Jim Matthews, Principal, Nearterm Corporation

People are more careful about their work when they understand the importance of what they are doing and how it impacts the organization. Recent findings suggest that this is particularly true for millennials, but it certainly applies to the broader work force as well.

Here is one way to help access associates better understand their impact on cash and patient satisfaction in a detailed, data driven way. First Pass Yield is typically defined as the percent of claims that survive the claims editor without intervention and go straight to the payor. The claims editor processes UB “field edits” and if a UB field is populated with the right mix of characters, it passes. But if there is a transposition error entered upon registration, the claim still passes the editor because the required characters are present and it is sent to the payor. It is then denied. When we look at denial rate and the reasons claims are denied, all hospitals are different. Front end data collection and data entry is always among them. One education approach is to physically map denials to UB fields. For example:

• Using a UB 04 form, ascribe the number of access related denials accumulated in a one month period in the actual form locator box on the form. Using a table, illustrate the revenue associated with each and also the error code. Then, tie the form locator to the field in your registration system that drives data to the UB. You can now point to the registration screen (s) and demonstrate the connection each field on the screen has to the UB and ultimately illustrate the connection to either denials of cash. After all, one key function of the access process is to produce a viable claim that results in payment.

• Address group training by sharing a presentation of 10 UB forms resulting in denials because of errors that can be attributed to patient access data collection. Indicate the revenue associated with each and the total. Apply the 10 to the entire population of errors for the same error code for a month to illustrate the financial impact of front end performance. Discuss patterns, determine root cause and ask the group for ideas about how to improve outcomes.

• Conduct individual sessions the same way by pulling denials by registrar. Discuss their individual performance in terms of impact on cash and patient satisfaction.

The exercises above will help you identify training needs and technical issues that influence first pass yield, denials and of course, cash.

Jim Matthews
Principal, Nearterm Corporation

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