How often is too often to ask for data update?
Providers balance accuracy, customer service
In the precarious world of checking information for patients who have been to their facility before, hospitals often juggle two important considerations: data integrity and customer relations.
"Patients are notorious for not giving good information and for information going stale," notes Pete Kraus, CHAM, business analyst for patient accounts services at Emory University Hospital in Atlanta. "They can have regular Medicare one month and move to an HMO the next. But if you grill them each month, you risk hearing, 'But you already have that.'"
In fact, he adds, patients may give that response even if their information has changed, and it comes up in subsequent conversation that, "Oh, yeah. I moved."
Some hospitals advocate full interviews at each patient encounter, while others let it go until the next week, or the next month, or longer.
This apparently no-win situation is one that technology has both helped and hurt, Kraus points out. It helps in that the information is retained, he says, but it hurts because patients' expectations are now that hospitals already have the data they need.
"Some patients really resent being interviewed over and over, even if it turns out something really needed to be changed," Kraus adds. "But if you let it slide, you have incorrect billing, wrong insurance, returned mail."
At Wake Forest University Baptist Medical Center in Winston-Salem, NC, previously collected patient data are brought forward if they are less than 90 days old, but registrars still verify the information with the patient if he or she is available, notes Keith Weatherman, CAM, MHA, associate director for patient financial services.
If the patient is not available, Weatherman says, "we will depend on the information."
His facility is in the process of implementing technology that will verify in real-time the patient's insurance, for most payers, as well as the person's address, he says.
"For self-pay patients," Weatherman adds, "we will continue to do a daily batch run to [a vendor] that bumps the names up against the Medicaid databases of all 50 states to see if there is a hit. We also send our Medicare patients through the batch to find out if there is a Medicaid secondary [payer]."
Automated 'day sheets' are patient pleasers
The Woman's Clinic in Boise, ID, uses a simple but efficient way of updating patient information that automates the process for employees, makes it easier for patients, and improves data integrity, says Lena Sears, patient billing supervisor.
While updating patient data is critical for any provider, she points out, the task is even more challenging for a women's clinic, as these patients are the most likely to have a name change, or in the case of obstetrics patients, for employer data to change as the women juggle career and family.
The Woman's Clinic has two sites, Sears notes, with the main location serving an average of 300 patients a day for physician and nurse practitioner visits. The second site averages about 75 patients a day.
Responding to patients who "really dug in their heels" when asked to manually fill out an entire data form, she explains, the clinic's scheduling supervisor and an information technology employee collaborated with the practice management system vendor to come up with an alternative.
Their solution was computer-generated "day sheets" that print out the day before scheduled patients come in for their appointments, Sears says. The sheets, which contain existing patient data in the left column and a blank, lined right column, are inserted into patient charts.
Information is updated every 90 days, she adds, so the computer records the date when a sheet is issued to a patient, and automatically repeats the process for the next appointment that occurs after a three-month period.
"When patients check in, they are handed those sheets, and asked to make any changes on the right-hand side," Sears notes. "They complete only the portions that have changed and sign the bottom of the sheet. One copy goes in the chart and another is used for data entry."
In addition to serving as a tool to update patient data, the form also incorporates patient authorization information, so patient authorization signatures are kept current, she says. That part of the form also notes that the patient understands that charges incurred are his or her responsibility, regardless of insurance status.
Until recently, the clinic kept hard copies for 90 days, but now employees simply scan the sheets into a document management system, Sears adds. "In case there was a breakdown of the practice management system, we would have the information."
As long as the sheets print out each day as expected, "it's a great method," she says. "Sometimes we have little computer glitches and they don't print out."
A problem also may occur when a patient cancels an appointment and the signature date stamp isn't removed from the system, Sears notes. In that case, the computer record shows that an update has just been done, so the system won't print a sheet for the rescheduled appointment when the patient comes in a week or so later.
"It becomes critical to have those dates removed if there are no-shows or cancellations," she says.
"Typically, what happens is as staff go along through the day, if there is a no-show, they take the day sheet that has been printed and go into the system and delete the date. But sometimes they get busy, or the sheet gets set aside."
The automated day sheets are "a very simple concept," Sears notes, and one that works for the clinic. "The thing you have to be cautious about is that sometimes it's easy for the patient to scan through and say, 'Oh, yes, everything's the same.'"
While those cases typically are caught on the back end, she adds, there are times when they get by, and staff find out later there is new insurance, or the woman is no longer working so her husband's insurance is primary.
From her perspective as billing manager, she "sometimes would say that every 90 days is not often enough," Sears notes. "That's only because you have patients who come in November and then again in January, when they have all new insurance. So you can get caught between some crucial timeframes and not get updated information."
Arm staff with advance knowledge
Looking past the "how often is too often" debate regarding the confirmation of patient data, Shawn Glinter, RN, MBA, contends that "it's not good enough to simply ask patients to verify their demographic information."
"It's important to realize that when patients come to the hospital, the last thing they worry about is paying the bill," adds Glinter, a former access director and revenue cycle management consultant who now works for a health care technology company.
The stakes are too high, he suggests, for providers to depend on anything less than a proactive approach that encompasses people, process, and technology.
"[Providers] have policies, but in general they're very lax on all three components of their policies," Glinter says. "You've got to empower staff, give them the ability to make decisions, but also give them the tools to do so."
"If you're going to bill a patient, for example, you want to make sure you actually verify that the address is correct," he contends. "In some states, you have to make sure that you've documented that record."
He cites an instance in which a hospital went through the entire billing and collection process with a patient, ultimately tracking down the person and talking about possible legal action, only to find out that for many months it had been sending the correspondence to the wrong address.
"That turns a situation very bad," Glinter says. "The hospital and patient [ultimately] worked it out, but it turned into a public relations problem and the hospital wrote off the entire bill because they had made this huge error."
One of the things he recommends is address verification software. "If you're a good, paying patient and you've been to five different departments and been asked for the same information, that's where technology is important."
Having the software in place is important, he adds, but so is teaching staff how to ask the questions. In many cases, Glinter says, patients perceive that registration staff are just going through the motions.
With the combination of a good process and technology, he suggests, the registrar might say something like, "I see you have given us this address, but if I run it through, a different one comes back. Have you ever lived at this address?"
"Explain to [patients] that you want to ensure that you have the most up-to-date information in case you have to reach them," Glinter says, "rather than, 'We need this to bill you.'"
Another effective tool, he notes, is having a way to flag the account so that registrars are alerted, during the registration process, to the fact that this patient has been in during the past 15 days and had his or her information verified.
In some cases, Glinter points out, it's not good enough to just have address verification software in order to bill correctly.
"Say you have a 21-year-old student who's handed you an insurance card and tells you he lives in the college dorm," Glinter says. "If you have an integrated product that is interfacing with the registration system, you want it to give you an alert message to have that registrar verify the guarantor of the account: 'What's the address of the parents?' Then all the bills and correspondence go to them, rather than to the dorm."
[Editor's note: Pete Kraus can be reached at [email protected]. Keith Weatherman can be reached at [email protected]. Shawn Glinter can be reached at (615) 491-3270.]
In the precarious world of checking information for patients who have been to their facility before, hospitals often juggle two important considerations: data integrity and customer relations.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content