Patient Registration Audit Program

1. Patient RegistrationAudit Program Department of Provider Relations April 2004

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

3. What is Patient Registration? • Verifying Patient Information • 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) Loyola University Health System – Patient Insurance Verification Report Location: LOC-General Medicine Provider: Clifford MD, Brad Building: Loyola Outpatient Center Patient Name: Smith, Mary Department: General Medicine Patient MRN: 1234567 Appt: 6/3/04 at 3:00PM Visit Type: NPV Please review the information below, cross out errors/make corrections. Patient Information: Smith, Mary SSN: 111-22-3333 Home Phone: 708-123-4567 Address: 222 Deer Street Birthdate: 01/31/51 City, State:Joliet, IL 60435-0000

4. 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

5. What Happens if aRegistration 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

6. 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

7. 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

8. 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%

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

10. Bottom line: $3.6 Million in potentially expedited or increased revenue 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

11. 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