Revenue Integrity Standards
and Accreditation in Healthcare
Registration Accreditation Standards
REGISTRATION Summary
Measuring performance helps hospitals assess revenue cycle efficiency and effectiveness.
Monitoring the Registration standards will ensure compliance with CMS guidelines and with the
regulations under the Affordable Care Act (ACA). These standards will help increase
effectiveness by helping to create a solid foundation on which the entire revenue cycle is built.
Registration staff must confirm patient identities, accurately obtain patient demographic
information, check for medical necessity on outpatient services and conduct initial financial
conversations with patients who did not process through the scheduling department.
Identifying patient financial responsibility for the current visit and for any prior balances will
need to be discussed at this point and monies requested and collected.
Communication with physicians and their staff is critical in obtaining completed orders and any
additional patient information needed.
All payer requirements must be met at the point of registration including notifications, prior
authorizations, pre-certifications and medical necessity determinations.
All of the registration responsibilities should be monitored on a continuous basis, daily if
needed, to determine areas for improvement in flow and/or accuracy. Patient satisfaction can
be measured and feedback given to staff and management for a constant evaluation of quality
of service.
Successful registration departments have integrated tools available for use such as document
scanning, estimation tools for financial responsibility and price transparency, online verification
tools and order tracking systems.
Monitoring standards will help hospitals identify areas of improvement needed and will assist in
establishing measurements for progress.
RG-01
The Registration department uses a system for
determining outpatient medical necessity for all
Medicare patients prior to service.
RG-01.01
All Medicare outpatients will be screened for medical necessity prior
to or at the time of registration. If testing is not medically necessary
an ABN will be obtained according to Medicare guidelines.
RG-01.02
The hospital will show evidence of medical necessity screening using
documentation in the record and with data collected.
RG-01.03
Best Practice Standard is 100% of registered outpatients will be
screened for ABN requirements prior to or at time of service.
Rationale for RG-01
Issuance of an ABN, as required by CMS, protects patients and
healthcare providers from unexpected liability for charges associated
with services not covered by Medicare. It’s important for all
outpatient Medicare tests and services to be screened for medical
necessity. CMS requirements can be found at the link below.
https://www.cms.gov/MEDICARE/medicare-general-information/bni/abn.html
Note:
This standard should be measured concurrently and not as a random
audit. If data confirms that the process is efficient and compliant,
data may be collected as a random audit at that time. Surveyors may
ask for record of prior data collected.
Equation:
N:
Registered Medicare outpatient accounts screened for medical
necessity
D:
Total of Medicare outpatient accounts registered
Surveyors will request documentation of tracking these patients and
may request charts for random accuracy reviews. It is the
responsibility of the hospital to collect and maintain data with
documentation to verify the data collected.
RG-02
Average registration interview duration
RG-02.01
Hospital will monitor the time to complete the registration
interview and document results.
RG-02.02
Results will be monitored and tracked by individual registrar or
by a process determined by the hospital.
RG-02.03
Best Practice Standard is 10 minutes per registration interview.
Rationale for RG-02
The registration interview should be as short as possible, while obtaining all
pertinent data. Shorter interviews lead to increased patient satisfaction and
improved flow in the hospital process. Whenever possible, when a patient
encounter is expected or scheduled, the pre-registration process should be
initiated or completed prior to the patient arriving in registration.
Note:
This standard should be tracked by measuring the average minutes
spent in the registration interview by registrar. Surveyors will request
documentation of data collected and any improvements completed.
Surveyors will request the data for analysis and may do random
observations of the interview process. It is the responsibility of the
hospital to collect and maintain data with documentation to verify
the data collected.
RG-03
Percent of accounts on hold for registration errors.
RG-03.01
Hospital will have process in place for monitoring registration
data errors.
RG-03.02
Concurrent monitoring is done and documented to promote
communication and feedback to staff regarding errors to
continuously strive for performance improvement.
RG-03.03
The billing department will communicate with the registration
department regarding accounts on hold for errors.
RG-03.04
Best Practice Standard is <1/16 of a day of total net revenue
will be on hold. Hospital will document revenue goal for
performance and survey monitoring.
Rationale for RG-03
Accounts with registration errors affect every step in the revenue cycle and
create issues that will extend a hospital’s A/R days. Tracking this issue on a
concurrent, minimum weekly, basis will allow hospitals to educate staff,
evaluate processes and decrease further errors.
Note:
This standard should be tracked by measuring the dollar amount of
claims on hold for registration errors on at least a weekly basis to
continuously improve data flow in the revenue cycle. Surveyors will
request documentation of set goals, data collected and any
improvements completed. Net revenue calculation will be determined
by the individual hospital.
Equation:
N:
Total $$ amount of claims on hold for registration errors
D:
Total $$ day of net revenue
Surveyors will request the data for analysis and will request random
charts for accuracy reviews. It is the responsibility of the hospital to
collect and maintain data with documentation to verify the data
collected.
RG-04
Medicare Secondary Payer (MSP) forms will be
completed on Medicare patients at every
registration encounter.
RG-04.01
MSP forms are required at every registration encounter with a
Medicare patient.
RG-04.02
The hospital will show evidence of MSP screening using
documentation in the record and with data collected.
RG-04.03
Best Practice Standard is 100% of Medicare registrations will
have an MSP completed.
Rationale for RG-04
Completing the Medicare Secondary Payer (MSP) form is important in the
coordination of benefits that CMS requires. It determines which insurance
pays primary and which is secondary. Sequencing of payers helps hospitals
avoid fraudulent billing and decreases liability of false claims. Further
information on the CMS guidelines for the MSP can be found at the link
below.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/InternetOnly-Manuals-IOMs-Items/CMS019017.html
Note:
This standard should be measured concurrently and not as a random
audit. If data confirms that the process is efficient and compliant,
data may be collected as a random audit at that time. Surveyors may
ask for record of prior data collected.
Equation:
N:
The number of MSPs completed for Medicare patients
D:
The total number of Medicare patients
Surveyors will request the data for analysis and will request random
charts for accuracy reviews. It is the responsibility of the hospital to
collect and maintain data with documentation to verify the data
collected.