One of the most important ways to improve A/R is the admissions/registration areas of any healthcare organization.
Many facilities band-aid issues within the admission/registration areas by correcting errors in billings, which is not effective nor is it cost efficient. It is estimated that it costs healthcare facilities $15 per visit to track and collect co-payments and deductibles after the fact. For many healthcare organizations, such as physician offices, this practice could result in a zero net revenue gain. Additionally, it costs healthcare facilities approximately $15 – $25 per visit for billing staff to correct registration errors and approximately $15 per statement sent to patients for co-pays, deductibles and co-insurances that could have been collected upfront.
So what steps can a healthcare facility take to remove the admissions/registration area band -aids and ultimately improve their A/R?
Step 1: Management should be open to change
Most admission/registration managers have vast experience in their field and want nothing but a well-run department. However, for many managers the stress of running a high-volume department that can potentially be open 24 hours a day does not allow them the luxury of thinking outside the box. Staff may not be willing to discuss issues with management, some applications do not provide error reports to managers, and some applications do not record who made the error(s) so they cannot be addressed with that individual. For improvement and changes within the admission/registration areas, management must be open to change, permit their staff to assist in recognizing issues and require their application(s) or MIS department to provide error reports.
Step 2: Assign an impartial third party
The first step in this process is to assign the task of meeting with the admission/registration areas to an impartial third party. This is the most important step in this process as admissions/registration needs to feel comfortable in discussing all issues they face daily without fear of retribution or criticism. The impartial third party should not only meet with management of these areas, but with 75% of the staff covering all shifts.
Step Three: Logging issues
This is not the time to address or correct issues that are discovered. Although issues presented need to be clear and concise, they should not be demonstrated or dissected as this is purely a fact finding process. All issues discussed are to be logged no matter how insufficient they may appear.
Step Four: Organization
Issues need to be organized into categories such as process, system, staffing, training and education. Once this is accomplished a meeting should be held with management to determine what issues are the priorities and can be addressed immediately versus issues that may take time to resolve (such as lack of staff).
Step Five: Resolving issues
Process issues: It is imperative that management and staff be open to resolving processing issues. A process should not be kept in place because it has “always been done this way” but because it enhances the admission/registration process. An impartial third party can assist management in looking at the processes, determining if they are assisting or hindering the workflow and changing what does not work.
System issues: Are the admission/registration pathways specific to your site or are they generic? Does the application provide “help” screens or pathways that are easy to maneuver and are they specific to your site? Are required billing fields designated as “must enter” and won’t allow staff to bypass? Is your IT staff knowledgeable of your environment and application? Is your application vendor directly involved with improving your application pathways? Can your staff search for a patient’s prior admission/visits within the application?
Staffing: Are the errors the result of under or overstaffing? Both can be issues for admission/registration areas as too much work per staff member can cause a hurried approach whereas too many staff can cause disruptions in daily work. When are most of your admissions/registrations? Can your facility add or deduct staff according to daily needs? Are pre-admissions/registration the practice of your department so that most of the information can be input prior to the patient’s visit?
Training: Has your staff been properly trained in the workflows of the department and admission/registration pathways within the application? Does staff understand what fields are required and why? Does your staff update prior admission/registration information or just process the data?
Education: Correction of errors must be done by the admission staff and not billing. This is very important because they need to understand what constitutes an error and why. Some applications only record the last person who worked on the admission/registration versus who made the error. This limitation should not stop management from requiring error correction. Although the last person who touched the admission/registration may not have made the error it is the responsibility of anyone who touches the admission/registration to ensure all information is correct.
Holding registration responsible for errors is a proven tool that will assist staff in knowing what an error is, assist management in recognizing what staff training needs are and allows billing to concentrate on their job responsibilities. As registration is made aware of their errors, it is imperative to teach them how to perform registrations and keep them from repeating the same errors over and over. Correction of their own errors will assist in staff in adhering to policy, train them in proper registration processes, and will ultimately decrease billing errors and free up billing to perform their job responsibilities.