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A supplement to the Patient Access Resource Center

Registration accuracy rates update Quarterly benchmarking report

Registration accuracy rates update2

Dear reader:

Welcome to the Patient Access Resource Center’s final quarterly benchmarking report of this year,

designed specifically for patient access managers and finance professionals. This report is based on the results

of a survey in which we asked approximately 150 of your peers to provide information about their registration

accuracy rates.

We wanted to compare the results from our May 2007 survey on registration accuracy. Today, the good news is

that more of your peers are tracking accuracy rates than they were 19 months ago. About 25% of managers said

they did not track accuracy rates in May 2007, compared to 3% today. We suspect that this decrease is a direct

result of the CMS Medicare Recovery Audit Contractor (RAC) program, which begins its nationwide rollout at

the end of this year. The three-year demonstration project collected more than $900 million in overpayments.

The overpaid claims originate on the front end, where accuracy is as important as ever. CMS’ auditing also

included a Medicare Secondary Payer (MSP) RAC, which collected more than $12 million in the demonstra-

tion. Although CMS terminated that program, MSP auditing is still a part of the nationwide RAC rollout.

More than 30% of you said your errors come from MSPs.

The report will cover the entire registration auditing process from how providers track results to the criteria they

use when analyzing the mountain of data. The report will also examine the types of errors most providers find

and how they are tackling these mistakes through comprehensive quality assurance and training programs.

If you have any questions about this report or if you’d like to suggest a topic for a future benchmarking

report, please contact Senior Managing Editor Dom Nicastro at [email protected].

And remember, your revenue cycle is only as good as your front end.

Best regards,

Dom Nicastro

Senior Managing Editor

Patient Access Resource Center

781/639-1872, Ext. 3413

[email protected]

December 2008 3

Most managers track accuracy ratesTwenty-five percent of patient access managers

stated that they did not track accuracy rates in our May

2007 survey.

They said they bemoaned the time restraints in double-

checking their registrars’ work.

Today, 97% of our respondents check accuracy rates,

seeing it as a crucial step toward a healthy revenue cycle

in which denials are down and claims remain safe from

government auditors (Figure 1).

“We track every entry required for a complete registra-

tion,” one respondent wrote.

Others said they simply don’t have the time or system

to do so and that tracking accuracy rates is difficult.

“Sometimes, you don’t know there are errors until

after the bill is denied,” one respondent said. “Also, there

are so many points of registration to track.”

What approach do they use?

Seventy-two percent of managers said they still use

a manual approach, 19% use a software package, and

the remaining 10% use a combination (Figure 2). One

respondent whose facility tracks accuracy rates manu-

ally said they are reported to the registrars monthly.

The data originate from a quick visual inspection of

the demographic sheet and any failed electronic claims.

As for the automated approach, some of the more

common software systems mentioned in the survey were:

AHIQA ➤

AccuReg ➤

CPSI ➤

Emdeon Denial Manager ➤

Compass and EPIC ➤

McKesson ➤ n

Figure 1

Do you track registration accuracy rates?

Figure 2

If you do track accuracy rates, what approach do you use?

Yes

97%

4%

No

19%

10%

72%

Electronic (software package)

Manual Other

Note: Percentages in some graphs might not add up to 100% due to rounding of figures.

Registration accuracy rates update4

Half of respondents perform audits dailyFifty percent of our respondents said they perform

registration audits on a daily basis (Figure 3). That rep-

resents a 12% increase from 2007, when 38% said they

track rates daily.

Thirteen percent said they perform these audits weekly,

20% perform audits monthly, and another 2% perform

annual audits. Some facilities do not audit on a regu-

lar basis. One manager said his facility performs audits

“whenever we can.”

Another said audits are performed for individual clerks

as needed, meaning audits are conducted when there is a

consistent pattern of errors.

Content of the audit

So what are you looking at to determine your facility’s

registration accuracy? It depends on the size of your facil-

ity, the number of staff members who report to you, and

your available time. Some have enough time for a thor-

ough, regular review.

“We use current Web sites for eligibility, and that

insurance is checked against what we have on our fact

sheet,” one respondent wrote. “We review to see if all

is correct before going to our financial auditor. We are a

small rural hospital and we have time to do this daily.”

Others judge the content of their reviews by patterns.

“If a pattern of poor work performance is noticed,

an intense audit will be conducted to determine the ex-

tent of the issue,” one respondent said. “Performance

improvement plans are then created with a three-month

period in which improvement must be made. If improve-

ment is not evident, disciplinary action is taken until the

problem is corrected or the clerk becomes unemployed.”

Survey respondents listed a wide variety of answers

to what they look at in terms of accuracy, including:

Demographic information ➤

Social Security number ➤

State of birth ➤

Referring doctor ➤

Admitting category ➤

Source code ➤

Durable power of attorney or living will ➤

Pregnancy field ➤

Patient employment information ➤

Medicare Secondary Payer questions for Medicare ➤

patients

Accident or medical code ➤

How information was obtained ➤

What documents were signed ➤

Where information was sent ➤

Some facilities simply include everything. “We have

over 100 rules built in the system to catch errors before the

bill drops,” one respondent said. “The registrar is respon-

sible for correcting prior to billing the claim.” n

Figure 3

How often do you perform registration audits?

0%

10%

20%

30%

40%

50%

Daily

Weekly

Monthly

Yearly

No audits performed

Other

50%

13%

20%

2%

6%

10%

Contact Senior Managing Editor Dom Nicastro

Telephone 781/639-1872, Ext. 3413

E-mail [email protected]

Questions? Comments? Ideas?

December 2008 5

Error rates getting better, but same struggles existThe good news with registration accuracy is that fa-

cilities seem to be doing better now than they were 19

months ago. Fifty-eight percent of our respondents have

91%–98% accuracy rates. In May 2007, that percentage

was 44%. Twenty-one percent now fall below the 85%

mark (Figure 4).

One respondent spoke about trying to get staff mem-

bers to work efficiently and effectively using the facility’s

own resources.

“We have trouble getting staff to think outside the box

and use the resources to obtain missing information,” the

respondent wrote. “Also, getting them to understand the

revenue cycle impact on their errors is a problem. And

our decentralized staff that is not under patient access has

no buy-in, and we do not have full support of their man-

agement staff.”

Other problems that led to registration errors included:

Consistent equipment malfunctions ➤

High pressure to produce speedy registrations with ➤

insufficient staffing levels

Lack of appreciation at the senior administration level ➤

for the tasks and functions of the front end

Poor full-time equivalents and equipment budgets ➤

Front-line staff/departmental ownership of all non- ➤

medical duties

Training issues with new information ➤

Antiquated registration systems ➤

Patients’ lack of knowledge ➤

Registrar apathy ➤

Lack of real-time feedback ➤

Eighty-six percent of respondents said insurance is

where most errors occur. Another 50% said data entry,

and 43% answered guarantor/subscriber (Figure 5).

Demographics (35%) and Medicare Secondary Payer

(MSP) errors (30%) were also high on the list. Other

managers said ED patients might give false information,

which can lead to claim nightmares.

They also talked about errors with referring and pri-

mary care physicians.

Poor hours and the pressure-packed environment of

the ED can also lead to errors, one manager said. “Most

of our errors come with emergency department registra-

tions,” the respondent said. “There’s the urgency needed

to register the patients as well as the higher turnover rate

due to the evening and midnight shifts.” n

Figure 5

What types of errors are you finding most often?

Data entry

Insurance info

MSP questionnaire

Emergency contact info

Guarantor/subscriber

Demographics

Co-pay/deductible info

Other

0%

20%

40%

60%

80%

100%

50%

86%

30%

16%

43%

7%

35%

12%

Figure 4

What are your accuracy rates?

Below 80%

80%–85%

0%

5%

10%

15%

20%

25%

30%

11%

86%–90%

91%–95%

4%

96%–98%

99%

10%

13%

30%

28%

4%

Registration accuracy rates update6

Variety of leaders handle trainingTwenty-nine percent of respondents reported that

their lead registrar conducts their organization’s registra-

tion training. Fourteen percent said that responsibility

falls on the patient access director (Figure 6).

But there are others who do the training, such as the

quality assurance (QA) leader (14%) and the PFS director

(about 2%). Other trainers included:

Registration supervisors ➤

PFS educator ➤

Information technology, medical records, and patient ➤

access coordinators

Combination of lead registrars and education team ➤

Education unit leaders ➤

Supervisors ➤

Administrator/business managers ➤

On-site trainers ➤

How they train

Managers used a variety of training tactics, including

use of classroom settings (65%) and competency quizzes

(44%). Thirty-two percent said they use PowerPoint pre-

sentations, and 6% rely on audio conferences (Figure 7).

Many managers also said one-on-one training works best.

Almost all of our respondents said they include read-

ing insurance cards (92%) and a review of their facility’s

policies and procedures (93%) as part of their training

(Figure 8).

In the age of self-pay patients, 45% of managers are

still providing training sessions on how to offer financial

assistance. n

Figure 6

Who conducts your registration training?

2%14%

Patient access director

PFS director

Lead registrar

29%

5%7%

9%

34%

QA leader

QA staff

QA leader & staff

Other

Figure 7

What method of training do you use with your registration staff members?

PowerPoint presentation

Classroom setting

Audio conference

Competency quiz

Other

0%

10%

20%

30%

40%

50%

60%

70%

80%

50%

86%

30%

16%43%

Figure 8

What is included in your training?

How to read insurance cards How to determine financial assistance Your facility’s policies and procedures Other

0%

20%

40%

60%

80%

100%86%

30%

16%

43%

December 2008 7

Medicare Secondary Payer Questionnaire Training Toolkit

The best opportunity to find out whether a patient has

another form of insurance that will supersede Medicare is

during the registration process. The Medicare Secondary Payer

Questionnaire Training Toolkit is the best source of insurance

information and will provide your staff members with the most

efficient registration form during the admission process.

If Medicare determines that another source, such as an

auto insurance company or workers’ compensation, should

be the primary payer of a patient’s treatment, it will not reim-

burse your hospital for the full amount of the claim. Facilities

can lose significant reimbursement dollars if the proper hierar-

chy of payers is not identified during the registration process.

The Medicare Secondary Payer Questionnaire Training Toolkit

is a CD-ROM packaged with an instructor’s manual that pro-

vides you with a collection of practical tools to help prepare

your access staff members to ask the right questions about

who is responsible for paying the patient’s bill.

The CD-ROM contains:

A PowerPoint presentation covering the basics of the ➤

Medicare Secondary Payer (MSP) questionnaire

Training scripts to help staff members explain the form ➤

and communicate with patients

An interactive ➤ Jeopardy!®-style game to add fun to the

training and help reinforce information

Case study–based quiz questions to teach correct re- ➤

sponses in various situations

Managers not overwhelmed by number of registrars Patient Access Advisor spoke with consultants earli-

er this year who said more patient access manager respon-

sibility is moving toward the front end.

Fifty-four percent of the respondents in our survey

said they manage 1–25 registrars, 24% have 26–50 reg-

istrars, and 10% said they have 51–75 registrars on their

staff (Figure 9).

Few managers said they have more than 100 registrars

(6%), but if that’s the case, many consultants say it’s the

number of direct reports, or the number of registrars that

directly report to you, that matters. Having more than 15

is a little high, says Steven Orvis, revenue cycle consul-

tant in Los Angeles. n

Samples of proven-effective policies and procedures ➤

Audit preparation steps and guidelines ➤

A Medicare accident detail form ➤

MSP terminology, definitions, and resources ➤

Engage staff members and ensure that they retain crucial

information with this multidimensional product. With this

training resource, your patient access staff members will be

prepared to:

Identify the complexities of the MSP questionnaire and ➤

understand its significance

Determine when the MSP questionnaire is applicable and ➤

when it needs to be introduced during registration

Recognize the importance of obtaining MSP information ➤

from the patient and applying a proper claim submission

Explain the purpose of the form to the patient ➤

Save money when you purchase multiple copies! Ask

your customer service representative about money-saving

discounts and bulk orders. To order, call 800/650-6787 or

e-mail [email protected].

Editor’s note: Jeopardy!® is a registered trademark of Jeopardy

Productions, Inc., in Culver City, CA. The MSP questionnaire game

on this CD-ROM is not endorsed by Jeopardy Productions, Inc.,

nor is it affiliated with Jeopardy Productions, Inc.

3%

54%

24%

6%

10%

3%

1 to 25

26 to 50

51 to 75

76 to 100

More than 100

I don’t manage

Figure 9

How many registrars do you have on staff?

Registration accuracy rates update8

This special report is published by HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. • Copyright © 2008 HCPro, Inc. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center at 978/750-8400. Please notify us immediately if you have received an unauthorized copy. • For editorial comments or questions, call 781/639-1872 or fax 781/639-2982. For renewal or subscription information, call customer service at 800/650-6787, fax 800/639-8511, or e-mail customerservice@ hcpro.com. • Opinions expressed are not necessarily those of the editors. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. HCPro, Inc., is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks.

12/08 SR5208

Speaking out: Your greatest barriers, successesThe challenges to achieving a solid accuracy rate during

the past 19 months remain the same: Turnover, staff buy-

in, and lack of proper resources all contribute to setting

back your patient access team.

We wanted to hear about those challenges directly from

the field. So we asked our respondents to tell us about their

greatest barriers. We also asked them to share with us some

of their recent process improvements that have helped

accuracy rates. Respondents said they struggle with the fol-

lowing barriers:

Understanding the Medicare Secondary Payer (MSP) ➤

questionnaire, such as how to correctly complete

it and where some of the information is keyed into

Meditech

Educating long-term employees about new methods ➤

and registration needs

Dealing with confusing insurance companies ➤

Bringing new hires up to speed with reading insur- ➤

ance cards

Dealing with registrars who hurry through the regis- ➤

tration process to get patients to their appointments

Handling too many other responsibilities (e.g., cashier- ➤

ing, mental health insurance preauthorization, and

patient escorting)

Dealing with lab and radiology technicans who per- ➤

form registrations in the respondents’ outreach loca-

tions, because they make the most errors and report

to departments other than registration

Getting new employees to take their job seriously ➤

Not having a computerized system to expedite the ➤

monitoring task

Taking the time to collect accurate information from ➤

patients

Incorrect information on insurance Web sites ➤

Changing payers and coordination of benefits because ➤

patients do not always provide all insurances

Inability to attract staff members with higher education ➤

and experience because of inadequate pay-scale levels

Respondents’ improvements included:

Implementing a quality assurance (QA) system, re- ➤

training all staff members on the MSP questionnaire,

and mandating that all decentralized staff members

use a QA system even if they are not under patient

access

Applying new rules, improving the AHIQA process, ➤

and boosting the accuracy rate from approximately

86% to 98% n