To provide a system to perform timely registration audits prior to claim submission, lowering the number of registration errors discovered at time of billing and provide trusted standardized statistics providing a method to train the registration staff and gauge productivity.

For more information contact:
Teresa Bassett, Patient Access Director
teresa.bassett@rivhs.com

Riverside instituted the manual registration audit process at Riverside Health System about 2 years ago. We found 1 FTE could only perform 20 registration audits per registrar per month, which were not enough to make statistically valid sample sizes. We average over 9000 registrations per month. The registration staff did not “believe” the audits were valid because the sample may be from 1 day or they felt the audited registrations were not representative of the quality of their work overall. Given the time it took to perform these audits, typically the claims had already been sent by patient accounting so that the audit results were for education purposes only. The revenue cycle management team was frustrated that our manual efforts were not able to achieve the desired outcomes as outlined above.

We chose the AHIQA web service and implemented the tool in the three acute care facilities with amazing results. Two months after the implementation of the automated registration scrubber tool, the registrars fully embraced making their own corrections and learning from their mistakes. During the initial phase of the implementation, we went from pages and pages of registration errors to just one and a half pages per day. The QA system identified data errors that patient accounting knew were wrong with the registrations but no one had communicated that information forward to patient access. We also found system interface issues where data fields that were completed by the registrars were not flowing over to the patient accounting system accurately or completely.

We went from 1 full time equivalent doing a small sample of audits to 45 minutes a day to perform audits on 100% of all registration demographics. Patient Accounting tracks the Top 10 Billing Errors caught by the bill scrubber software. Prior to the implementation of the automated QA system, registration errors were always among the illustrious Top 10. Since implementation of the registration scrubber software, registrations errors have fallen completely off the Top 10 list! The billers can now spend their time on more meaningful pursuits and the registrars are taking more pride in the quality of their work. Both Patient Access and Patient Accounting staff are thrilled and relations between the two departments have improved dramatically.

 

Our accuracy within AHIQA across all registrations is running around 88%. This is then translating into a billing system clean claim rate of 84%, up from 62% 18 months ago. This translates into 2 less billers (out of 7 initially).

It has also lead to a reduction in the AR over 90 days from 38% to 20% this month! As bills go out cleaner, fewer get denied and therefore the collectors have fewer rejections/denials to work. The AR over 90 days dropped $8 million for us out of a total gross AR that runs around $98 million. We've collected more cash in 2005 with no more FTEs in a year in which the health system's revenues and volumes were up.  We are now looking to redeploy some of the collectors into other areas as they are not needed in insurance follow-up.

We have also been able to use the AHIQA accuracy percentages to form the basis of an incentive based pay system for the patient access staff. Average pay out was $123 for fourth quarter out of a possible $200. HR loves the quantitative method of determining the payout.