrough Management Strategy Revolutionizing The World's Top Corporations, the cost of poor quality (COPQ) can be summed up as follows:

“15 to 25% of gross revenues”.3

THE COST OF POOR QUALITY

Impact of Poor Quality

Using that COPQ calculation, an organization with $200 million in gross revenues could be

million dollars as a result of poor quality.

While 82% of U.S. companies are involved in quality programs, only actually calculate the cost of quality.

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THE COST OF POOR QUALITY

Impact of Poor Quality

33%

losing as much as $30 - $50

Quality is measured by the costs of ...

The involves the costs of:FailuresReworkInspectionPrevention andThe loss of customer goodwill – 5

THE COST OF POOR QUALITY

Impact of Poor Quality

doing things wrong.Cost of Poor Quality

business!

PATIENT ACCESS IMPACT

How does Patient Access impact those gaudy numbers? Denials represent 1% –

3% of total revenue Technical Denials

represent 28% of all payment denials

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PATIENT ACCESS IMPACT

Impact of Poor Quality

PATIENT ACCESS IMPACT

How does Patient Access impact those gaudy numbers?Technical Denials

No eligibility No authorization Invalid diagnosis Duplicate account Invalid/missing

information

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PATIENT ACCESS IMPACT

Impact of Poor Quality

PATIENT ACCESS IMPACT

An organization with 200 million in gross revenue and 3% of claims denied $6,000,000

Technical Denials represent 28% of denials $1,680,000

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PATIENT ACCESS IMPACT

Impact of Poor Quality

PATIENT ACCESS IMPACT

FTEs Title Pay RateAnnual COPQ

1 QA Rep FTE $15.00 (100% ) $31,200

6 Billing FTE $15.00 (20%) $37,440

200 Dups/month HIM FTE $10.00 (1 hour/dup.) $24,000

4 PAS Mgr. $19.00 (10%) $15,808

Plus Technical Denials: 1,680,000

Total Costs of Poor Quality: $1,788,448

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PATIENT ACCESS IMPACT

Impact of Poor Quality

WHY QUALITY CONTROLHASN’T WORKED

Most registration areas employ some form of “quality control” Typical quality control methods could be

characterized by:100% AuditsSupervisor AuditsRandom SamplingError Feedback from Patient Accounting

Claim Scrubber ReportsReturned Work

Required Fields 10

WHY “QC” HASN’T WORKED

WHY QUALITY CONTROLHASN’T WORKED

100% AuditsNobody really does this….why?

Equivalent to doing the registration twice Too costly Too time consuming Diminishing returns

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WHY “QC” HASN’T WORKED

WHY QUALITY CONTROLHASN’T WORKED

Supervisor AuditsToo much variation among supervisors

Errors reflect the biases of individual supervisors

Errors reflect the relative thoroughness of individual supervisors

Clinical supervisors have little or no “access management” training

Inconsistent enforcement

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WHY “QC” HASN’T WORKED

WHY QUALITY CONTROLHASN’T WORKED

Random SamplingFew managers have been trained to

produce statistically valid samplesFew managers are knowledgeable about

employing performance improvement techniques to address the errors identified by sampling

Sampling alone will allow too many errors to “fall through the cracks”

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WHY “QUALITY CONTROL” HASN’T WORKED

WHY QUALITY CONTROLHASN’T WORKED

Error feedback from the Patient Accounting departmentReturned uncorrected errors

The Old Assumption:Registrars will learn if they are required to “fix” returned errors

The ProblemHow do you know they will actually fix the errors?

Do you have the resources to review them again to be sure? 14

WHY “QC” HASN’T WORKED

WHY QUALITY CONTROLHASN’T WORKED

Error feedback from Billing“Claim Scrubber Reports”

Usually contain too much information– Because these reports contain every reason a claim may fail an edit, they are usually too big to be useful the registration managers

– Usually generated too late to be useful

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WHY “QC” HASN’T WORKED

WHY QUALITY CONTROLHASN’T WORKED

“Weighted” Fields The Old Assumption

Lets focus on the “most important” fields (translation – billing fields)

The ProblemA focus on billing fields sends a message that non-billing fields are not important

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WHY “QC” HASN’T WORKED

WHY QUALITY CONTROLHASN’T WORKED

Examples of so-called unimportant” fields

Middle name Social security number Work phone (patient, guarantor,

emergency contact) Reason for visit Primary/Referring care physician Insurance group number Insurance effective & expiration dates Accident code

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WHY “QC” HASN’T WORKED

WHY QUALITY CONTROLHASN’T WORKED

Required FieldsThe Old Assumption

If we make the field a “required” field, this will solve the problem.

The Problem Required fields only address

“quantitative” data integrity issues – they force registrars to populate a field with something….

Required fields do not necessarily address “qualitative” data integrity issues – entered data may still be incorrect

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WHY “QC” HASN’T WORKED

THE ROAD TO QUALITY

High levels of quality are not achieved by accident. Today there is a growing recognition of the importance of the “front-end” to revenue cycle in general and to denial avoidance in particular.

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THE ROAD TO QUALITY

A NEW DAY

Today, healthcare organizations have more choices than ever when considering a registration quality solution. The selection process becomes even more difficult when application features and functionality is described using technical jargon and

that differ from assumed meanings.

20Dictionary.com

terms of art

A NEW DAY

Today, healthcare organizations have more choices than ever when considering a registration quality solution. A recent LinkedIn™ Group request for application suggestions and Google™ search returned the following applications:

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AHI QA Accureg Passport Revenue 360 DaVincian Technologies Risarc Admission Error Tracking

System (AETS)

DCS AuditLogix Eagle Gold Benchmark Healthwares Systems Loxigon Rqi - Kramer RegQA - Recondo

REGISTRATION QUALITY “TERMS-OF-ART”

Real-Time Business Rules Alerts 500 Rule Database Customizable Alerts “Intelligence” Customizable Alerts Monitors 100% of

Accounts Report Cards

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The key to making is understanding what vendors mean by the following terms:

TIP:

informed choices

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“Real-Time”

When I say “real-time”, you think what?The actual time during which a

process or event occurs Computing : Of or relating to a system

in which input data is processed within milliseconds so that it is available virtually immediately as feedback, e.g., in a missile guidance or airline booking system.

Google.com

REGISTRATION QUALITY “TERMS-OF-ART”

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“Real-Time”

When I say “real-time”, a vendor might mean:A message appears immediately on

the user’s screenThe error is sent immediately to a

report that compiles 24 hours later

The error appears at the end of the registration

The error is sent immediately to a worklist on another screen

REGISTRATION QUALITY “TERMS-OF-ART”

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“Real-Time”

A message appears immediately on the user’s screen:

REGISTRATION QUALITY “TERMS-OF-ART”

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“Real-Time”

A message appears immediately on the user’s screen:

REGISTRATION QUALITY “TERMS-OF-ART”

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“Real-Time”

The error is sent immediately to a worklist on another screen

REGISTRATION QUALITY “TERMS-OF-ART”

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“Real-Time”

The error is sent immediately to a report that compiles 24 hours later!

REGISTRATION QUALITY “TERMS-OF-ART”

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“Business Rules”

When I say “Business rules, rules engine or alert database”, you think…..?

REGISTRATION QUALITY “TERMS-OF-ART”

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“Business Rules”

When I say “Business rules, rules engine or alert database”, a vendor might mean:Data Edits, but only by:

Prefix, suffix, presence, absence, Field length

Data Edits against interfaced databases: Eligibility Responses Address Verification Databases Contact Management Databases

(phones) Credit Scoring, Propensity to Pay apps

REGISTRATION QUALITY “TERMS-OF-ART”

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“Monitors 100% of Accounts”

When I say “monitors 100% of accounts”, you think…..? Every account Every field

Field length, prefixes, suffixes Populated vs. unpopulated fields Misspellings Forbidden characters ( $, *, &, @, %, -, etc.) Incorrect data Missing forms, signatures, etc. Red flags

REGISTRATION QUALITY “TERMS-OF-ART”

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“Monitors 100% of Accounts”

When I say “monitors 100% of accounts”, a vendor might mean:All accounts by data field, but only by:

Prefix, suffix, presence, absence, Field length – and/or……

Data Edits against interfaced databases: Eligibility Responses (only connected

plans) Address Verification Databases Contact Management Databases (phones) Credit Scoring, Propensity to Pay apps

REGISTRATION QUALITY “TERMS-OF-ART”

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“Alerts”

When I say “Alerts”, you think…..?

Pop-up Reminders

REGISTRATION QUALITY “TERMS-OF-ART”

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“Alerts”

When I say “Alerts”, your registrars think…..?

REGISTRATION QUALITY “TERMS-OF-ART”

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“Alerts”

When I say “Alerts”, a vendor might mean:

A pop-up message during the registration

A pop-up message after the registration

A worklist of alerts on another screen

A worklist of alerts on another day

REGISTRATION QUALITY “TERMS-OF-ART”

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“500 Rule Database”

When I say “500 Rule Database”, you think…..?

And…

Lets hit the ground running… I wonder how I’ll use my bonus?

REGISTRATION QUALITY “TERMS-OF-ART”

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“500 Rule Database”

When I say “500 rule database”, a vendor might mean:

And…

Lets expand the value of the project…

By customizing each rule at $$ per hour…

REGISTRATION QUALITY “TERMS-OF-ART”

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“Customizable Alerts”

When I say “customizable alerts”, you think…..?

And…

I wonder how I’ll use my bonus?No cookie cutter requirements…

REGISTRATION QUALITY “TERMS-OF-ART”

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“Customizable Alerts”

When I say “customizable alerts”, a vendor might mean:

And…

By customizing each rule at $$ per hour…

I guess I’ll have get started building rules…

REGISTRATION QUALITY “TERMS-OF-ART”

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“Report Dashboard”

When I say “report dashboard”, you think…..?Reporting by:

Facility Division Department Shift Manager Registrar Error

REGISTRATION QUALITY “TERMS-OF-ART”

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“Report Dashboard”

When I say “report dashboard”, a vendor might mean:Reporting by:

Facility Division Department Shift Manager Registrar Error

REGISTRATION QUALITY “TERMS-OF-ART”

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“Intelligence”

When I say “intelligent guidance” or “actionable intelligence”, you think…..?

REGISTRATION QUALITY “TERMS-OF-ART”

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“Intelligence”

When I say “intelligent guidance” or “actionable intelligence”, a vendor might mean:Business rulesEditsAlertsRule-based Process Automation

REGISTRATION QUALITY “TERMS-OF-ART”

RULE-BASED PROCESS AUTOMATION

Benefits Transformation of workflow Technology acceleration Vastly increased efficiency Expanded financial counseling Improved cash flow and collections Improved customer service Eliminate whole categories or errors

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The Missing Piece

The Old Approach Each application functions as a silo Information is copied or re-keyed into other

systems Features To Look For Now:

Full integration between all applications Ability to use multiple integration modes, HL7,

scripting Ability to display scripts or registrar guidance Ability to build “action rules”- rules that execute

actions based on data from other applications – without registrar intervention or prompts

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RULE-BASED PROCESS AUTOMATION

SUMMARY

In This Session we:

Explored the cost of poor quality registration

Learned why some forms of “quality control” don’t work

Reviewed the terms vendors use to describe quality application features and functions

Learned the difference between rule-based process automation and business rules

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QUESTIONS?

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CONTACT INFORMATION

John Thompson, PMP, CHAM, CRCE-I, CRCR

Principal, Access Management and Technology Innovation Services

jthompson@coalitionrc.com(301) 802-3078

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