Presentation on theme: "CHAA Examination Preparation"— Presentation transcript:
1 CHAA Examination Preparation Future Development – Session IPagesUniversity 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 ProblemsFor most hospitals, the #1 reason claims are rejected or denied is:INACCURATE DATA ENTERED DURING REGISTRATIONTherefore, 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 payerIncorrect or missing Member IDClaim submitted to wrong payer (e.g. traditional Medicaid versus Medicaid HMO)Incorrect addressMissing or incorrect phone numbersMissing pre-cert/authorization/referral information needed in order to submit claim
5 CDEs = $$$,$$$,$$$ The Importance of CDEs Confirming this information has been collected and is correct at the time of registration eliminates:DOWNSTREAM issues associated with billing payersProblems in collecting liability from patientsCDEs = $$$,$$$,$$$
6 Data IntegrityData Integrity refers to the process of ensuring that data is:CONSISTENT and CORRECTAccording 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 InformationAdministrative Data = Demographic, Socioeconomic, and Financial dataThe 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 MPIHow 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 NameDateDiagnosis, signs, or symptomsTest or therapy ordered (Procedure)Physician’s signatureIt 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 FlowQuality Assurance is ensuring a certain standard is consistently met.
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 FeedbackLetters from patients and familiesConversations with patients/familiesActive Customer FeedbackCustomer SurveysCustomer Comment CardsCustomer 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 SurveysHealthcare 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 ImprovementQuality 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
21 The Joint CommissionTJC 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 CommissionTJC 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.