Case Study: Bon Secours Charity Health System -
Patient Registration Solutions Mitigate Errors and Protect Revenue Integrity
Note: This case study was produced for HealthWare Systems by Healthcare Business Insights.
The entire revenue cycle relies on the information gathered during patient access, and
incomplete or inaccurate data can lead to significant revenue loss and place an unnecessary burden on back-end resources. Academy research shows 30–40% of denials are caused by registration errors, representing as much as 0.5% in lost revenues. Many healthcare organizations recognize this correlation and have implemented various initiatives to minimize errors, with Academy research indicating that hospitals and health systems in the top quartile have a registration accuracy rate of 97% or greater compared to the national average of 93%.
Critical to the success of many better performing hospitals and health systems, registration quality assurance tools help staff automatically identify errors that can go unnoticed if the organization has a poorly administered manual review process or no auditing at all. One organization that has made significant strides is Bon Secours Charity Health System in New York.
Registration Accuracy Challenges
Douglas Barry, Vice President of Revenue Cycle, first joined the organization during a
period of transition and the health system did not have a process in place to review registration accuracy. As a result, he helped implement a manual review process to improve the accuracy of patient registrations and reduce denials.
However, Barry recognized that the sample size scrutinized by his limited resources
failed to identify the true opportunity and had limitations—staffing reductions and
restructuring—that made it difficult to successfully maintain a manual review process.
While this manual process was a significant improvement compared to not having
reviews in place, Bon Secours Charity Health System felt that an expanded sample
would further enhance performance.
Patient Registration Solutions
Prior to joining Bon Secours Charity Health System, Doug had experience using registration accuracy tools and recognized the potential benefits of implementing a patient registration solution. "I had a past history of using [registration QA tools] and know the impact it has on backend operations,” he says. “I knew the value associated with that and knew that given our limitations around resources and restructurings, we needed to make sure it was as clean as it could be.”
Ultimately, Bon Secours Charity Health System chose to implement ActiveDEFENDER, a tool from HealthWare Systems that monitors the entire patient encounter. In describing the selection process, Doug compares HealthWare Systems to the solution
provider he worked with in his previous position. “HealthWare is probably the more sophisticated of the two,” he explains. “The other one appeared to be very archaic and the reports weren’t as sophisticated. It just seemed there was a better market presence from HealthWare and better integration.” The implementation was speedy -the solution was up and running in just 30 days.
ActiveDEFENDER works in conjunction with Bon Secours Charity Health Systems’ existing registration system. As the registrar enters the information, the encounter accuracy tool constantly monitors the data based on customized edits from the health
system. For example, a Medicare policy number must be 10 characters long, and Bon Secours wanted an edit within the system that ensured registrars entered a policy number with 10 characters. If ActiveDEFENDER identifies an issue with a Medicare
policy number—or any other error based on more than 80 customized checks—it stores that information in the registrar’s work queue. Registrars are responsible to manage their work queues. They constantly review them to see if they made any errors and make the necessary corrections.
In an effort to reduce the number of errors in patient access, the health system has integrated ActiveDEFENDER into its registrar performance evaluation. “If [registrars] make a mistake and correct it on the spot, we don’t count it as a mistake and we let the tool do its job,” Doug says. “If you don’t correct it, it counts against you.” ActiveDEFENDER tracks the errors that go uncorrected and provides leadership with report cards for each registrar. These reports show comparisons among registrars and campuses, the error percentage and type for each registrar, and any repeated mistakes registrars are making. With the reports, leadership can initiate targeted education for registrars that are continuously scoring low or making the same mistakes.
Going forward, Bon Secours Charity Health System is working with HealthWare Systems to implement ActiveCHECK, a real-time information verification tool that will alert registrars immediately whenever an error is identified. In addition to providing registrars with real time error alerts, such as an undeliverable address notification, this tool will also provide directions to immediately correct the error or scripting to obtain the necessary information from the patient. Similar to ActiveDEFENDER, Bon Secours will be able to customize the checks and the follow-up workflow associated with each error.
According to Barry, implementing HealthWare Systems’ tools has had an immediate and far reaching impact. Currently, the health system’s registration accuracy rate is at 99.9% across all three hospitals, a significant improvement over the 62% prior to implementing a review. This also puts Bon Secours Charity Health System among the top 10% of organizations in terms of registration accuracy according to Academy survey results.
By reducing the number of errors, Bon Secours has improved its overall financial performance on the back end. For FY 2013, denials at the health system are tracking 20% below budget. In addition, the organization is now collecting 99.4% of its expected reimbursement (net charges) compared to 91% prior to implementing HealthWare Systems’ tools. Over that same period, bad debt has decreased by approximately 50%. “It impacts things all the way around” Doug notes. “I have been preaching this for 35 years; if you do it right it is amazing what you don’t have to do.”