CHAA Examination PreparationFuture Development – Session II

Pages 113-127

University of Mississippi Medical Center

What to Expect…

• This module covers various aspects of Patient Access knowledge found in pages 113-127 of the FUTURE DEVELOPMENT section of the 2010 CHAA Study Guide.

• A quiz at the end will measure your understanding of the content covered.

Staff Education and Competency

• KEY PERFORMANCE INDICATORS (KPIs) are created to help an organization DEFINE and MEASURE progress toward organizational goals.

• They reflect the CRITICAL SUCCESS FACTORS.

• They must be QUANTIFIABLE(measurable).

• Examples: 97% Accuracy Rate, Register X amount of patients per hour, Patient wait times less than X minutes, Point of Service Collections, etc.

Revenue Cycle KPIs• In the past, hospitals focused a majority of

their efforts at the end of the Revenue Cycle.– What is wrong with this process?

• Most revenue cycle problems occur when the hospital is collecting and verifying patient information needed to ensure a clean submission claim and receipt of full payment.– So how would you address this problem?

Performance Improvement Methods

• PROCESS IMPROVEMENT is the act of INCREMENTALLY exceeding the requirements through continual ENHANCEMENTS and REFINEMENTS.

• There are SCIENTIFIC and SYSTEMATIC methods, techniques, and tools used to improve performance.

• Before you conduct process improvement, the OBJECTIVES and OUTCOMES must be MEASURABLE and WELL UNDERSTOOD.

FOCUS - PDCA• The purpose of FOCUS – PDCA is to improve the

product or service from the CUSTOMER’S VIEWPOINT.

F – Find a process improvement opportunityO – Organize a team who understands the

processC – Clarify the current knowledge of the processU – Uncover the root cause of the variation or

poor outcomeS – Start the “Plan-Do-Check-Act” Cycle

Six Sigma• Six Sigma is a process improvement

technique using organizational wisdom and statistics to identify and eliminate the “DEFECTS” in a process.

• A “defect” is anything outside of customer expectations.

• It focuses on making sure we’re doing the right things correctly the very first time.

Lean

• Lean and Six Sigma are complimentary in nature.

• Lean focuses on ELIMINATING NON-VALUE ADDED STEPS in a process.

• Lean ensures we are focusing on the RIGHT THINGS.

Process Reengineering

• This involves FUNDAMENTAL RETHINKING and RADICAL REDESIGN of business processes to achieve DRAMATIC improvements.

Changes must be:»Radical»Dramatic»Contemporary

Flowcharts & Process Maps

• A Flowchart is a graphical representation of activities that make up a process.– Steps taken in registering a patient

• A Process Map is a graphical picture of the actual workflow through a company.– This helps clarify who is responsible for a

step or a task in the process

Patient AccessTraining Models

• Hands-On Computer Training

• Formal Classroom Training

• Peer-to-peer training

• Self-paced Training

• Role Playing

• Experiential

• CBT (Computer Based Training)

Patient Access Training Modules

• Computer systems Training

• Customer Service Standards

• Insurance Verification

• Pre-Certification• Calculating Patient

Liability

• Overview of healthcare finance

• Medicare/Medicaid• Managed Care• Revenue Cycle Ops• Medical

Terminology• Scheduling• Regulations: HIPPA,

EMTALA, etc.

Competence

• Competence is a STANDARDIZED requirement for an employee to properly perform a specific job.

• It encompasses a combination of skills, knowledge and behavior.

• Two Types of Competencies are:– Behavioral and Technical

Behavioral and Technical Competencies

• BEHAVIORAL COMPETENCIES are learned through life experiences which form our behavior patterns.– The ability to get along with others, adapt, be

a team player, have a positive attitude, maintain composure under pressure, etc.

• TECHNICAL COMPETENCIES are learned in an educational setting or on the job.– Registering, verifying information, calculating

deposits, the ability to read and write, etc.