1. CHAA Examination Preparation
Future Development – Session I
Pages
University of Mississippi Medical Center

2. What to Expect…
This module covers various aspects of Patient Access knowledge found in pages of the FUTURE DEVELOPMENT section of the 2010 CHAA Study Guide.
A quiz at the end will measure your understanding of the content covered.

3. INACCURATE DATA ENTERED DURING REGISTRATION
Billing Problems
For most hospitals, the #1 reason claims are rejected or denied is:
INACCURATE DATA ENTERED DURING REGISTRATION
Therefore, patient access staff must focus on getting the CRITICAL DATA ELEMENTS (CDEs) correct when collecting information from the patient.

4. Critical Data Elements
The most common CDE mistakes include:
Patient name on claim not matching patient name on file with payer
Incorrect or missing Member ID
Claim submitted to wrong payer (e.g. traditional Medicaid versus Medicaid HMO)
Incorrect address
Missing or incorrect phone numbers
Missing pre-cert/authorization/referral information needed in order to submit claim

5. CDEs = $$$,$$$,$$$ The Importance of CDEs
Confirming this information has been collected and is correct at the time of registration eliminates:
DOWNSTREAM issues associated with billing payers
Problems in collecting liability from patients
CDEs = $$$,$$$,$$$

6. Data Integrity
Data Integrity refers to the process of ensuring that data is:
CONSISTENT and CORRECT
According to CHAA, your PRIMARY ROLE IS:
is to create a basis of the medical record by capturing specific information prior to the patient’s encounter at the point of entry into the healthcare system.

7. Types of Data You gather Administrative and Clinical Data:
Clinical Data = Medical Related Information
Administrative Data = Demographic, Socioeconomic, and Financial data
The two most COMMON DATA ELEMENTS used throughout the healthcare experience are:
Legal Name and Date of Birth

8. Data Storage and Retrieval
The main REPOSITORY (virtual storehouse/closet) used in patient access is the :
Admission, Discharge, Transfer (ADT)
The primary Patient Tracking Link considered to be the most important resource in the healthcare facility is the:
Master Patient Index (MPI)

9. Importance of the MPI
How does proper use of the MPI serve the patient and the hospital?
Links patient being registered for care with existing medical records (if possible).
Improves patient safety by increasing the chance of proper patient identification.
It increases the ability of the hospital to obtain payment for services by properly identifying the patient.

10. What to Know about Physician’s Orders
Components of a valid physician order are:
Patient Name
Date
Diagnosis, signs, or symptoms
Test or therapy ordered (Procedure)
Physician’s signature
It must be LEGIBLY written.

11. Data Integrity – Quality Assurance
Ensuring the accuracy of registration data collected results in fewer denials, rejected claims, and other delays.
Facilities use INTERNAL AUDITING in order to gain a SNAP-SHOT of the results produced by current processes. UMHC’s auditing process is called:
AccuReg

12. Data Accuracy – Quality Assurance
Data obtained from the audit is used to implement performance improvement initiatives designed to meet the revenue cycle goals of:
Reducing Accounts Receivable (A/R)
Improving Cash Flow
Quality Assurance is ensuring a certain standard is consistently met.

13. Access Management Data

14. Quality Assurance & Customer Service
According to a Press-Ganey Survey, “Satisfied Patients Become Loyal Patients.”
Satisfaction depends on:
Wait times, proper room and food temperature, technical competence, protection of privacy, friendliness and courteousness of staff, etc.
Compassion is as significant as Competence.

15. Evaluating Customer Satisfaction
Passive Customer Feedback
Letters from patients and families
Conversations with patients/families
Active Customer Feedback
Customer Surveys
Customer Comment Cards
Customer Callback Programs
“Surveys are the BEST method to find out if a customer is satisfied.”

16. Using Survey Results Positive Feedback: Negative Feedback:
Provides an opportunity for positive employee engagement and also helps gain market share (customers).
Negative Feedback:
Provides an opportunity to apply quality improvement principles in an effort to respond to the feedback with service recovery efforts.

17. The Power of Surveys
Healthcare organizations are starting to PUBLISH results.
Insurance companies are moving toward reimbursing treatment at facilities that meet or exceed a certain level of performance benchmark.
Surveys are also used INTERNALLY within individual organizations to measure employee/staff satisfaction.

18. When Creating a Customer Satisfaction Survey…
You MUST DETERMINE:
What data measurements are required?
Face to face survey, telephone, , comment card, etc.
What data measures are important to the organization’s decision making process?
Patient wait time, compassionate staff, food/room temperature, etc.
What data measures are important in the day to day management?
What are the factors that will keep customers coming back?

19. Collecting Data Analyzing Data Taking Action Evaluating Results
Quality Improvement
Quality Assurance is ensuring a certain standard is consistently met.
QUALITY IMPROVEMENT is best described by Lexus:
“The Relentless Pursuit of Perfection.”
It’s a never ending cycle of:
Collecting Data Analyzing Data Taking Action Evaluating Results

20. Access Management Data

21. The Joint Commission
TJC REQUIRES healthcare organizations to IDENTIFY and REPORT on quality improvement initiatives.
TJC defines QUALITY CONTROL as the performance processes through which actual performance is measured and compared with goals, and the difference is acted on.

22. The Joint Commission
TJC defines QUALITY IMPROVEMENT as an approach to the continuous study and improvement of providing health care services to meet the needs of individuals and others.
TJC defines PERFORMANCE IMPROVEMENT as the continuous study and adaptation of a health care organization’s functions and processes to increase the probability of achieving desired outcomes.