Patient Registration Audit Program Department of Provider Relations April 2004

What is Patient Registration? 1) Identifying Insurance Insurance plan name Plan type (HMO) Patient name Patient ID # Employer group # Effective date Co-payment amount

What is Patient Registration? 2)Verifying Patient Information Loyola University Health System – Patient Insurance Verification Report Location: LOC-General MedicineProvider:Clifford MD, Brad Building:Loyola Outpatient Center Patient Name: Smith, Mary Department: General Medicine Patient MRN: Appt:6/3/04 at 3:00PMVisit Type: NPV Please review the information below, cross out errors/make corrections. Patient Information: Smith, Mary SSN: Home Phone: Address:222 Deer StreetBirthdate:01/31/51 City, State:Joliet, IL Information sheet given to each patient at clinic check-in to review: Name, address, phone Employer Emergency contact Guarantor (person responsible for the bill) Insurance Subscriber (person who holds the insurance)

Causes of Incorrect Registration  Registration is complex –Hundreds of medical insurance plans to register Each plan has unique ID card –85+ individual data fields per SMS registration Outpatient clinics often register 100 – 150 patients per day –More than 500 choices for one field – “insurance plan code” Insurance plan code selected based on ID card Registration staff perform many functions –Patient registration (SMS system) –Appointment scheduling (IDX system) –Order/charge entry (LUCI system, soon EPIC) –Co-pay collection

What Happens if a Registration is Incorrect?  Delayed or denied insurance payment to Loyola –Resulting in delayed or reduced revenue  Delayed communication with patients –Due to incorrect patient address or phone number  Dissatisfied registration and billing staff –Time spent addressing patient complaints and “fixing problems”  Dissatisfied patients –Hours spent on the phone with Loyola and the insurance plan to resolve billing problems

Solutions Implemented Process:  Centralized registration audit program created –Provide direct feedback regarding errors to registration staff  Registration Specialist position created by Ambulatory Services (registration “expert” assigned per clinic)  Targeted training conducted on “most common” errors –Through monthly Registration Forums  Registration Recognition Program created to acknowledge top performers

Solutions Implemented Information Systems:  SMS access policy –Requires training, competency and audits for system access –Reduced number of SMS users by 253 (from 934 to 681)  Identified SMS “system” issues affecting accuracy –Reduced insurance “plan code” selections from 514 to 236

Results - Overall & Insurance Accuracy 12,580 registrations audited from Oct 01 – Feb 04 Increased average audit accuracy from 96% to 97% Increased average insurance accuracy by 6%

Insurance error rate decreased by 6% Fewer insurance errors mean a reduction in delayed and denied revenue Results: Reduced Insurance Error Rate

Results: Impact on Reimbursement For example: 600,000 outpatient visits/year x $100 per visit = $60 Million in charges FY02: 12% error rate = $7.2 Million delayed/denied FY04 (to date): 6% error rate = $3.6 Million delayed/denied Bottom line: $3.6 Million in potentially expedited or increased revenue

Next Steps  Unplanned audits –To validate “planned” audit scores  Registration Oversight Committee (Provider Relations, Ambulatory, MIS, LUPF, PFS) determines consistent policies  Ambulatory Services plans to proactively verify insurance  Working with Information Technologies to improve “system” functionality –’04/’05 implementation of EPIC to move some functions from registration staff to clinical staff –’05 implementation of new registration system to improve accuracy  Patient education –Instructing patients to bring insurance cards, co-pays, referrals