User-friendly system takes error tracking to new heights
User-friendly system takes error tracking to new heights
CBO staff examine every question on the face sheet’
A process that tracks every registration for errors — and corrects them before the bill drops — has improved accuracy dramatically, reduced accounts receivable (AR) days, and boosted staff morale at Catholic Health West (CHW) hospitals in the San Francisco Bay Area.
Facilitating that effort, says Barbara Griffin, director of patient financial services for CHW Bay Area, is an admitting error tracking system (AETS) from Burbank, CA-based RISARC that allows central business office (CBO) staff to look at registration face sheets on-screen.
"The system brings up every space on the face sheet where information isn’t there, and says, This field is blank’ or You need this information,’" she adds. While CHW uses the AETS to track 54 items — "every question we ask on the face sheet" — it can be set up to track fewer elements, depending on user preference.
The job of CBO screeners is to get that information — usually from an attached patient insurance identification card — but the real "bang for the buck" comes from looking at the fields that are not blank, Griffin says. That’s where the screeners see potential problems — that numbers have been transposed (making the address or the Social Security number incorrect) or that the attached card is for Aetna insurance, but the registration has Blue Cross information.
Error rate plummets
The overall error rate, Griffin notes, has gone from about 40% four years ago to as low as 2%. "This month, I have two hospitals at 2%, and one that went up to 5%. We’re immediately going into this system to see why. What we usually discover is that they’ve hired somebody new."
"Because I put my top-notch billers [in the screening jobs], they know if an insurance address is wrong," she notes. In the case of such errors, Griffin adds, the screeners make the correction and then go into the account and make a note that the changes took place.
The AETS system also allows Griffin to pull reports by individual registrar — by week, month, and year. "For at least [the past] three years, I can tell you the errors that an individual has made. If somebody in the business office makes a change to the face sheet, I can identify that, because 100% [of registrations] are audited before the bill goes out the door."
Error tracking by individual is crucial to the process, Griffin points out, because it’s human nature for people to say, "That’s not my problem," when group feedback is given.
The method is "very fair to registration people," she adds, noting that employee morale has thrived under the system. "In the beginning, it was like, Big Brother is watching me,’ but now they say, Did you see our numbers?’ They know what the error ratio is, and they feel very proud of the job they’re doing."
The system is "user-friendly and it builds self-esteem," Griffin says. "If you’re an employee and you had a 50% error rate, and now you’re at 98%, you pretty much know what your evaluation will be."
Hospital administrators, meanwhile, "make a big deal out of how accurate the staff are, and celebrate the successes," she says. "We have luncheons and parties for the admitting department because their [error] numbers are so low." CBO staff are rewarded when there are drops in AR days, Griffin adds.
Use of the tracking system has resulted in a dramatic decrease in errors during the first year of use, she says. "It gives you the most frequently occurring errors, so you concentrate on [addressing] those, even though you’re looking at all the errors."
"Admitting managers learn from using the system," Griffin notes. "Instead of sending all the claims down, billing them, getting correspondence back, and going back and training everybody, we’re doing specialized training based on that person [who made the error]."
The more training the managers do, the smoother the work is, and the clearer their job becomes, she adds. "Before, they didn’t know exactly what the issues were. Now all of the errors from the business office go back to each hospital, and they do a whole training process."
Griffin holds regular monthly meetings with admitting managers. "We go over the error rate, and they share how they handle issues such as an insurance company they’re having a problem with."
Error breakdown surprising
Interestingly, in at least one of the CHW Bay Area hospitals, the tracking system showed that the registrars who had been on the job the longest, and who were presumed to be the most accurate, actually were making the most errors, says Eric Rogers, a former admitting manager who is now manager of government programs for the CBO.
"[The system] really defined for me where the whole staff didn’t know what was going on, and where individuals needed help," he points out. "When I started, I didn’t have a lot of experience as an admitting manager, so I began using this tool; and for the first six months, I did the entire process. I double-checked the downloads, did editing of face sheets, did the quality-control work."
While that validation process now is done by CBO screeners, Griffin notes, it was an ideal way for a new manager to learn quickly.
Registrars who don’t report to an admitting manager — those who work in the laboratory or other ancillary areas — also are included in the AETS process, which allows users to see the error rate according to where the patient was registered, Rogers says. The system revealed, for example, that a wound-care clinic that was a vendor within the department and did its own registration had an error rate of almost 100%, he notes. "They weren’t completing the registrations, and they didn’t know what to ask."
Rogers met with ancillary department managers, went over the system and how it would affect them, and sent admitting staff to help with training, he adds. "It seemed like they improved overnight."
Patients are happier under the new system because accounts are much less likely to be moved to the self-pay category because the insurance information was wrong and the claim was denied, Griffin notes. "They don’t have us calling them to find out information."
At the time, the patient financial services departments of seven hospitals — since reduced to three — were merged in 1997 into one CBO, based in San Mateo, CA, she explains, between 75% and 50% of accounts, depending on the hospital, typically were paid after the first bill.
"We were hiring staff to rework [unpaid] accounts," Griffin says. "You shouldn’t have to do that if you do your training."
Now between 87% and 92% of claims billed to the insurance company are paid during the first 45 days, she adds.
Another huge impact of the error tracking system has been the reduction in bills returned by insurance companies because an identification number is wrong or additional information is needed, Griffin notes.
"That correspondence used to be astronomical. Daily, each hospital probably received 100 to 125 pieces or more." When only 50% of claims were being paid, the pieces of correspondence could be "in the thousands," she continues.
"There is all this rework — tracing and making calls — you have to do, and it may generate payment, or it may bring another piece of correspondence," Griffin explains.
Correspondence is tracked by the reason it is sent, she says. If there are a number of requests for identification numbers, for example,"we go into the AETS system and see if [incorrect ID numbers] are an issue there," Griffin adds.
Although a request by an insurance company for a copy of the medical record does not mean there is an error, she says, "if we’re getting a lot of those requests, we work with the carriers to find out what it is that is making them need that information."
With the implementation of the tracking system, there are "probably 10 to 15 pieces [of mail] a day, maybe 25 on a Monday, that require correspondence, because the information we’re sending is correct," Griffin notes.
Tracking can be done without an on-line system, she says, noting that many hospitals have staff who manually tick off errors on a form.
"The good thing about this system is [that work] is done for me." At a glance, "I can see the number of registrations done every day, so I can see if one person is doing all the work and another is not really doing a fair share," Griffin explains.
"When you look at the reports, it’s either always the zip code they don’t put down, or something else that is always the same for that person," she says. "For years, we’ve all said registration [accuracy] is key, but we never really explored it down to the individual error."
Some processes give you the error rate after you’ve billed, she notes, "but after you’ve billed is too late."
One of the most interesting things about the detailed examination of errors allowed by the AETS system, Griffin says, is that it has caused a reexamination of the old "80-20 rule" of billing.
"Historically, if you talk to most directors of accounting, they say that 80% of what you bill gets paid, and 20% you rework," she explains.
"If you had asked me before, I would have said the same thing, but when I saw the error report, I realized the [rework] must be higher.
"You may think you’re reworking 20%," adds Griffin, "and in dollars that may be true, but in workload, it may be 60-40."
[Editor’s note: Barbara Griffin may be reached at (650) 817-3181 or by email at
[email protected].]
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