Tools, Tests, and Tips for Building a Successful Team

StaffCompetency in PatientAccess

Michael S. Friedberg, fache, cham

Staff Competency in Patient Access: Tools, Tests, and Tips for Building a Successful Team is the ultimate

resource to keep up with your organization’s competency requirements. Inside you’ll get:

• Samples of competency programs for registration staff

• Tips on how to schedule and assign competency assessments and metrics to measure the results

• Sample job descriptions to efficiently manage the hiring process

To get the most out of your staff, you must meet three major challenges:

• Establish a hiring process that yields motivated and talented employees

• Create an organized orientation to prepare your staff to handle the complexities of their job and

provide them with necessary tools to perform their duties

• Implement a detailed program to evaluate and reassess staff and use the data to develop initiatives

for performance improvement

Here are the tools you need to hire the right people, enable them to do their jobs, and keep your organization

running efficiently.

Included in this book and on the accompanying CD-ROM are more than 50 tools you can customize to assess

the competency of your staff.

In this era of increased consumerism, pressure exists for your hospital to remain competitive. Hire the right

people, reduce turnover, improve staff assessment, and put your employees in position to succeed with Staff

Competency in Patient Access: Tools, Tests, and Tips for Building a Successful Team.

StaffC

ompetencyinPatientA

ccessFriedberg

StaffCompetency in PatientAccessTools, Tests, and Tips for Building a Successful Team

Michael S. Friedberg, fache, cham

SCPA

200 Hoods Lane | Marblehead, MA 01945www.hcmarketplace.com

|

PARC is your one-stop resource for the successful management of your Patient Access department. Visit us at www.accessresourcecenter.com to learn more.

Staff Competency in Patient Access

iii

Contents

Dedication..........................................................................................................................................vi

About the author ............................................................................................................................vii

Foreword..........................................................................................................................................viii.

Chapter 1: Introduction.................................................................................................................. 1.

Chapter 2: Baseline hiring: Hunting for the right candidates ................................................. 5

Employee.motivation:.The.great.debate............................................................................................... 7.

The.importance.of .job.descriptions...................................................................................................... 7.

Chapter 3: The interviewing process:........................................................................................... 9

Identify.interviewers............................................................................................................................ 9.

Conduct.multiple.interviews.............................................................................................................. 10.

Asking.the.right.questions................................................................................................................. 10.

Conduct.initial.competency.exams.................................................................................................... 12.

Chapter 4: Initial training............................................................................................................. 15

Program.development........................................................................................................................ 15

Training.manual................................................................................................................................ 16

Registration.reference.guide............................................................................................................... 19.

Chapter 5: Training: Initial and ongoing efforts ...................................................................... 21

Who.should.conduct.the.training?..................................................................................................... 21

Initial.training.................................................................................................................................... 22

Sample.training.curriculum.............................................................................................................. 22

Retraining.for.existing.staff .members................................................................................................ 31

Training.Tip.#1:.Create.standards.for.all.free-form.fields.................................................................. 32

Training.Tip.#2:.Properly.define.guarantor....................................................................................... 33

Training.Tip.#3:.Issues.related.to.selecting.the.correct.carrier.and.plan.codes................................. 35.

Staff Competency in Patient Accessiv

Contents

Chapter 6: Quality review............................................................................................................. 37

Proactive.management.vs..reactive.management.(a.philosophical.shift).......................................... 38

Sample.registration.quality.assurance.program................................................................................ 39

Automated.solution............................................................................................................................ 42

Quantity.of .registrations.performed.................................................................................................. 42

Customer.service................................................................................................................................ 43

Hiring.staff .to.do.the.work................................................................................................................. 44

Developing.a.career.ladder................................................................................................................. 45

Ghost.effect......................................................................................................................................... 46.

Chapter 7: Creating useful management tools ......................................................................... 47

Key.performance.indicators............................................................................................................... 47

Developing.the.indicators................................................................................................................... 49

Sample.indicators............................................................................................................................... 49

Benchmarking.................................................................................................................................... 50.

Chapter 8: Sample job descriptions............................................................................................. 53

Lead.Patient.Access.representative..................................................................................................... 54

Patient.Access.representative............................................................................................................. 58

Supervisor,.Access.Services,.emergency.department......................................................................... 64

Administrative.support.associate.VI.................................................................................................. 66

Financial.counselor.I.......................................................................................................................... 69

Financial.counselor.II........................................................................................................................ 71

Financial.counselor.III....................................................................................................................... 73

Career.ladder.for.financial.counselors................................................................................................ 76

Chapter 9: Sample staff competency exams.............................................................................. 77

Core.competency.exam...................................................................................................................... 78

Ambulatory.care.center.competency.exam....................................................................................... 87

Admitting.competency.exam............................................................................................................. 89

Entitlement.competency.exam........................................................................................................... 91

Emergency.department.competency.exam........................................................................................ 94

Verification.competency.exam........................................................................................................... 96

Core.competency.exam.answer.key.................................................................................................... 98

Ambulatory.care.center.competency.exam.answer.key..................................................................100

Staff Competency in Patient Access v

Admitting.competency.exam.answer.key........................................................................................101

Entitlement.competency.exam.answer.key......................................................................................102

Emergency.department.competency.exam.answer.key...................................................................103

Verification.competency.exam.answer.key.......................................................................................104

Patient.Access.department.job.proficiency.competency..................................................................105

Chapter 10: Additional resources..............................................................................................119

Sample.Liberty.Health.quality.assurance.template..........................................................................119

Sample.staff .reminders.or.“competency.clues”...............................................................................126

Interview.form.................................................................................................................................131

Contents

Staff Competency in Patient Access �

NFL.quarterback.and.successful.businessman.Roger.Staubach.once.said,.

“I’ve learned if you have the right people in the right places doing the right things, you can be

successful at whatever you do.”

You.can.apply.these.words.of .wisdom.to.the.Patient.Access.department..When.talking.to.my.col-

leagues.throughout.the.access.community,.I’ve.found.that.the.one.common.challenge—regardless.

of .the.size.of .the.hospital,.type.of .hospital,.or.location—is.finding,.training,.motivating,.and.retain-

ing.good,.qualified.staff .members.to.work.in.Patient.Access.

Confronted.by.the.challenges.of .continuous.change,.America’s.hospitals.have.shown.remarkable.

resilience.in.applying.scientific.management.methods.to.key.business.processes.in.order.to.produce.

the.operating.margin.needed.to.sustain.their.mission..Over.the.past.20.years,.the.business.office.has.

transformed.into.Patient.Financial.Services,.and.Medical.Records.into.Health.Information.Manage-

ment..Then.hospitals.and.insurance.carriers.heatedly.debated.the.definition.of .a.“clean.claim,”.and.

cluttered.files.made.for.hazardous.trips.(pun.intended).through.Medical.Records.and.the.business.

office..Now,.document.imaging.systems.and.technologically.advanced.claim.editing.systems.are.

resulting.in.“clean.claim”.submission.rates.well.in.excess.of .90%.as.most.hospitals.have.largely.re-

placed.paper-intensive.processes..Many.hospitals.and.health.systems.now.have.most.of .the.elements.

in.place.for.an.electronic.medical.record.that.physicians.can.access.from.the.patient’s.bedside.or.from.

the.privacy.of .their.own.offices.

During.the.past.10.years,.pressures.created.by.managed.care.growth.are.prompting.a.similar.trans-

formation.as.Admitting.and.Registration.evolves.into.Patient.Access.Management..Where.registrars.

used.to.get.by.with.cheat-sheets.and.a.Rolodex®.with.summary.information.on.local.employers.and.

Chapter 1

Introduction

Staff Competency in Patient Access

Chapter 1

�

their.health.plans,.today’s.patient.representative.also.has.to.review.referrals,.obtain.authorizations,.

verify.eligibility,.and.request.payment.at.time.of .service.(see.Figure.1.1)..

The.revenue.cycle.has.become.“rocket.science,”.yet.high.school.graduates.paid.at.a.rate.comparable.

to.a.Wal-Mart.cashier.still.carry.out.Patient.Access.tasks..The.challenge.as.a.manager/director.in.

Patient.Access.is.to.develop.the.tools.and.techniques.to.overcome.the.hurdles.created.by.the.inherent.

problems.with.Patient.Access.

Patient.Access.is.the.revenue.cycle’s.Achilles.heel,.the.classic.example.of .“garbage.in”.producing.

“garbage.out.”.There.are.well-documented.causes.for.poor.data.collection.during.the.registration.

process,.including.the.following:

Little.or.no.formal.initial.training

Absence.of .routine,.periodic.retraining

No.feedback.on.error.rates,.fostering.a.lack.of .accountability.for.errors

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Figure 1.1 Patient representative tasks

Patient Representative

Smile and provide caring

customer service

Determineeligibility

Determine admission

Select the correct

insurance

Enter information

into the computer

Screen for governmental

programs

Obtainauthorization

Reviewreferrals

Collectcopayments

Respond to doctors and

nurses

Note: This figure also appears on the accompanying CD-ROM

Staff Competency in Patient Access

Introduction

�

Pressures.to.register.rapidly,.often.at.the.expense.of .data.quality

Lack.of .tools.necessary.to.accomplish.required.tasks

Complex.systems.that.provide.too.many.choices

So.what.are.the.answers?.How.do.we.find.the.“Holy.Grail”.of .Patient.Access?.I.think.the.better.ques-

tion.is,.“Does.the.Holy.Grail.of .Patient.Access.exist?”.Even.if .it.doesn’t,.many.providers.are.moving.

toward.creating.accountability.for.their.staff..This.is.generally.accomplished.through.a.quality.as-

surance.monitoring.program,.either.electronic.or.manual.and.coupled.with.detailed.and.continuous.

training.based.on.the.results.of .the.quality.assurance.reviews.

However,.the.discussion.is.more.basic.in.terms.of .overall.management.strategy..Patient.Access.man-

agers.are.reactive instead.of .proactive..Let’s.lay.our.cards.on.the.table.for.a.minute:.It’s.a.challenge.to.

serve.as.the.Patient.Access.director..All.the.other.managers.in.the.hospital.look.to.you.for.answers.

when.there.are.issues,.and.the.issues.are.not.always.directly.related.to.you or.to.your.department..

In.addition,.you.don’t.produce.any.revenue,.so.you.can.never.really.prove.your.value.any.more.than.

the.staff .working.laundry.or.security.can..How.many.meetings.have.you.attended.where.some.issue.

was.blamed.on.the.failures.within.registration?.It’s.time.to.answer.the.critics.and.provide.good.data.

on.the.“good.work”.you.do..

Note,.however,.that.no.matter.how.good.you.make.your.training.and.accountability.model,.if .you.don’t.

have.the.right.people.in.the.right.positions.doing.the.right.things,.then.success.is.exceedingly.difficult.

This.book.has.three.goals:

Provide.insight.into.the.hiring.process

Demonstrate.a.framework.for.competency.and.quality.assurance.monitoring.

Identify.the.ways.to.use.the.data.created.in.the.monitoring.process.to.provide.proactive.

management.to.Patient.Access

The.discussions.and.suggestions.provided.come.from.my.years.of .experience.working.in.different.fac-

ets.of .healthcare,.including.the.period.during.which.I.worked.as.a.corporate.director.of .access.for.a.

multihospital.system..In.addition,.through.various.professional.organizations,.I.have.come.to.know.

many.of .the.leaders.in.the.field.of .access.management..The.concepts.in.this.book.are.a.compilation.

of .a.number.of .processes.and.theories..I.wrote.this.book.to.help.you,.and.I.hope.you.find.that.I.was.

successful.in.doing.so.

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