Put a stop to registration delays; make these changes
Registration delays mean poor customer service scores for access — which in turn means big headaches for patient access directors. If registration wait times are too long, this will have a negative impact on patient satisfaction, physician satisfaction, and the clinical departments who are waiting for the patient, according to Joe Palumbo, CAM, CHAA, manager of patient access site administration at Rex Healthcare in Raleigh, NC. "Patients will either voice their concerns at the time of registration or in the clinical area. Some will wait and mail a letter with their concerns."
Diane Murphy, RN, BS, MSHCA, also a patient access manager at Rex Healthcare, says that pre-registration and pre-call are two process approaches that allow the department to streamline the registration process at time of service.
"Each scheduled case comes across with key elements from the scheduling system to our admit-discharge-transfer system," Murphy explains. "Our pre-registration co-workers continue to process the account to a seamless registration."
This processing includes pulling over insurance and demographic information from previous visits to eliminate repeating asking the same questions at the time of face-to-face registration. If the patient is new to the facility or no insurance is available at the time of pre-registration, a report is generated to the pre-call coworker to call the patient and gather the information over the phone prior to registration. Once the correct information is obtained, the verification team will confirm the insurance information before the date of service.
"From a QA/QI [quality improvement/quality assurance] standpoint, we track and review our wait times, along with peak registration times and daily volumes, to adjust staffing accordingly," says Murphy. "We also share the outcomes with our front-line co-workers at our monthly staff meetings. Our wait times are also part of our annual performance goals for patient access."
Monthly outcomes are presented using a spreadsheet in a visual presentation, tracking each point of service and the department's year-to-date performance. Intake specialists are also provided with a monthly report card that lists all of the outcomes that the coworker is accountable for. These include registration accuracy, upfront collection percentage, customer compliments, and average wait time.
"The coworker receives a verbal coaching if their performance needs improvement," says Palumbo. "But if the coworker meets all of their individual goals, patient access has a 'Pay 4 Performance' program. This program rewards intake specialists for their extra effort in a monetary way monthly. Each month, the outcomes are reviewed by management to ensure that the momentum is maintained."
"Unlike most health care systems, we consider our department to be more than just admitting and registration," says Deloris A. Neal, regional director of patient access for Resurrection Health Care in Chicago. "We train our registrars to be an integral piece of the revenue cycle process.
"The five-minute registration process that our patients go through accurately ensures great financial outcomes when each patient is processed accurately," says Neal. "We monitor the patient visit history. When we notice a hospital visit has occurred less than 90 days ago, we can fast track the registration as long as there has not been a change in the demographics or insurance." Patient access staff now schedule 98% of all patient services. "This concept was developed so patients would not have excessive wait times in registration, thereby delaying the clinical service they are scheduled for. This generates backlog for the physician, which eventually will reflect negatively on our physician satisfaction," says Neal.
Currently, patient access schedules 5,000 patients a month on average, with a 1.2% average abandoned call rate. All calls are answered within an average of 22 seconds. "We monitor our patient flow to gauge our high and low volumes and allocate the staff as needed," says Neal. "Nonetheless, it is still very unpredictable."
For this reason, patient access has found it beneficial to cross-train registrars to work in all locations so staff can be re-assigned as need. "Unfortunately, we still struggle with walk-in patients who come to the hospital for basic lab tests or X-rays, where no appointment is required and patients are registered on a first-come, first-served basis," says Neal.
Registration delays mean poor customer service scores for access which in turn means big headaches for patient access directors.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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