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.