Teams speed billing, enhance cooperation
September 1, 1997 5 minutes read
Teams speed billing, enhance cooperation
Staff keep tabs on patient’s record with new process
Newly designed work teams that shepherd accounts from preadmission to post-discharge have streamlined work flow, reduced the number of full-time employees, and slashed billing time at University of California, Los Angeles, (UCLA) Medical Center.
The improvements are based on the principles of patient-focused care, says Ruth Irwin, manager of patient administrative services (PAS) for the department of admissions and registration. PAS team functions include portions of medical records, admissions, registration, utilization review (UR), and patient accounting. (See box, p. 133.)
As a result of consolidating those tasks, the average time it takes to get a bill out the door has been reduced from 30 days or more when the teams began operating in 1994, to 18.95 days in 1995, and 12 days in 1996, Irwin says.
"Basically, we have shifted staff closer to the [medical] record," says Linda Blanchard, MPH, RRA, director of medical records for the UCLA Medical Center. "[Staff] are actually on the unit and can control the records, and control of the records is always a big issue. So this is a plus."
Blanchard has relinquished her authority over the PAS team’s medical records function, but there are quality control processes in place, she says. She coordinates an oversight group with representatives from each of the areas covered by the team which meets every other month. "If we have issues, they are raised there, and then Ruth [Irwin] is responsible for going back [to the PAS teams] and dealing with them," Blanchard adds.
Complaints about such matters as charts not being in order or items missing from medical records are brought before the oversight committee or, if the committee has just met, communicated to Irwin. If edits uncover data quality issues with the PAS team’s abstracting, those also are reported, Blanchard says.
When an outside consulting group looked at improving performance efficiency, the PAS department began examining, among other things, the functions that were performed to get a patient’s bill out the door and how many days it took, Irwin explains. "We found functions being duplicated."
A task force identified these major problems:
• long waiting times before patients reached their rooms;
• multiple phone calls for preadmission;
• delays in getting patient charts to medical records;
• delays in initiating treatment;
• delays in billing;
• high number of days in accounts receivable.
As part of the performance improvement initiative, nursing staff were grouping patients with similar conditions together; the decision was made to assign a PAS team to each of those patient units, Irwin says. Depending on the size and complexity of the patient population they serve, the PAS teams consist of one or two financial counselors and one or two administrative service associates (ASAs). A team also may have a senior admitting worker.
An ASA performs multiple tasks, Irwin notes, while the senior admitting worker is in a support position that covers preadmission and admission functions. Although PAS teams are based on individual patient units, they report directly to the admissions and registration department.
The teams handle everything from the time a physician makes the decision to admit the patient until post-discharge, Irwin says. "When the account leaves our department, it goes straight to the billers."
When the patient is discharged, the PAS team retrieves the medical record from the nursing unit, does all the abstracting outlining how the patient was admitted, the number of consults, operative reports, and other state reporting requirements and then sends the record to the coders, who code the account for billing. It then goes to the medical records department.
In the past, financial counselors would enter financial summaries, then patient accounts would hold the account for billing until all requirements were met, such as obtaining discharge summaries or hard-copy certifications, she says.
When all these functions were consolidated into the PAS team’s responsibilities, patient accounting, utilization review, and medical records were able to decrease staff proportionately, Irwin says. There also was an overall decrease of 10 full-time equivalents among the five departments involved.
The PAS teams initially processed all the Medicaid continued stay reviews, but after awhile they concluded that this was not an efficient use of time, so that task reverted to UR. However, the teams still handle the Medicaid extensions for transplant patients.
PAS team members all had to apply for their positions underwent an extensive four-module training program, spending two to three weeks in each department they were taking duties from. Staff from those departments conducted the training. After about 18 months, Irwin says, the admissions and registration department took over the training, with support from technical advisors from the other departments.
Key to the program’s success was the development of an ASA time line showing when certain tasks had to be completed because the team’s duties affect the operation of other departments, Irwin explains.
"Every other area’s performance is contingent on receiving work from us, so it was important to [establish] when discharge folders had to be processed, when the chart information had to be sent to UR, and when the medical record had to be in the coding department," she adds. "For example, for patients discharged yesterday, the medical record is required in coding by 1 p.m. today within 24 hours. This was crucial. We wanted to make sure we didn’t negatively impact the departments we were assisting."
Although the PAS teams report to admissions/registration, they are stationed full-time on the nursing units and become part of the team on that floor, Irwin notes. "They’ve already dealt with [the patient] during preadmission, so if there is any question in-house regarding that account, the financial counselor is there to handle it."
PAS team members work with unit secretaries on obtaining charts, and the admissions and registration department provides periodic inservices for the secretaries on such issues as proper chart order and the necessity of obtaining medical records on a timely basis, she says.
The inservices for unit secretaries are done in conjunction with a representative from medical records or coding, Irwin notes. "We stress that what they do impacts reimbursement, that if the chart is out of order, [medical records] may miss something major and decrease the amount of money the hospital gets paid."
Adding to the cooperative spirit fostered by the PAS teams is Partners in Excellence, the hospital’s incentive program used to assess teams throughout the facility on their performances, Irwin says. Meeting certain goals brings cash bonuses. For this program, the 28 PAS team members, plus additional coding and UR employees about 116 people in total are part of one team, she adds.
Despite the traditional reluctance of medical records directors to let go of the abstracting function, doing so can work, Blanchard emphasizes. "[Medical records directors] think only their staff can do it, but that’s not valid. It can be done by others it’s just a matter of maintaining quality checks and communication between areas."
For more information, contact:
Ruth Irwin, Manager of Patient Administrative Services, Department of Admissions and Registration, UCLA Medical Center, 10833 Le Conte Ave., Los Angeles, CA 90095-1734. Telephone: (310) 206-8529.
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