The Value of Quality E.D. Registration
When analyzing E.D. practices, one of the most overlooked variables that drives reimbursement is initial patient registration. In the past, we have discussed how documentation, payer mix, coding, and the effective capture of all of the charts are real issues that drive your reimbursement. Over the last few years, I have noticed that poor initial patient registration has become a major factor in E.D. physician reimbursement. Do you know step by step how the capture of patient demographic and insurance data works at your hospital? My guess is that most physicians have a general idea of how the process works; however, very few actually know and understand the details of the process.
Understand the Process
At this point, I would encourage at least one physician from every E.D. group to take some time when they are not working to come to the E.D. to understand the registration process. This may well be the most important non-clinical time you can spend enhancing your reimbursement. To begin, you should get with the registration personnel and their administrative supervisors and let them explain how the process is supposed to work. Then, you need to see the process in action. As you might guess, the process often fails to be executed as designed. Often you will find that the administrative personnel don't have any idea that their people have either changed the process or failed to execute as designed. Why does this happen? Simply put, to often the administrative supervision for the E.D. registration process resides in administration rather than the E.D. Therefore, you have the hen house unguarded.
Secondly, you should take a few minutes when you are working to make certain the registration process is being followed by all of the personnel. In many instances, you will find that one shift, usually the night shift, fails to perform up to an acceptable standard. Paying attention to these details will not only allow you to understand the process, you will soon be able to spot problem areas quickly and get with the personnel to make the necessary changes.
Lastly, you should alert every physician in your group of the process, problems, and who to seek out for solutions if new problems arise. If all of your physicians are paying some attention to this process, you will have a much greater chance to improve your process and thus reimbursement and patient satisfaction.
The Financial Impact
Recently, one of my E.D. client hospitals changed the registration process without their knowledge or our knowledge. Immediately, their percentage of patients registered as self pay increased 50% from the historical average. This continued for several months and thus we notified the client of the potential cause of the problem as we have seen this many times. Obviously, the E.D. payer mix had not changed this much; therefore, they set up a meeting with high level officials to review the process and discuss solutions. The financial impact without correction would be as follows:
Additional Monthly E.D. Volume Erroneously Registered as Self Pay: 400 x 12 months
Percentage of Patients that called in and provided corrected information: 20%
Number of monthly patients erroneously registered after calls: 320 x 12 months
Collection rate of self pay patients: $20/patient
Collection rate of insured patients: $140/patient
Annual potential loss to group: $140-$20 x 320 x 12= $460,800
How to Fix the Problem
First and foremost, realize that you do have a problem. Every E.D. I have worked with over the last thirteen years has a registration process that has room for improvement. Second, establish communication with administrative personnel over the registration process. Meet regularly to review problems, establish protocol, and monitor changes. Third, if you fail to get the proper resolution, push for administration to place someone in the E.D. to directly supervise the process. Fourth, work in conjunction with the hospital to establish a mechanism to measure success or failure. Last, pay attention to the details and educate your physicians such that everyone knows how to spot problem areas. Obtaining administrative support for better registration should not be difficult as their reimbursement is also affected by poor registration; however, navigating your way through the hospital bureaucracy to obtain change will be your greatest challenge.