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
[email protected](301) 802-3078
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