'If you can get it right up front, you're ensuring accuracy, preventing rework, and preventing denials,' says Alicia Auman, director of patient access at KSB Hospital.
Patient access plays a tremendously important role within the revenue cycle, which is why Alicia Auman, director of patient access at KSB Hospital in Dixon, Illinois, has worked so hard to transform her department from top to bottom, starting with how it's viewed by everyone else.
"We really had to focus on changing the mindset of the organization to understand that access was not just registration," she says. "I worked with the CFO to change the mindset."
Instead of viewing patient access as simply a data-entry role, these staffers are now viewed as "front-end billing experts, trained on how to properly identify rules, plans, and policies, and understanding that access handles 70% of what goes out on a claim."
"If you can get it right up front, you're ensuring accuracy, preventing rework, and preventing denials," Auman says.
Auman talked with HealthLeaders about the steps KSB Hospital's patient access department took to revamp the way it was organized, the way it worked, and its results. The conversation has been lightly edited for length and clarity.
1. Bring All Registration Staff Together
"One of the first things that I did was make sure that we had all the registration staff working under one umbrella. Historically everyone was separate. We have the hospital and some outlying clinics, and I had about 21 people on my team, which consisted of the hospital and just one clinic that was attached.
I worked with the outlying clinics and the clinic management teams to explain why it was important to have registration report to access. Those people were never connected to access and didn't really understand the impact they're having on the revenue cycle and negative impacts on the revenue cycle.
They knew that they're scheduling appointments and creating an encounter so the doctor can do their work and document. But having them join the [access] team was tremendous, for not only the organizational success of the revenue cycle but for those people to understand the work that they're doing and empowering them to know that they have the skills to do their job, do it well, and have a consistent process.
We were to get all the access team members under one umbrella and moved our department from about 20 people to about 70 people."
2. Implement Pre-Registration
"We implemented pre-registration to capture more accurate information and to expedite the check-in process. We had long lines at registration and [patients] feeling like they don't have any privacy. Now, we have patients share that they feel more privacy when they're doing the pre-registration process over the phone.
They like knowing that they've already given their information so they can just get in the line, give their name and date of birth, and get on their way to their appointment. Our check-in times for pre-registered patients moved from about three to five minutes per registration to about 45 seconds."
3. Use Front-End Technology
KSB Hospital implemented front-end technology from the company AccuReg, such as automated claim verification, front-end claim scrubbers that catch errors immediately, and tools to collect copays and payments at the point-of-service.
"You can't manage what you can't measure, and we had no way to measure any issues that we had. The billing department would just send me handwritten printouts … saying, 'this is incorrect,' with never any explanation as to what needed to be fixed or why.
We were getting things that were six months old or more, and billing wants us to go to the registrar and say, 'Why did you do this,' and 'you need to fix that.' And now it's way too old; nobody's going to remember why they did anything wrong.
[Also] when people were verifying [patient] information there was a manual process to push eligibility out to get information for that. We had complaints from providers on the long registration time and complaints in the billing office on not having correct information. The access team could never win. We were either getting yelled at up front or getting yelled at later on.
Now, [with AccuReg's quality assurance product] we have real-time edits that prompt the registrar to talk to the patient at the point of service. We have eligibility verification, which automatically checks eligibility.
When we started with [the tool], our baseline was 80% final accuracy. Now our initial accuracy rate is 95%. That that shows us that the staff are not only correcting but they're learning from things that they're correcting. Now our final accuracy rate is 99% consistently.
Our point-of-service collections are usually between $11,000 and $30,000 per week, depending on payer mix and our volumes.
Access related denials were around 21%, now they're around 7% of total denials.
And since implementation in 2019, [the technology] helped us to prevent $800,000 per month on average in denied charges, with more than $20 million in total savings … that would have been denied."
4. Cultivate Leaders and Educators
"We implemented a QA analyst and educator for the team to help streamline processes, make sure that we're being consistent with education, and to also maintain software needs.
AccuReg … has a lot of information and obviously you have to keep up with payer changes and edits. So, having a person dedicated to being an educator that would go out and do all this education for the team, in addition to looking at all the reporting that we have now, and understanding what the team's needs were for education is huge. Access is everywhere … in most organizations, your team is always spread out. So having one person, and having that one message of how to do something, is tremendous.
We also implemented leads for departments, like central scheduling, insurance verification, pre-registration, check in, and office scheduling. Having leads is awesome because now people have somebody to go to for their basic day-to-day workflow questions, and it also empowers those people to be the owner of that area of the department."
5. Develop a Career Ladder
"We developed a tiered pay scale. People who check in patients are paid in tier one. Once you have training and you've been in the department for a while, you can move into pre-registration, and you would get a little bit of a bump in your pay. You're growing a little bit; we trust you with more and more responsibility. Tier three would be the authorization team and financial counseling.
Since we implemented all of this, the staff satisfaction and our retention has gone up. Turnover was reduced by 42% to 25% in two years.
These people need to know how to do this job. It's not just checking the in patients; it's not just creating an encounter. There's important information that you need to get up front. And I think that we have changed that mindset in doing a career ladder.
It was awesome because I wanted to show people that you can come in to access. Don’t think of it as an entry-level position; think of it as an opportunity to build your skill set … you can go on to do something different in the revenue cycle … it really just opens their eyes [that] there's a whole career path within healthcare that's not clinical."
Alexandra Wilson Pecci is an editor for HealthLeaders.
Change the mindset from registration as data entry to an important part of the revenue cycle.
Use technology and data to streamline tasks and measure effectiveness.
Develop a career ladder and leadership and education roles for staff.