On-site training, auditing a success for registration
December 1, 1998 5 minutes read
On-site training, auditing a success for registration
Long-time managers assume new role
Decentralizing registration while keeping staffing costs and error rates under control has been an ongoing challenge at health care organizations across the country. For the Franciscan Hospitals of Ohio Valley in Cincinnati, the mix is working, says Patricia J. Young, CHAM, regional registration process manager.
Franciscan’s success, she explains, has come with the virtual disintegration of the patient registration department and the assumption of registration duties by other areas. The key has been Young’s transformation — along with her counterpart at the hospital’s other campus — from traditional department manager to a kind of floating monitor of registration accuracy and efficiency.
"Our main focus in the whole process was to increase customer service for the patient and the physician," she says. "We felt we needed to develop a method for the patient to go straight to the [clinical] department and get registered so tests could be ordered on the computer and they could have the tests."
The idea was to replace the "get up, sit down, get up, sit down" routine of traditional registration, Young adds. With that in mind, the hospital decentralized its registration procedures, she says. Patients were sent to the point of service, where a "quick and dirty" registration was performed by the technician or clerical person in that department. "They did just enough to allow them to get a number to order the test," Young explains. These quick registrations, which included basic demographic information and a copy of the patient’s insurance card, were then sent to the billing department for completion.
Unfortunately, she adds, the employees doing the quick registrations, although highly skilled in clinical duties, were not attuned to insurance regulations and compliance issues. "We found we were jeopardizing the billing process. In this age of insurance, nobody knows what [coverage] they have, and what they have changes from day to day. When the patient asked questions, the [technicians] didn’t know the answer. They could tell them if there was a problem with their blood, but nothing about the registration or insurance arena."
At that point, Franciscan made the decision to decentralize what was left of the registration department — central scheduling and emergency department (ED) registration — and have those employees work for the managers in their areas. (See related story, p. 138.)
Instead of reporting to Young, the ED registrars would report to the nursing department through the ED manager, and the central scheduling employees to the surgery department. That freed Young, who works at Franciscan’s Western Hills campus, and her fellow registration manager at the Mount Airy campus, to begin close monitoring of registration in the ancillary departments. Using an Excel worksheet to track errors, Young oversees registration activity wherever it is done, she says. "We also do a page of these employees’ evaluations, so instead of being based just on clinical performance, they’re also based in part on clerical."
During her registration audits, she has found a series of simple but crucial errors. "We found things like not witnessing [the signing of] Medicare questionnaires with a full name, which is a requirement. These are just little things, but things that could cause a bad audit from Medicare and lead to a full investigation, which is something nobody wants." These "little things," Young adds, were those she had no time to do while managing a registration department with 21 full-time-equivalent positions.
Billing workshops successful
"We have found that training is the key, no matter what, no matter who the employees are," she emphasizes. "It must be ongoing training, because insurance companies are changing, rules are changing."
Young and her counterpart at the Mount Airy campus work closely with the hospital’s managed care department to keep the lines of communication open. "Sometimes [registrars] don’t realize that contracts with managed care companies require us to do something that we think the patient should do," she adds. "It might be that for a certain procedure we have to call and make sure there is a referral because of the way the contract is written. We might assume the patient has done that."
In another effort to improve communication between departments, the hospital recently held an all-day workshop for the billing department. "There was a lot that the billers completing these quick registrations didn’t know," she points out. "Nobody had told them, for example, that for a quick registration, the [departmental technician or clerk] only put down limited information and then copied the insurance card."
The idea was that billers would complete the registration, building on those data. But when billers saw that certain insurance information was not in the computer, they would throw the bill back to the department involved, Young says. "At the workshop, we let them pretend they were the registrars in these departments. They were saying, Oh, I see why [registrars] don’t see that. They only see three screens, and there are 18 in a full registration.’"
The ongoing difficulty in a decentralized registration environment, she stresses, is keeping staff up to speed on what they need to know. The process is complicated by the large number of people in departments with a great deal of turnover, she adds. "For people in these departments, their job is often a steppingstone to some other clinical position. In registration, it tends to be a career job."
The addition of the registration process managers has helped this situation tremendously, she notes. Now, even though these registrars are disseminated throughout the organization and report to different managers, they can look to Young and her Mount Airy colleague for education. "Even the clinical people are more comfortable with doing registration because they know they can call us. Before, they went to their manager, who said, I don’t know anything about registration.’"
Even with these improvements in place, Franciscan is looking at another option that would further alleviate the training dilemma, she says. The hospital is considering establishing a call center, which could meet the organization’s customer service and accuracy goals in a more organized way.
"The patient would go to the point of service and would pick up a phone and give registration information to [a representative in] the call center," she explains. "We would have [the call center staff] every day to train and update, instead of training somebody in a clinical department for two months and then they’re gone."
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