Disjointed’ training, authorization errors targeted in new education push
Compliance concerns spark effort; staff morale gets boost
Error rates are down and staff confidence is up at Jackson Memorial Hospital in Miami, thanks to the institution of a training and development group within patient access services, says Gil Amara, CHAM, assistant administrator for patient access services.
Responding to the compliance concerns dominating today’s health care environment, Amara designated a supervisor and two trainers to provide comprehensive, uniform training of all new patient access employees. In addition, the new education personnel conduct regular inservices for access employees and get the word out to other depart ments on what patient access is all about, he adds. "Before, each individual supervisor trained each individual employee, and we also had lead employees who helped train," Amara says. "We found that everything was disjointed, not consistent, and that there was no continuity. Emphasis was placed differently by different people."
Access representatives were producing accounts with numerous errors and omissions, which caused a domino effect when those accounts reached patient accounting, adds Brian Palmer, coordinator of the patient access services training and development group. Because the accounts are routed according to plan code — whether it be for Medicare, Blue Cross/Blue Shield, or another payer — the mistakes could cause long delays in payment or even reimbursement denials, he notes.
Documentation was a big issue, Palmer points out. For example, an access representative might be on the telephone for 45 minutes, waiting in vain for an authorization from an insurance company. If the employee doesn’t follow the correct protocol by documenting the unsuccessful attempt, explains Palmer, it could appear as though he or she was not doing the job. "We also had to have a continuum of effort," he adds. "If an employee worked 7 a.m. to 3 p.m. and was not able to get an authorization number, it was the responsibility of that rep to give the account to the lead worker on the shift and make sure it was passed along." That often did not happen in a timely manner, he says.
With the more consolidated, organized training effort, "we’re seeing a drop in error rates with the admission package," Amara says. "We now have employees who feel they are more competent in what we have to do and are more comfortable because they know how to access information."
At Jackson Memorial, there are several computer systems that incorporate billing aspects, and "they don’t all talk to each other," Amara points out. "We established a procedure for accessing authorization information in several locations so it could be looked for enterprisewide." Reinforcing that procedure in staff inservices has caused the number of errors in obtaining authorization at the time of billing to drop dramatically, Amara says.
When the training program started in June 1997, the department had a 51% error rate on all accounts, Palmer notes. After six months, that figure fell to 32%.
Offsite staff get trained, too
Inservices address Medicare and secondary payer forms and managed care procedures, among other topics (see related story at left), Amara says. "It re-emphasizes what employees have already learned, because many things change in the course of a year. There are pieces of paper, e-mail, staff meetings [that disseminate information], and we want to tie that together."
The latest training emphasis, he says, is on bringing staff at Jackson Memorial’s offsite registration areas into uniformity with procedures at the main campus. One procedure being targeted is the classification of a patient’s indigence rating.
"Because we are the county hospital, all the indigent [people] in Miami and Dade County can access our services," Amara says. "We go through their financial information and, based on criteria given us by the Miami/Dade County ordinance, classify their indigence level. We’re taking that concept and making sure it’s done uniformly throughout the whole system. We’re beginning to audit those [off-campus] sites."
In addition to the training sessions for patient access staff, the department’s trainers give information overviews to new case managers, billing and collection employees, and physicians’ office staffs, Amara says. "We usually set these [over views] up on a semiannual basis, and [the target audience] depends on what the need is," he adds. If more case managers are being hired, for example, a session will be scheduled to educate them on access issues.
Regular luncheons are held with the office staffs of the University of Miami School of Medicine’s physicians, who admit to Jackson Memorial, he says. "We go over who we are, what we do, and what they do. We try to break [the number of participants] into three smaller groups to make it more manageable."
To create the Patient Access Services Training and Development Group, Amara moved full-time equivalents from less critical positions. Among other changes, a night supervisor position was shifted to the day schedule.
"Sometimes you have to make a sacrifice in one place to make progress in another," he says. "It seems to be having a positive impact. Everyone is on the same page with procedures and policies. The good part is that as people become more and more educated, they’re doing the job better. Because of that, my goal is that we don’t need additional people to do this [training] function."
Plans call for expanding the training group, he adds. "We’re looking to add an off-site coordinator and a third trainer."
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