Too many clinical claims denials? Education is key
Too many clinical claims denials? Education is key
A perfect job is 'invisible'
Don't expect a bouquet of flowers if patients gets their appointment reminder, they show up on time, the right payer gets billed, and the hospital is reimbursed.
"It's the nature of the work," says Douglas Weaver, operations manager for outpatient registration and insurance verification at University of Michigan Health System in Ann Arbor. "When it's right, it just flows. When it's perfect, we are invisible."
On the other hand, other departments are likely to waste no time in letting you know when access has made a mistake, serious or otherwise. In some cases, what went wrong is not even the fault of the patient access department.
"One of the biggest things we are held accountable for, but over which we have limited control, are registration-related rejections," says Weaver. "There is a whole category of claim rejections and denials that roll up into the category of registration. But often these are payer-related, or are attributable to billing systems issues."
One recent example involved an error in Medicare's crossover claims file. This caused them to electronically send a secondary claim to the patient's supplemental insurance. "So we were getting rejections for insurance companies that we never registered and never billed," says Weaver.
When the claim was denied with the explanations, "This patient can't be identified," or "This contract ended," registration staff were asked why they billed the wrong insurance company. Even though Weaver's department didn't cause these errors, they took responsibility for getting it resolved.
"They continue to provide examples to their Medicare representatives and track the progress of the fix," says Weaver. "The lesson here is that even if you didn't cause the error, it may be to your advantage to own it."
Offer expertise
To improve relationships with clinical areas, University of Michigan's access department created an internal help desk. This mini-call center, staffed by four people during regular business hours, initially supported the registration staff when they needed assistance with a challenging registration.
Common questions involved how to register payers who have complex network affiliations, or how to match a particular payer's product line to a specific insurance plan code within the health information system.
As their skills improved, though, the registrars didn't need the help desk as often. More often, the help desk staff work with clinical areas and the billing department to resolve issues such as complex coordination of benefits.
"If the clinic has a patient in front of them, they might ask, 'Can you update this right now, as I am speaking with you?' The help desk can provide those kinds of services," says Weaver. "It has gotten all kinds of kudos. It's been worth it for the good public relations alone!"
At a recent revenue cycle forum meeting, a referral coordinator from one of the clinics did an un-prompted testimonial. She said to her colleagues, "If you don't use the registration help desk, you should. They are fabulous!"
The help desk logs every call it receives. "So we get some really good, solid data on what sorts of issues are out there," says Weaver. "We have learned, for example, when our own staff don't have or aren't using the tools available to them. We often get a jump on systems and payer issues that are causing claim rejections when we're contacted by several billing areas about a common issue."
One was the need for education about what patient access actually did and didn't do. "We found that our clinic customers didn't completely understand the role of registration, and how it interfaced with their information systems," says Weaver.
Clinic staff wrongly assumed that registration contacted every patient for every visit to verify all of the required information. In fact, this occurs only if the scheduler flags the system for registration to contact the patient.
"There was a misconception that is we touch every single outpatient visit, when we actually don't," says Weaver. "If the information is correct and confirmed by the patient at the time of scheduling, we don't touch it, because it would be duplicate work. So that's been an eye-opener for our clinic partners."
To educate the clinics, access developed a presentation called "Registration and Clinic Operations: Co-owning Patient Care and the Revenue Cycle." The presentation covers patient flow through the scheduling process to registration, back to the clinics as they do pre-appointment financial clearance, and finally to the patient's check-in, charge capture, and billing. To date, the presentation has been given at approximately 30 clinics.
"We do this 'road show' clinic by clinic. We address our process and how it interfaces with theirs," says Weaver, "The education, of course, goes both ways. I've learned that I had a number of assumptions about clinic operations that were flawed. Likewise, the clinics had assumptions about registration that were sometimes incorrect, inaccurate, or simply outdated."
Better communication
A clinic or the billing department may look at a scheduled patient visit and become completely confused by incomplete information. For instance, a patient might have two insurances, but neither one is registered. "It may be that there is a very complicated coordination of benefits going on, and we purposely detached the insurances so that we can resolve it," says Weaver.
To shed light on complex cases like this, the patient access department informed the clinics where their notes can be located in the system. "This shows them what steps we have already taken, so they can see the work we have actually done," says Weaver. "This has been really helpful."
For instance, a patient may come for a clinic appointment with no insurance attached. The notes might indicate that registrars tried to contact the patient once in the daytime and again in the evening, and there was no callback.
"By reading the notes, they will know that if the patient shows up, they have to get them on the phone to us immediately," says Weaver. "They will know that we have done our part, and it's not just a hole in the process."
Another part of the presentation deals with quality assurance. Clinics are informed that registration aims for 95% accuracy rates with registrations. Patient demographics and physician information must be verified at each scheduling event, according to the health system's requirements.
"And we really rely on the clinics to do that for us, because they are going to funnel the work to us based on what they verify," says Weaver. "We found that some clinics didn't realize that an 'all clear' signal at scheduling would cause that patient's visit to bypass registration entirely."
Relationships with clinical areas have improved, though this isn't measured by formal surveys or written praise. "It's not the most scientific way of going about it, but we are getting fewer complaints, and sometimes spontaneous compliments," says Weaver.
[For more information, contact:
Douglas Weaver, Operations Manager, Outpatient Registration and Insurance Verification, University of Michigan Health System, Ann Arbor, MI. Phone: (734) 647-6323. Fax: (734) 936-4577. E-mail: [email protected].]
Don't expect a bouquet of flowers if patients gets their appointment reminder, they show up on time, the right payer gets billed, and the hospital is reimbursed.Subscribe Now for Access
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