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2©2016 Experian Information Solutions, Inc. All rights reserved. Experian Public.

Winston Henderson IVSacred Heart Health System

Julie RadtkeExperian Health

Introducing:

©2016 Experian Information Solutions, Inc. All rights reserved. Experian Public.

Revenue Cycle Improvement and Efficiencies with RQA and AlertBuilderSacred Heart Health System


The Problem of PerceptionThe role perception plays in our decision-making


The Problem of PerceptionThe role perception plays in our decision-makingAn attempt to solve the “paper problem”

PAPER COPIES ELECTRONIC FILES ON NETWORK DRIVE

SHORTCUT ON ALL DESKTOPS



COMPUTERS REPLACED

SHORTCUT MISSING CALLS TO IT SUPPORT



“Star Drive Program”

“Network Share”


Perception vs. Reality“Our brains are wired to find meaningful patterns. We connect A to B and often times A really is connected to B. The trouble is many patterns are false.”

— Michael Shermer


Have you ever identified an employee as a top performer and later changed your mind?

As revenue cycle leaders, we often have strong beliefs.

► We believe we know how well our department is performing.

► We believe we know which of our employees are top/mid/low performers.

► We believe we know what is required to improve efficiency and performance.

As human beings, we are susceptible to confirmation bias.

► We look for evidence that confirms what we already believe to be true and we ignore the disconfirmatory evidence.

How do we know for certain that our perception of reality matches reality?

Keep this question in your mind as we move further into the presentation.

The Problem of PerceptionThe role perception plays in our decision-makingChallenging our own preconceived notions


The Evolution of Perception

How Sacred Heart’s perception evolved through the use of Registration QA (RQA) and AlertBuilder


Prior to the implementation of Passport eCare NEXT, Sacred Heart relied on outdated methods to measure and evaluate the quality of front-end registrations.

Bill scrubbers (which already captured basic errors like missing policy IDs, group numbers, authorization numbers) were used as a primary data source.

Accounts caught by the scrubbers would be audited for other errors which, at the time, could only be identified manually.

This redundancy or “double dipping” from existing data sources limited the “scope” of errors we could capture.

Our perception at the time was that our accuracy rate was between 97-98% on average.

These results which were reported to senior leadership garnered significant praise.

We believed we were operating at peak efficiency.

The Evolution of PerceptionAccuracy reporting before Experian


In 2014, the Experian Health RQA product was implemented, electronically auditing 100% of encounters at (or before) the time of service.

Our initial accuracy rate was revealed to be 84% using only the standard alerts.

This revelation completely transformed our perception of which employees (and departments) were low/mid/top performers.

Not only did the various weekly reports allow us to evaluate performance regularly, but Passport eCare NEXT’s work queues allowed us to evaluate them in REAL-TIME.

Employees could now monitor their own accuracy and respond to alert notifications that acted like virtual trainers, pointing them in the right direction.

With a new plan in place, we worked to improve performance every day. Today our facility accuracy rate is now between 96-97% which includes out-of-scope areas.

The Evolution of PerceptionGaps revealed through new Experian Health tools


Even with all the improvements, there were still many errors that could only be captured manually and were unique to Sacred Heart’s financial system.

The biggest problems at the time were caused by incorrect insurance carriers loaded.

► With 9 different commercial carriers for Blue Cross, it was no surprise that employees had difficulty loading the carrier specific to their patient’s plan.

► Carriers we wanted to discontinue could not be inactivated in our financial system MS4 until all existing claims were resolved, leaving the door open for employees to continue selecting the carrier.

Sacred Heart was granted access to AlertBuilder, giving us control to create new custom alerts based on our own unique needs as a client.

This allowed us to address and virtually eliminate the majority of those carrier errors.

Our custom alerts now make up about 20% of the total alerts fired, capturing more errors now than ever before.

The Evolution of PerceptionAlertBuilder and Client Control


The Evolution of PerceptionExamples of Custom Alerts


While Experian Health offered us greater control over Registration QA with AlertBuilder, they continued to dedicate resources to help us learn the nuances of the product.

Over the course of the next 2.5 years, we worked closely on new alert enhancements, troubleshooting, basic and advanced training on best practices for alert logic and solved complex problems as partners.

We ran into an unforeseen road block with RQA early during implementation that would not have been resolved without the expertise and dedication of the Experian Health analytics team.

► Associates would be assigned 30-40 encounters within Passport eCare NEXT that they did not register or touch. These encounters were riddled with outstanding actionable alerts.

► The initial perception indicated that Registration QA simply wasn’t working correctly.► This anomaly prompted an in-depth investigation from both Sacred Heart & Experian Health

analytics to identify the root cause which turned out to be our host system MS4.

The Evolution of PerceptionExperian Health devoted to strong partnership with clients


The Evolution of PerceptionThe HL7 Message Problem

MS4 HL7 MESSAGEToday’s Encounter Integrated Systems

MS4 PassportHL7 MESSAGE

JSMITH JOHN.SMITH

Today’s Encounter


JSMITH NOT MAPPED

Today’s Encounter

Experian Health

Experian Health



MS4 HL7 MESSAGEToday’s Encounter

IF PATIENT NAME IS UPDATED

HL7 MESSAGEPRIOR Encounter







JSMITH JOHN.SMITH

Today’s Encounter


PassportHL7 MESSAGE

JSMITH JOHN.SMITH

PRIOR Encounter

PassportHL7 MESSAGE

JSMITH JOHN.SMITH

PRIOR Encounter

PassportHL7 MESSAGE

JSMITH JOHN.SMITH

PRIOR Encounter

PassportHL7 MESSAGE

JSMITH JOHN.SMITH

PRIOR Encounter

Experian Health

Experian Health

Experian Health

Experian Health

Experian Health




JSMITH JOHN.SMITH

Today’s Encounter


PassportHL7 MESSAGE

JSMITH DEFAULT USER

PRIOR Encounter

PassportHL7 MESSAGE

JSMITH DEFAULT USER

PRIOR Encounter

PassportHL7 MESSAGE

JSMITH DEFAULT USER

PRIOR Encounter

PassportHL7 MESSAGE

JSMITH DEFAULT USER

PRIOR Encounter

Experian Health

Experian Health

Experian Health

Experian Health

Experian Health


How to Align Perception to Reality

The basic steps for success with Registration QA


Jane Smith’s accuracy rating is 74%

John Smith’s accuracy rating is 99%

What action should management take?► After investigation, it is revealed that Jane’s error count was inflated by a glitch affecting the area

she happens to work. When those errors are removed from the equation, Jane is actually at 98%.

► The investigation also revealed that John Smith has not been correcting his errors at all. Instead he has been “force” resolving those alerts to artificially improve his low accuracy rating of 68%.

Even with the sophisticated tools Experian Health provides us with, our perception can still be inconsistent with reality if we don’t take the time to understand the product.

Registration QA is not a quick fix or a “magic wand”. It doesn’t eliminate work but rather it refocuses your attention where its needed when its needed.

How to align Perception to RealityAwareness of how perception affects actionScenario: Accuracy ratings and corrective action


If leaders who ACT on these scores do not understand the system or the reports at a basic level, they will not know if the scores are accurate.

● Disciplining employees for low performance who may in fact be mid-high performers

● Rewarding employees for high performance who may in fact be low performers

Unable to determine root cause for low performance scores. Are system problems causing them? Are ineffective processes causing them? Is there a training deficiency that needs to be addressed? Failure to identify these basic elements results in:

● Managers pushing staff to “do better” without providing them with a path to achieve that goal

● Failure to identify and revamp failed processes, system redundancies

● Fear of disciplinary action will decrease morale, performance & employee retention

● Clean claims & revenue will decrease

How to align Perception to RealityCommit to understanding RQA beyond surface assumptionsWith great power comes great responsibility


Training with RQA is never “finished”. Weekly rounding is a must.

As a leader it is your responsibility to your team to engage, encourage and train them.► Performance scores can be a scary subject to many people.

► Promote a culture of openness and transparency and speak honestly about how the RQA scores are used.

If an employee has a low accuracy rating, your first action should not be disciplinary in nature. Instead, drill down to identify the root cause first.

Corrective action is a last resort and should only be utilized when appropriate. The following conditions should be met:

► Sufficient training was provided and the employee has had enough time to learn and apply the knowledge.

► The leader understands the data and reporting well enough to determine whether the accuracy rating is a true reflection of reality.

How to align Perception to RealityEmployee Rounding & TrainingEmpowering your team to succeed


Liaison must have the technical acumen & the time invested to become the client expert.► Must understand your financial system and how it talks to integrated systems.

► Must be able to identify and resolve anomalies adversely affecting the data validity of RQA scores.

Liaison will become the process owner for custom alerts using AlertBuilder.► Custom alerts that address nuances unique to your systems and processes will be essential to your success.

► Liaison will identify the need, research to see if an alert is possible, build and test it.

► They will notify the affected leaders and staff prior to deployment.

► While the liaison will closely monitor the alert after deployment, feedback from the staff will be essential to your success. You can test for all kinds of conditions but there will always be variables you cannot anticipate.

► A single alert can resolve hundreds or thousands of errors each month but an alert working incorrectly can do just the opposite, substantially impacting your bottom line.

How to align Perception to RealityBenefits of assigning employee as a “liaison” to Experian HealthThe secret to bolstering RQA, developing custom alerts and more


Questions?


Presenter Contact InformationWinston Henderson IV, CHAA

Senior Revenue Cycle Operations Coordinator

Sacred Heart Health System | Member of Ascension Health

5151 N 9th Ave. | Pensacola, FL 32504

Phone: Office (850) 416-4228 | Fax: (850) 416-6775

Email: [email protected]

©2016 experian information solutions, inc. all rights ......as human beings, we are suscept ible to...

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