training, quality, and communication...3 achievements uc irvine medical center is ranked among the...
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UC Irvine Health Training, Quality & Communication flow for Admissions and Clinic StaffPresented by:Belinda Talley, Manager Quality Assurance & TrainingTerri Fox, Assistant Director Quality Assurance & Training
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Introduction to UC Irvine HealthMission(Our Purpose): Discover, Teach, Heal
Academic Medical Center Level 1 Trauma Center 411 Beds acute care hospital /tertiary & quaternary care 115,793 Inpatient days FY 2015 595,229 Outpatient Visits in FY 2015 48,415 ED visits in FY 2015 15,400 Surgeries in FY 2015 4,089 Trauma patients treated –more than half of O.C. Traumas 450+ Primary and Specialty physicians Multiple locations throughout Southern California 450+ Registration Staff
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Achievements
UC Irvine Medical Center is ranked among the nation’s best hospitals by U.S. News & World Report‐ for 16 years. We are also recognized in the top 50 U.S. medical centers for orthopedics and ear, nose and throat care.
Our Chao Family Comprehensive Cancer Center is one of only 47 in the nation —and the only one in Orange County — designated for excellence by the National Cancer Institute.
UC Irvine Medical Center is Orange County's only Level I adult and Level II pediatric trauma center, which means our trauma and critical care physicians are fully equipped to treat life‐threatening injuries 24 hours a day, seven days a week.
More than 100 physicians are listed as Best Doctors in America by Best Doctors Inc.
Since 2001, U.S. News has given national recognition to our programs in cancer; digestive disorders; ear, nose and throat; geriatrics; gynecology; kidney disorders; nephrology; and urology.
Joint Commission awarded disease‐specific certification for UC Irvine Health Heart Failure Program.
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AchievementsEarned The Leapfrog Group’s “Top Hospitals” recognition and three straight ‘A’ Hospital Safety Scores.
Joint Commission awarded certification as Orange County's first Comprehensive Stroke Center, an advanced designation reserved for hospitals capable of receiving and treating the most complex stroke cases.
UC Irvine Medical Center was Orange County’s first hospital to receive American Nurses Credentialing Center Magnet Recognition for nursing excellence.
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We are part of Patient Financial Services but our training encompasses all Ambulatory and Admissions Front‐End Staff
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History
Training for new employees was limited to the system training for scheduling and registration functions only and they were then released to their practices and/or Admissions
Practices/Admissions management staff were responsible for all other training (financial implications, demographics, insurance, etc)
In 2009 we implemented a new Health Information System which gave us an opportunity to create a standardized training program which includes more than system training
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Why develop a standardized training process? We received feedback from our billing and finance areas that front‐end
registrations were inconsistent from practice to practice and our denials were high and causing a negative impact on revenue
We learned from our front office and Admissions management teams that they needed assistance with training due to lack of permanent “training” staff within the practices
Each practice was responsible for training their own staff. Practices often covered each other. Training in one practice was different than in another. The management team was looking for consistency in processes and to improve and increase their revenue
Patient satisfactions scores were impacted by our inconsistent registrations
Executive leadership requested that training be consistent, across the board, in order alleviate the above mentioned issues/concerns
Lack of accountability due to inconsistent training
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What is included in the standardized training program? QUEST is the name of our Registration/Scheduling Application We have five dedicated trainers for the UC Irvine Health system Prior to entering the training program each employee “shadows” a co‐worker in their
assigned practice. In addition they attend Employee Orientation as well as completing all Medical Center and department related CBT’s and cashiering training
The next step? Attend our one week training program which includes the following:
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STARS is a “home‐grown” system based on Microsoft Access Software and some web based reporting and work lists
Prior to STARS we had a “paper process” in place
Employees assigned to the role of Authorization Coordinator or Surgery Scheduler are required to attend full (not the Overview) STARS training
STARS authorization coordinator training is one full week
STARS surgery scheduler training is two full weeks (includes one week of authorization coordinator training)
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Why do we use STARS? Provides a system to advise users of status of all authorizations/referrals and where they
are in the process of being completed
Significantly reduces the amount of phone notes sent to the clinic(s) regarding referral status
Ensures our patients will be scheduled to the correct service/physician based on the referral request
Provides the ability to create alerts based on payer, physician and/or clinical requirements
Provides a “one‐stop” shop for the physician to review and understand the status of their patients’ authorization/referral
Allows communication between Admissions, the Operating Room and the Center for Perioperative Care areas which has reduced surgical cancellations
Cases are created to track the process of authorizations/referrals. These cases are in a “pending” status until the authorization is received and they reside on a work list assigned to the authorization coordinator/surgery scheduler. Once the authorization is received, the case is completed and routed to a scheduling work list
Provides our billing departments with a location/resource to review all authorizations/referrals and their outcomes
Ability to report on referral/authorizations. Examples include but are not limited to volumes, services being referred to and from and can also be used for productivity measures
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Quality Assurance Program ‐ History Prior to standardized Quality Assurance process, manual quality reviews were
performed by 8 FTEs for the entire organization
Quality reviews on 100% of inpatient accounts were completed by the same 8 FTEs
10 reviews on each outpatient staff member per month were performed (<3% of total outpatient visits/ approx. 50,000 per month)
Inability to accurately gauge opportunities for improvement (by department/user)
Denials due to inaccurate registrations
Lack of Accountability
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Quality Assurance roadmap to success Denial task force was created to collaboratively address front end registration denial issues
(Patient Financial Service, Physician Billing, Admissions, HIM, Revenue Integrity, Quality
Assurance & Training)
Some Opportunities Identified: Eligibility verificationMissing Insurance/AuthPlan Description Incorrect # Medicare Sign OverCoordination of BenefitsPolicy Number Group NumberClaims Address Insured PersonInsurance effective date Insured Employer InformationInsured Person RelationshipReferring PhysicianAccident Detail InformationGuarantor InformationPrimary Care Physician information
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Manual Quality Review to Automation! In October of 2014 an automated registration quality system was integrated with our
Health Information System to provide real time monitoring and reporting of registration quality. In addition, the system will flag registration errors for correction prior to discharge and billing
Benefits: System performs Quality monitoring on 100% of all visits within the
organization! Allow users to access information through a real‐time triggered interaction or
through a work queue to help manage and distribute workflow Create rules/logic within the system to instruct the registration staff on the
correct way to register accounts Provide immediate feedback to staff on registration errors (based on rules built) Provide real‐time eligibility without having to go to another system Provide real‐time address verification without having to go to another system
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Benefits continued: Gives the user the ability to Post back insurance information from eligibility
response to the system Eligibility responses can be configured to present information in a certain
format
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Ability to run eligibility on New patients prior to registering in our System without navigating to other sites
Reporting capability Positive Financial impact Because we have an automated Quality Registration Monitoring system, UC
Irvine Health has been tasked to lead the 2016 Registration Quality Program initiative for the UC System. Our focus is improving the quality of our registrations to positively impact revenue and decrease front end denials.
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Challenges to implementation of automated registration quality system
Keeping Managers and staff engaged during the implementation process and afterwards
Seems overwhelming to staff initially
Getting the team to realize it was a teaching tool ‐ It’s a positive tool!
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How do we communicate and maintain engagement with quality and training? Computer Based Training for updates to system and/or new processes
Refresher classes based on results of quality reviews (individual and/or teams)
One on one training based on management feedback or based on quality reviews
Site visits to review processes and provide feedback on how to improve
Daily review of work queues in automated quality system is done by QA team who then reaches out to the employee and the manager to ensure unresolved alerts are addressed prior to billing
Set goals in alignment with improvement in quality
Generic email distribution lists exist and are used to communicate updates regarding billing, insurances, authorizations, contracts, updates to registration rules and anything related to finance
We have a dedicated phone line for our front end registration users to call for questions regarding insurance, contracts, eligibility and other financial questions.
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REGLINE communication exampleFrom: Talley, Belinda F Sent: Thursday, April 14, 2016 4:56 PM To: UCIMC Regline Subject: REGLINE: New and updated Plan Descriptions in QUEST Importance: High REGLINE TO: All Staff RE: New and updated Plan Descriptions in QUEST New or updated plan descriptions have been added to QUEST.
Plan Code QUEST Description Purpose of Plan Description
441 UCIMG TUS PCN UHC SR To be used to register patients who have a United Healthcare Senior HMO plan AND is assigned to UC Irvine Health Medical Group Tustin
487 UCIMG TUS PCN HUMANA SR To be used to register patients who have a HUMANA Senior HMO plan AND is assigned to UC Irvine Health Medical Group Tustin
576 UCIMG ORN PCN UHC SR To be used to register patients who have a United Healthcare Senior HMO plan AND is assigned to UC Irvine Health Medical Group Orange
577 UCIMG ORN PCN HUMANA SR To be used to register patients who have a HUMANA Senior HMO plan AND is assigned to UC Irvine Health Medical Group Orange
758 MOLINA SR To be used to register patients who have a Medicare Sign‐over assigned to Molina
759 MOLINA MEDI‐CONNECT To be used to register patients who have signed over their Medicare AND Medi‐cal benefits to Molina
N75 FIRST HLTH UC USHIP To be used to register all undergraduate students within the UC System
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STARS communication example From: Talley, Belinda F Sent: Monday, December 21, 2015 11:56 AM To: UCIMC-STARS Cc: Subject: STARS Cases for PAV III Dermatology Consultations Importance: High Good Morning, Please be advised that all Dermatology Consultations for PAV III require the CPT of 11100. Obtaining this additional CPT Code will ensure that the patient has a meaningful consultation. When entering a STARS cases for Dermatology PAVIII a service alert will display in STARS advising that the CPT code 11100 is also required. Please be sure to pay attention the alert to obtain additional CPT code when submitting for the consultation. If you have questions, please call the STARS team at 714‐456‐9999.
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Communication (cont) Monthly meetings are held with all Registration and Scheduling staff
Quarterly meetings are held with our Authorization and Surgery Scheduling teams
QA and Training Management team attends Ambulatory and Admissions Management meetings to provide feedback/information and solicit new training needs
Reports are provided to all Managers/Supervisors on a daily, weekly, monthly basis Scorecard – Quality Assurance Score by department and user Alert Breakdown – Unresolved Alerts for the previous week ‐ by department
and user Alert Blast – Unresolved Alerts for the previous day – by user Manual Resolved – Alerts that were resolved from work queue and not from
Health Information System Current top error – List of top errors by department and user
Track and trend errors and provide training to those users not meeting standards
Quality Standards
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What are our Quality Results?
83
8785
98 97
92
75
80
85
90
95
100
Emergency Admissions Ambulatory
Quality Score prior toQA SystemCurrent Quality Score
Registration QA System implementation datesEmergency – December 2014Admissions – December 2014Ambulatory – September 2015
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Positive feedback from Admissions and Ambulatory staff
Eligibility is easier for users to read and interpret
Admissions and Ambulatory users like the added ability to post back from our eligibility system to our Health Information System
Users like the alerts as they provide a learning opportunity as well as correcting the registration prior to billing
Added Accountability
Billing has advised that collections continue to increase each year
Billing edits have decreased since the implementation of the automated registration quality system
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Contact Information
Terri Fox, Assistant
Director Quality Assurance & Training
714‐456‐7997
Belinda Talley
Manager Quality Assurance & Training
714‐456‐3997
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Glossary of Terms
QUEST: The name of UC Irvine Health’s registration and scheduling system
CBT: Computer based training modules
STARS: System for tracking authorizations, referrals and surgeries
Alert: Registration, demographic or Insurance errors identified by the Quality system based on the logic built