CHAA Examination Preparation Future Development – Session I Pages 104-113 University of Mississippi Medical Center What to Expect… • This module covers various aspects of Patient Access knowledge found in pages 104-113 of the FUTURE DEVELOPMENT section of the 2010 CHAA Study Guide. • A quiz at the end will measure your understanding of the content covered. Billing Problems • For most hospitals, the #1 reason claims are rejected or denied is: INACCURATE DATA ENTERED DURING REGISTRATION • Therefore, patient access staff must focus on getting the CRITICAL DATA ELEMENTS (CDEs) correct when collecting information from the patient. Critical Data Elements The most common CDE mistakes include: – Patient name on claim not matching patient name on file with payer – Incorrect or missing Member ID – Claim submitted to wrong payer (e.g. traditional Medicaid versus Medicaid HMO) – Incorrect address – Missing or incorrect phone numbers – Missing pre-cert/authorization/referral information needed in order to submit claim The Importance of CDEs • Confirming this information has been collected and is correct at the time of registration eliminates: – DOWNSTREAM issues associated with billing payers – Problems in collecting liability from patients CDEs = $$$,$$$,$$$ Data Integrity • Data Integrity refers to the process of ensuring that data is: – CONSISTENT and CORRECT • According to CHAA, your PRIMARY ROLE IS: – is to create a basis of the medical record by capturing specific information prior to the patient’s encounter at the point of entry into the healthcare system. Types of Data • You gather Administrative and Clinical Data: – Clinical Data = Medical Related Information – Administrative Data = Demographic, Socioeconomic, and Financial data • The two most COMMON DATA ELEMENTS used throughout the healthcare experience are: – Legal Name and Date of Birth Data Storage and Retrieval • The main REPOSITORY (virtual storehouse/closet) used in patient access is the : – Admission, Discharge, Transfer (ADT) • The primary Patient Tracking Link considered to be the most important resource in the healthcare facility is the: – Master Patient Index (MPI) Importance of the MPI • How does proper use of the MPI serve the patient and the hospital? – Links patient being registered for care with existing medical records (if possible). – Improves patient safety by increasing the chance of proper patient identification. – It increases the ability of the hospital to obtain payment for services by properly identifying the patient. What to Know about Physician’s Orders • • • • • Components of a valid physician order are: Patient Name Date Diagnosis, signs, or symptoms Test or therapy ordered (Procedure) Physician’s signature It must be LEGIBLY written. Data Integrity – Quality Assurance • Ensuring the accuracy of registration data collected results in fewer denials, rejected claims, and other delays. • Facilities use INTERNAL AUDITING in order to gain a SNAP-SHOT of the results produced by current processes. UMHC’s auditing process is called: – AccuReg Data Accuracy – Quality Assurance • Data obtained from the audit is used to implement performance improvement initiatives designed to meet the revenue cycle goals of: – Reducing Accounts Receivable (A/R) – Improving Cash Flow Quality Assurance is ensuring a certain standard is consistently met. Access Management Data Weekly Accuracy Rate 0.99 0.97 0.95 0.93 ED PEDS/PRE 0.91 CENTRAL STANDARD 0.89 0.87 0.85 Quality Assurance & Customer Service • According to a Press-Ganey Survey, “Satisfied Patients Become Loyal Patients.” • Satisfaction depends on: – Wait times, proper room and food temperature, technical competence, protection of privacy, friendliness and courteousness of staff, etc. • Compassion is as significant as Competence. Evaluating Customer Satisfaction • Passive Customer Feedback – Letters from patients and families – Conversations with patients/families • Active Customer Feedback – Customer Surveys – Customer Comment Cards – Customer Callback Programs “Surveys are the BEST method to find out if a customer is satisfied.” Using Survey Results • Positive Feedback: – Provides an opportunity for positive employee engagement and also helps gain market share (customers). • Negative Feedback: – Provides an opportunity to apply quality improvement principles in an effort to respond to the feedback with service recovery efforts. The Power of Surveys • Healthcare organizations are starting to PUBLISH results. • Insurance companies are moving toward reimbursing treatment at facilities that meet or exceed a certain level of performance benchmark. • Surveys are also used INTERNALLY within individual organizations to measure employee/staff satisfaction. When Creating a Customer Satisfaction Survey… You MUST DETERMINE: • What data measurements are required? – Face to face survey, telephone, email, comment card, etc. • What data measures are important to the organization’s decision making process? – Patient wait time, compassionate staff, food/room temperature, etc. • What data measures are important in the day to day management? – What are the factors that will keep customers coming back? Quality Improvement • Quality Assurance is ensuring a certain standard is consistently met. • QUALITY IMPROVEMENT is best described by Lexus: – “The Relentless Pursuit of Perfection.” • It’s a never ending cycle of: Collecting Data Analyzing Data Taking Action Evaluating Results Access Management Data Weekly Accuracy Rate 0.99 0.97 0.95 0.93 ED PEDS/PRE 0.91 CENTRAL STANDARD 0.89 0.87 0.85 The Joint Commission • TJC REQUIRES healthcare organizations to IDENTIFY and REPORT on quality improvement initiatives. • TJC defines QUALITY CONTROL as the performance processes through which actual performance is measured and compared with goals, and the difference is acted on. The Joint Commission • TJC defines QUALITY IMPROVEMENT as an approach to the continuous study and improvement of providing health care services to meet the needs of individuals and others. • TJC defines PERFORMANCE IMPROVEMENT as the continuous study and adaptation of a health care organization’s functions and processes to increase the probability of achieving desired outcomes.