Use checklists, audits, tests to evaluate staff
Goal is to ensure competence
Patient access staff are the very first contact many patients have with physicians and facilities. Whether staff are registering patients in the emergency department, call center or at the front desk of a physician's office, "this first impression has long-lasting effects," says Colleen McMahon, senior manager of the integrated call center/ University of Pittsburgh Medical Center (UPMC) physician service division, registration and scheduling.
"To ensure that you have the correct staff in the correct position, it is important to measure their competency," says McMahon.
Accurate scheduling and registration are important to both patient and provider satisfaction, says McMahon, and are "the key pieces that begin the health care revenue cycle."
McMahon says that the accuracy of registration and scheduling, customer service skills, copay collections, assignment of benefits, privacy notices, and financial assistance notices and counseling are particularly important to measure.
UPMC's patient access department measures these competencies in the following ways:
1. Trainers do quality assurance (QA) audits by monitoring calls.
This is to ensure that staff are following the department guidelines when scheduling and registering patients. "The QA audits give us the opportunity to determine specific areas of education needed on an individual basis," says Maureen Miller, training supervisor for UPMC physician service division, registration and scheduling.
A manager might remind staff to ask patients about additional needs before ending a conversation. "Or, we may determine that an individual requires some added training on the protocols and procedures for a particular department," says Miller. "That training may take the form of a one-on-one session or utilize one of our web-based training tutorials."
Managers audit staff on a monthly basis, based on the volumes of calls and registrations they complete. "This QA process is part of our control requirements for Sarbanes-Oxley compliance," Miller notes.
2. Benchmarking tools are utilized.
Copay collections, encounters without charges, and charge lag details are analyzed and trended weekly. When the results of these reports fall in the acceptable range, managers congratulate the staff and encourage them to continue with their good work.
"When goals are not met, staff are engaged in a discussion," says Miller. "Each department collaborates on procedures that will enhance collections, specific to their department."
The training department provides educational materials and Web-based training tutorials to help staff meet these goals.
4. A group of trained staff perform an assessment.
A recent program assessed several different aspects of UPMC's patient access department. This included appropriate signage and whether staff were following established front desk procedure and policy.
"Armed with a checklist, both technical and customer service skills of front desks were observed and reported," says McMahon. If the staff "passed," they were immediately recognized with a congratulatory letter from executive leadership.
"For those departments with deficits, management was notified," says McMahon. "During this process, educational memos were sent to all staff reviewing noted areas of difficulties."
Sites were audited a second time and scores compared. "All of the findings were entered into a database, educational memos were written and distributed, and the training department enhanced discussions of those areas deemed troublesome," says McMahon.
As a result of these audits, tools are being developed for staff to use when discussing UPMC's financial assistance program.
According to Maribeth Quinn, director of business process improvement and technology training at Nationwide Children's Hospital in Columbus, OH, competency is important to measure because access staff "are, in many ways, the biller for the organization."
If all information is provided accurately, the claim often will go out without further work and be paid much faster. "Our hospital has actually not done much competency testing, so this is new for us," says Quinn. "I think that one particular challenge is that hospital billing has many changes. Keeping up with the changes can be difficult."
One area that is particularly important to measure is that the right patient is selected in the system to begin with. This is necessary for billing, but much more significantly, it can affect the clinical care the patient receives. "If someone registers or schedules the wrong 'Billy Smith,' we may not know they have allergies," says Quinn.
Nationwide's access department developed a multiple-choice test to determine competency. In addition, staff complete a new patient registration and a follow-up patient registration involving changing the insurance and guarantor information.
For audits, 10 registrations completed by the same person are picked, to see if all the required information is provided. "Did they run eligibility for the insurance? Did they run the checklist at the end of the registration?" says Quinn. "For our system, that means the system checks for minimum requirements. The system gives you a green check mark if you meet these minimums."
Webinars are used to keep staff updated on new insurance programs and how to read insurance cards. "We also will look at recent errors that we are seeing, and make sure people know how to do the process correctly to stop the error," says Quinn. "The webinars are not mandatory, though we are considering that at least one 'super user' attend from each area."
[For more information, contact:
Colleen McMahon, Senior Manager, Integrated Call Center, University of Pittsburgh Medical Center, Quantum One E-410, Pittsburgh, PA 15203. Phone: (412) 488-4858. Fax: (412) 432-5370. E-mail: [email protected].
Maribeth Quinn, Director, Business Process Improvement and Technology Training, Nationwide Children's Hospital, Columbus, OH. E-mail: [email protected].]
Patient access staff are the very first contact many patients have with physicians and facilities. Whether staff are registering patients in the emergency department, call center or at the front desk of a physician's office, "this first impression has long-lasting effects," says Colleen McMahon, senior manager of the integrated call center/ University of Pittsburgh Medical Center (UPMC) physician service division, registration and scheduling.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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