this conversation may be recorded for quality purposes fundamentals of a call observe quality...
TRANSCRIPT
This Conversation May Be Recorded for Quality Purposes
Fundamentals of a Call Observe Quality Assurance Program
Jasmine ThomasQuality Assurance SpecialistWellSpan Access Call Center
What should you be listening for?
Establish the specific behaviors employees must practice based on departmental goals and expectations.
Wildly Important Goals
Did the agent ask the caller for their preferred name and address the caller by that name throughout the call?
Did the agent pull the caller/patient up in the scheduling system?
Did the agent remind the caller to review their preparation instructions?
• Authenticates Two Identifiers• Verifies Diagnosis/Symptoms/Dx Code(s)• Encourages Caller to Register for
Labs/Schedule Imaging Studies• Clearly Identifies Arrival Instructions
What should you
be listening
for? Listens Actively
Avoids long, unexplained, Silent Pauses
Uses Courteous Words & Statements
Enunciates Clearly & Speaks Slowly for Ease of Understanding
Establish behaviors that are specific to a call center and/or customer service work environment.
Create an Evaluation Form!! Does Not Meets
Partially Meets Meets Exceeds Not Applicable
Determine how you are going to rate each behavior.
Define Each Behavior
Checks Scheduling System for Additional Appointments to be Registered
o Does Not Meet- Agent fails to pull the caller up in the scheduling system. Agent pulls the caller up in the scheduling system but does not complete the registration for any future visits occurring within the next 30 days.
o Partially Meets- NAo Meets- Agent pulls each and every caller up in the scheduling
system, identifies any future visits occurring within the next 30 days and completes the registration for said visit(s).
Define Each Behavior
Listens Actively
o Does Not Meet- While completing the registration, the agent does not give the caller their full attention, continuously interrupts the caller while they are speaking and continuously asks the caller to repeat themselves.
o Partially Meets- Agent only gives the caller their undivided attention during parts of the registration. During other parts of the registration, the agent is, noticeably, distracted and/or asks the caller to repeat themselves.
o Meet- Agent gives the caller their undivided attention, is able to pull cues from the caller/conversation to assist in the registration and listens without interrupting the caller.
First Impression/Great Greeting
Telephone Skills
Identifying Information
Customer Experience
Handoffs
Closing
Bonus (how to achieve an Exceeds)
Categorize the
Behaviors
Develop a Scoring System/Scoring Key
Does Not Meet: 75% <
Partially Meets: 75 – 84.99%
Meets: 85 – 100%
Exceeds: 100% >
Does Not Meet: 0 – 43
Partially Meets: 44 – 49
Meets: 50 – 55
Exceeds: 56+
Create a Summary
Make sure your team understands the behaviors and how they are being evaluated
Keep your team privy to any changes/updates
Provide timely feedback
Schedule routine Coaching
Calibrate!!!
QA Specialist
Best Practices
Questions???
Sample Calls…
Well THAT Didn’t Go Well …Well THAT Didn’t Go Well …
Lessons Learned from a Project Failure
Virginia RobbinsDirector, Patient Access
Penn State Hershey Medical Center
The ProjectThe Project
Implement automated eligibility checking for: Ambulatory pre-registration ED registration
Let’s call it product “Auto Elig” from Vendor X
Some Key FactsSome Key Facts
Fully employed physician model One Patient/One Chart, OP and IP Ambulatory Pre-Registration
5000 visits per day Team Manager: 6 months in position and new to leadership
ED Registration 200 visits per day Manager: 1 year in position, 4 years in Access leadership
Team MembersTeam Members IT Analysts
Role is to understand software Meet system requirements
Access Team Manager/Manager Running complex teams and meeting
operational business needs Director
Simultaneously responsible for Access evaluation of new Revenue Cycle software
Project GoalsProject Goals
1. Ambulatory: Eliminate manual eligibility verification of 5000 visits/day Automate process Work exceptions only Increase accuracy, reduce time, reduce staff
2. ED: Replace multi site verification with single site Increase accuracy, reduce time, not staffing impact
Ambulatory Pre-Registration ProcessAmbulatory Pre-Registration Process
1. Create encounter in billing system to initiate billing process
2. Set “Precert” to Y if service could potentially need pre-certification
3. Has patient been seen within 6 months? Yes: verify insurance eligibility No: Call patient, perform full registration, verify insurance
eligibility
Pre-Registration Process – Con’tPre-Registration Process – Con’t
4. Copy co-pay information from insurance eligibility source to billing software for practice site staff at patient arrival
5. Set “Referral” to Y if patient’s insurance requires a referral for specialist care
Downstream Processes – Patient AccessDownstream Processes – Patient Access
Centralized Pre-Certification team pulls all “Pre-Cert = Y” encounters, review benefits, initiates pre-certification process if needed.
Centralized Referral team writes PSHMC referrals and calls non-PSHMC PCPs to obtain referrals.
Downstream Processes - Practice SitesDownstream Processes - Practice Sites
Patient arrives for care, checks-in Pre-Registration complete; reduces registration
time Pre-Cert and/or referral, if needed, are in place Co-pay displayed in billing system for easy
collection
Project ProgressionProject Progression
Director unable to be present due to competing project requirements with Revenue Cycle software evaluation (Red Flag #1)
Vendor X spent 6 hours with Pre-Registration and Pre-Certification managers to review current procedures in detail
IT not present (Red Flag #2)
Project ProgressionProject Progression
Vendor X returns with project plan based upon their standard processes and without reference to our current processes (Red Flag #3)
Step 1: implement new tool without automation. i.e., replace today’s multiple web sites with vendor’s one web site
Project ProgressionProject Progression
Interfaces built and mapping done to send billing data to Vendor X’s Auto Elig website
Pre-Registration Associates trained in Auto Elig Ready for Go Live!
GO LIVE ResultsGO LIVE Results
Vendor’s automatic “push” of encounter to Auto Elig website is up to 7 days prior to date of service
We validate at 25 days prior to date of service to … Allow time to obtain Pre-Certification Allow time to write Referral
We had to do manual push of data, encounter by encounter
GO LIVE ResultsGO LIVE Results
Manual push takes 30-40 seconds longer to process than previous websites
30 sec * 5000 lookups daily = 41.6 extra hours/day = 5.7 FTEs worth of additional processing time
This is progress?!?
It Gets Worse …It Gets Worse …
Even if Auto Elig could check at 25 days (which it cannot) it also cannot return the co-pay to the billing system in the same place and format that the Practice Site Check-in Staff expects to see (500 people)
Stakeholder base just exploded beyond Patient Access … and they weren’t included in the project.
Time for DiscussionTime for Discussion
Vendor: PSHMC is validating at 25 days instead of 7 days as all
other clients do 7 days is best practice PSHMC must change
PSHMC: Very willing to change processes but … How do other clients do pre-certification?
Discussion continues …Discussion continues …
Vendor: Ummm…..
Answer: Ordering physicians’ offices obtains Pre-Certification No other clients with centralized Pre-Certification team
because … No other clients with fully employed physician model
Ambulatory Lessons LearnedAmbulatory Lessons Learned Vendor:
Did not identify what is unique to PSHMC despite six hours review of current processes
Lessons: Vendor assumptions may be invalid Assume you know more than the vendor Question everything Put the breaks on if not satisfied with
information provided
Ambulatory Lessons Learned (Con’t)Ambulatory Lessons Learned (Con’t)
Operations leadership Pre-Registration Team Manager too green to see where
new process was lacking Director was not present; conflicting projects
Lessons: Don’t exceed bandwidth Balance operational needs and new technology
implementation
Ambulatory Lessons Learned (Con’t)Ambulatory Lessons Learned (Con’t)
Operations/IT Intersection IT did not need to understand current processes to
implement new product Operations team did not understand the “techie talk”
Lessons Need project leadership resource No operational duties Manage vendor relationship
Meanwhile, over the in ED …Meanwhile, over the in ED …
All is working well Why? ED visits are for today so encounter flows to Auto
Elig automatically (trigger is 7 days or younger) ED Registration Associates pull ED co-pay,
continue to manually add to billing system
ED BenefitsED Benefits
One source of eligibility verification instead of previous multiple sites
ED co-pay is available at check-out per previous process; no change
Time-savings per registration but volume is too low to impact staffing (ED 200 visits per day over 24 hours v Ambulatory 5000 visits per day over 8 hours)
So Where Do We Go From Here?So Where Do We Go From Here?
Coming soon to a theatre you:
Automated Eligibility, Take II What’s different this time …
Project Manager is assigned Director is leading Operations project team Solved the 7 day/25 day barrier Practice Site leadership on board – staff will learn how to
use Auto Elig
Proposed New Flow For AmbulatoryProposed New Flow For Ambulatory
Create encounter at 25 days prior to date of service (not change)
Manually validate eligibility at 25 days only if Pre-Cert = Y (20%)
Automatic eligibility verification at 7 days for all other services (80%)
Exception worklists for the 80% Practice Site: get co-pays in Auto Elig
QUESTIONS?
Getting it Right Up Front:
Registration Accuracy
TAKING A CLOSER LOOK: REGISTRATION ACCURACY We will take a look at how to ensure
registration accuracy from three different perspectives: Registrar Department Organization Quality Assurance Process
RESEARCH ON ACCURACY
30-40% of denials are caused by registration errors, representing as much as 0.5% in lost revenues
Hospitals in the top quartile have a registration accuracy rate of 97% compared to the national average of 93%
GETTING IT RIGHT UP FRONT: REGISTRAR Use all available resources
Help documents
Follow an established workflow Workflow is set of tasks—grouped chronologically—that
are necessary to accomplish a given goal Goal is to maximize efficiency and accuracy
GETTING IT RIGHT UP FRONT: DEPARTMENT Department specific policies and procedures
Necessary as a resource and to hold staff accountable Have staff review policies and procedures annually
(including clinical staff who perform registration tasks)
Develop workflow Have new staff trained using workflow
Choose training staff wisely
GETTING IT RIGHT UP FRONT: ORGANIZATION QUALITY ASSURANCE Resources
Help documents Email – Distribution lists Hot Tips Monthly Registration Newsletter
Bill Edits System generated Customized based on registration errors
GETTING IT RIGHT UP FRONT: ORGANIZATION QUALITY ASSURANCE Maintain a Quality Assurance (Audit) Process
To monitor and track registration errors to identify necessary improvements to the registration process
To improve the education and enhance the accountability of registrars in order to achieve the highest standards of registration accuracy
GETTING IT RIGHT UP FRONT: ORGANIZATION QUALITY ASSURANCE
INTERNAL AUDITS Monitor and correct accounts on daily reports
System generated reportsCustom reports
EXTERNAL AUDITS Billing and Registration Departments
REGISTRATION ACCURACY STANDARDS
The parameters of the Accuracy Standards policy should be clearly defined and consistent across all registration departments and should include:
Registration Quality Assurance Referral Legend
Accuracy Rates
REGISTRATION ACCURACY STANDARDS
Registration Quality Assurance Referral Legend
Lists errors and the assigned point values
Audits range from 1 to 5 points
Incorrect Location = 1 point
ABN not presented to the patient (Compliance) = 5 points
QUALITY ASSURANCE FEEDBACK Automated email sent directly to registrar
Explains the error
Provides what corrections were made
Reference to a help document (when necessary)
REGISTRATION ACCURACY STANDARDS
QUESTIONS?