CHAA Examination Preparation

1
CHAA Examination Preparation

• Future Development Session I
• Pages 104-113
• University of Mississippi Medical Center

2
What to Expect

• This module covers various aspects of Patient
  Access knowledge found in pages 104-113 of the
  FUTURE DEVELOPMENT section of the 2010 CHAA Study
  Guide.
• A quiz at the end will measure your understanding
  of the content covered.

3
Billing Problems

• For most hospitals, the 1 reason claims are
  rejected or denied is
• INACCURATE DATA ENTERED DURING REGISTRATION
• Therefore, patient access staff must focus on
  getting the CRITICAL DATA ELEMENTS (CDEs) correct
  when collecting information from the patient.

4
Critical Data Elements

• The most common CDE mistakes include
• Patient name on claim not matching patient name
  on file with payer
• Incorrect or missing Member ID
• Claim submitted to wrong payer (e.g. traditional
  Medicaid versus Medicaid HMO)
• Incorrect address
• Missing or incorrect phone numbers
• Missing pre-cert/authorization/referral
  information needed in order to submit claim

5
The Importance of CDEs

• Confirming this information has been collected
  and is correct at the time of registration
  eliminates
• DOWNSTREAM issues associated with billing payers
• Problems in collecting liability from patients
• CDEs ,,

6
Data Integrity

• Data Integrity refers to the process of ensuring
  that data is
• CONSISTENT and CORRECT
• According to CHAA, your PRIMARY ROLE IS
• is to create a basis of the medical record by
  capturing specific information prior to the
  patients encounter at the point of entry into
  the healthcare system.

7
Types of Data

• You gather Administrative and Clinical Data
• Clinical Data Medical Related Information
• Administrative Data Demographic, Socioeconomic,
  and Financial data
• The two most COMMON DATA ELEMENTS used throughout
  the healthcare experience are
• Legal Name and Date of Birth

8
Data Storage and Retrieval

• The main REPOSITORY (virtual storehouse/closet)
  used in patient access is the
• Admission, Discharge, Transfer (ADT)
• The primary Patient Tracking Link considered to
  be the most important resource in the healthcare
  facility is the
• Master Patient Index (MPI)

9
Importance of the MPI

• How does proper use of the MPI serve the patient
  and the hospital?
• Links patient being registered for care with
  existing medical records (if possible).
• Improves patient safety by increasing the chance
  of proper patient identification.
• It increases the ability of the hospital to
  obtain payment for services by properly
  identifying the patient.

10
What to Know about Physicians Orders

• Components of a valid physician order are
• Patient Name
• Date
• Diagnosis, signs, or symptoms
• Test or therapy ordered (Procedure)
• Physicians signature
• It must be LEGIBLY written.

11
Data Integrity Quality Assurance

• Ensuring the accuracy of registration data
  collected results in fewer denials, rejected
  claims, and other delays.
• Facilities use INTERNAL AUDITING in order to gain
  a SNAP-SHOT of the results produced by current
  processes. UMHCs auditing process is called
• AccuReg

12
Data Accuracy Quality Assurance

• Data obtained from the audit is used to implement
  performance improvement initiatives designed to
  meet the revenue cycle goals of
• Reducing Accounts Receivable (A/R)
• Improving Cash Flow
• Quality Assurance is ensuring a certain standard
  is consistently met.

13
Access Management Data
14
Quality Assurance Customer Service

• According to a Press-Ganey Survey, Satisfied
  Patients Become Loyal Patients.
• Satisfaction depends on
• Wait times, proper room and food temperature,
  technical competence, protection of privacy,
  friendliness and courteousness of staff, etc.
• Compassion is as significant as Competence.

15
Evaluating Customer Satisfaction

• Passive Customer Feedback
• Letters from patients and families
• Conversations with patients/families
• Active Customer Feedback
• Customer Surveys
• Customer Comment Cards
• Customer Callback Programs
• Surveys are the BEST method to find out if a
  customer is satisfied.

16
Using Survey Results

• Positive Feedback
• Provides an opportunity for positive employee
  engagement and also helps gain market share
  (customers).
• Negative Feedback
• Provides an opportunity to apply quality
  improvement principles in an effort to respond to
  the feedback with service recovery efforts.

17
The Power of Surveys

• Healthcare organizations are starting to PUBLISH
  results.
• Insurance companies are moving toward reimbursing
  treatment at facilities that meet or exceed a
  certain level of performance benchmark.
• Surveys are also used INTERNALLY within
  individual organizations to measure
  employee/staff satisfaction.

18
When Creating a Customer Satisfaction Survey

• You MUST DETERMINE
• What data measurements are required?
• Face to face survey, telephone, email, comment
  card, etc.
• What data measures are important to the
  organizations decision making process?
• Patient wait time, compassionate staff, food/room
  temperature, etc.
• What data measures are important in the day to
  day management?
• What are the factors that will keep customers
  coming back?

19
Quality Improvement

• Quality Assurance is ensuring a certain standard
  is consistently met.
• QUALITY IMPROVEMENT is best described by Lexus
• The Relentless Pursuit of Perfection.
• Its a never ending cycle of
• Collecting Data Analyzing Data Taking
  Action Evaluating Results

20
Access Management Data
21
The Joint Commission

• TJC REQUIRES healthcare organizations to IDENTIFY
  and REPORT on quality improvement initiatives.
• TJC defines QUALITY CONTROL as the performance
  processes through which actual performance is
  measured and compared with goals, and the
  difference is acted on.

22
The Joint Commission

• TJC defines QUALITY IMPROVEMENT as an approach to
  the continuous study and improvement of providing
  health care services to meet the needs of
  individuals and others.
• TJC defines PERFORMANCE IMPROVEMENT as the
  continuous study and adaptation of a health care
  organizations functions and processes to
  increase the probability of achieving desired
  outcomes.