Quality Team Speeds Claims Processing by Reducing Errors
May 1, 2017 4 minutes read
EXECUTIVE SUMMARY
Patient-access leaders at Upstate University created a quality team by reallocating existing revenue cycle roles, which put accounts receivable to less than 30 days.
- Previously, each supervisor managed their own accounts that fell to various work queues.
- Experienced registrars were moved into the quality positions.
- Areas where employees were making errors were incorporated into training.
A group of five dedicated quality specialists achieved dramatic gains at Syracuse, NY-based Upstate University Hospital, including putting accounts receivable at less than 30 days.
After the department went live with the Epic electronic record system several years ago, accounts were sent to work queues in real time so that errors could be fixed before claims were sent out. All supervisors managed their own accounts whenever they could find a spare moment.
“Within a few weeks, that became overwhelming. We knew we had to change our approach,” Shelley White, director of patient access services, recalls.
It became apparent that a designated quality team could produce a dramatic effect on the overall revenue cycle. “It was an ‘aha’ moment. It’s a lot more efficient to have a few people who do this well,” White says.
Finding the resources for the new positions was the first step. “I knew I couldn’t just go ask for six or seven more FTEs [full-time employees]. But it was so important to me to make this happen,” says White, who devised the idea of reassigning existing FTEs to a designated quality role. “We had people throughout the department experienced at working on these accounts. I was able to take experienced registrars with seniority and technical skills, and move them into these promotional roles.”
The team of four people, who are at a supervisory pay grade level, go through work queues, conduct quality assurance for new hires, and audit accounts. “No longer are supervisors doing that only if they can get to it,” White says. “That was really where it became successful — it was no longer just one more task of a busy supervisor.”
The quality team review has avoided scores of claims denials by fixing errors on accounts. “Having the team on these accounts every single morning to make sure there is no delay in claims has been instrumental in the revenue cycle’s success,” White says. “If there’s any kind of questionable error, they fix it.”
White says that given time, she probably could have obtained sufficient data to justify adding new FTEs for the quality roles. “At the time, I needed to act fast and come up with resources,” she says. “But the payoff has been ten-fold.”
Rapid-fire Changes
Targeted audits are conducted to see how employees are handling new requirements, such as the Medicare Outpatient Observation Notice. “That has helped us immensely, with the constant new regulations coming our way,” White says. “All of us in patient access are experiencing rapid-fire changes.”
The quality team identifies challenges the employees are facing. “We have real-time information on what we are doing well and what we are not doing as well,” White explains, noting that training targets problem areas. “We refine policies, whether administrative or departmental, based on the quality team’s feedback.”
At times, quality scores dip because of a new regulation or other process change. It’s not because overall quality has declined, she says.
“If our total accuracy score is sometimes not at a number that we think would be acceptable, it’s because we are getting nitpicky,” White admits. Recent areas of focus have included legibility of scanned documents and whether a consent was properly witnessed. “While these things technically don’t cause a bill edit, we have really gotten ‘into the weeds’ in areas we didn’t previously look at,” White says. Here are some other benefits of the department’s quality team:
- New hires can strive to move into quality roles.
“You can be a registrar, do a good job, have your seniority, and hopefully move to this team over time,” White says.
- Cross-training allows the quality team to fill in during sudden volume surges in the ED or other registration areas.
“Even though I don’t want to use them on a regular basis to fill staffing voids, there are times when we really need them to plug in some gaps,” White says.
- It has shifted the department’s overall focus to quality.
“We do everything possible to remind people of quality,” White says. Data on employee performance are covered during a monthly meeting with a supervisor. “We created a database, which at the moment is pretty manual. Out of that, we get an employee scorecard,” White says.
Supervisors no longer meet with employees only if there’s a problem — they do so to continually emphasize quality. “It may just be a 10-minute meeting, but it’s a dedicated time to meet,” White says. “We get so busy sometimes that you meet with the problem employees and you forget the top performers.”
New hires are expected to hit certain performance targets, and this is taken seriously. Some recently have failed probation. “It sent a message that it’s no longer a ‘warm body’ syndrome,” White says. “We lay out every resource you can imagine to help them. But you can no longer just kind of skate by.” n
SOURCE
- Shelley White, Director, Patient Access Services, Upstate University Hospital, Syracuse, NY. Phone: (315) 464-5035. Fax: (315) 464-5062. Email: [email protected].
Staff shifted priorities without adding more full-time employees.
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