COMMON QUESTIONS & ANSWERS

Q:  We are currently performing a 20% manual QA on all our registrations.  Our stats are very good.  Why would we need to incorporate your service?

Statistics derived from anything less than 100% QA Case Review is just an estimate.  A 100% QA Case Review isn’t an estimate but an exact value of your registration quality.   If you are fixing the 20% reviewed cases that are identified in error, then only 20% of all your cases have a better chance of completing the reimbursement cycle. With our 100% case review, all of your patient’s claims will have a better chance of reimbursement for your facility.
 

Q:  How long does the set up this service take?

Approximately 2 to 4 weeks after we receive the first raw data sample.  There is no other setup required for the life of the service. 

 

Q:  Is there a limit to the number of edits that we can incorporate into our Reg QA process?  If so, what is the charge for each edit?

No, there is no limit.  You also have the ability to add, delete or change any of the edits, at any time, at no additional charge.
 

Q:  If I were to need a one time report, that would consist of information in our daily registrations, but not with criteria of our other edits or traps, could we acquire that report?  (For example:  A report of all cases in the last three months where a patient, retired and over the age of 65 years, did not have Medicare as their primary insurance.)

Yes, that is a common request.  Many times, our clients need to identify if something is a potential problem before they institute a new edit in our Reg QA service.  Anytime, any information is needed to be valued or quantified, just contact us with the details of the report you need.  Requests for one time reports are easier to obtain from us, than the processes most facilities need to go through to obtain the report from their IT department.
 

Q:  We have many electronic billing edits in place that stops the claim from submission, if a case’s information is in error.  Do we need to perform Reg QA too?

Most electronic billing system’s edits are limited to what is generated on the standard billing forms.  They do not have the ability to trap for information outside of the billing forms, such as collection information for self pay accounts, Medicare Questionnaire field values or Physician billing information.  Billing system traps are typically generated for specific insurance plan codes, specific diagnosis guidelines and simple field value inconsistencies.   They are not setup to handle complex edits or information that is not part of the standard claim forms.
 

Q:  Our facility is planning to install a new mainframe system in the next year.  Should we wait to incorporate the Reg QA service after the installation?

No, it is not necessary.  The information we use for our service is the same in all mainframe systems.  Our VPN access to your facility will not change, nor will the edits that you want to trap for.  The only minor change would be the raw data file, but that is a minor one time request from your IT department.  From past experience, new mainframe installations frequently cause temporary havoc on the billing cycle.  It would be best to keep a reliable, accurate Reg QA process going through the transition period.
 

Q:  Will training be required of our staff for the use of your service?

No.  If there is a need for it, it will be minimal since there is no software to learn.  We pride ourselves in making our Reg QA service user friendly and self explanatory.  The information you obtain from the registration error stats we produce will help in your internal training for future new hires as well as re-educating your staff on common errors that may be misunderstood.  Our employee error reports include detailed error information, as well as an explanation to why the case was in error and how to fix the error.  This consistent information continually and acccurately trains ALL your staff on a daily basis without additional trainers or formal training sessions required.
 

Q:  What is your process in determining who made the error on a specific registration?  I have different staff members that value different parts of the individual registrations.

Some facilities want the last registrar who touched the case to be the “responsible” person for the whole case.  Other facilities may want the Medicare Questionnaire only fields assigned to someone different (“responsible person” who completed the MSP).  We groom this service to what processes your facility uses.  So you can tell us, what and when you want any case to error, and which employee you would like to take responsibility for the error.
 

Q:  Can any of my employees change a trap that you have set up?

No.  We ask for only a select few people (usual two) that have the authority to make changes to the edits or reports.  This also helps keep the edits and reports manageable and organized.
 

Q:  I am the manager over Patient Access at our facility, but we have “de-centralized” registration.  How does your service help with Registration errors out of my control?

We can develop individual reports of the registration errors caused outside of your managed area.  They can be all inclusive or separated by department(s), by employee or by manager.  The error reports are great informational tools to communicate with outside managers on the negative revenue impact their staff have on their area.
 

Q:  Can I have my pre-registration cases monitored for all my edits too?

Yes, we can do that for you.  You also have the option to include your pre-reg errors in your daily and monthly stats, or you can exclude them from your stats and only utilize the individual cases in error as a monitoring tool for a potential revenue problem.  

 

Q:  What is the worst error percentage you have seen at a given facility?  Or what is the “normal” error percentage?

We have seen a wide range of error percentages.  The average error percentage when we start our service is about 30 - 45%.  Shocking, I know.  However, when 100% accurate case review is done, the statistics don’t lie.  A hospital system, with a 45% error percentage, can lower their error rate down to a mere 2% in one year, with the statistics we produce, and the determination and training of the employees to repair those cases.  Most of our clients strive to achieve and maintain a goal of 1 or 2% error rate.   
 

Q:  How much is the cost of this service?

Our service cost would replace the number of FTE’s it would take to perform a 20% case manual review.  Example:  1500 registrations per day would take approximately 1 to 1 1/2 full time QA analysts to perform a 20% case manual review.  Our yearly service fee would replace those yearly hospital staff salaries, as our service does not require additional hospital staff resources to maintain.  In 2006, we adjusted our yearly service fee to a flat fee that would benefit both the Registration Department budget, as well as the hospital budget.  Our flat fee includes all of our features, with no addtional costs.  It is probable that our service will pay for itself in the first week it is in place, by the amount of errors we find in cases prior to billing that were destined to be rejected by the insurance company.
 
Q:  Do you do "real-time" error monitoring?

No.  We have seen more and more patient cases appear in error after the patient has been registered and has had treatment.  Faulty information can be entered either by other programs that interface to your mainframe or information that is inappropriately changed and fed from the back end forward.  Real-time error monitoring also slows the progression of busy registration areas and impacts negatively on patient satisfaction in expediting the registration  processes they go through prior to treatment.  We offer, free of charge, a second review of all cases just before they hit the billing system to assure no adverse changes to the case were made.  Hourly checks have also been requested, to assure that the employee is available to fix their own errors before they leave for the day.  This is ideal for those that are going on vacation, or may only work part-time.  Hourly checks are also an option for your facility, at no additional charge.
 
Q:  We utilize software our IT department developed for our QA.  Our error rate is improving.  What does your service provide that we don't already have?

    Most software products are limited to "non-human" intelligence.  They also claim    

      to perform 100% QA, but cannot perform complex "human logic" type edits.   

      This in turn puts a limit to what you can trap for accurately. Since we perform  the  

      edit creations, and have the ability to include many scenerios as well as exclude

      many scenarios to each edit, we feel that our edits are more accurate and more 

      reliable than software that limits you to pick your fields to compare or sort by.

      For example:  Sample edit may be....trap for all cases that the patient is a minor

      and the guarantor is the patient.  In a software situation, you'd chose the patient

      name and date of birth and would compare to the guarantor name and possibly the 

      guarantor relationship code to generate your error list for this edit.  But what if you

      would like to exclude all minors that are pregnant, or obtaining labs for STD's? 

      Those types of situations would warrant a guarantor to be minor.  In a software

      driven error checking, the software would generate an error for that type of case,

      inappropriately.  Those types of errors would need to be manually removed from

      your stats to make the total error calculation correct.  However, those exclusions

      can be built into our edits, so that your errors are all true errors, and the manual

      removal of inappropriate errors from your stats are not needed.
    Also please see our comparison of QA service vs QA software.
 
Q:  When did PARS start?

Barbara Allgire, the president of PARS, was a former employee of a multi-facility hospital system.  She worked within all aspects of the patient path during her years there.... including central supply, ward clerk duties, medical records analyst and registration QA analyst.  In her last years with the hospital system, she worked in patient accounts and saw first hand how all the pieces played a part in the whole revenue cycle.  She felt that there had to be an easier way to monitor and access all these areas.  She continued her career doing consulting work for hospitals across the country where she identified that the same issues and problems seemed to be at every facility. 

Barb met with some programming friends to develop a tool to help with some of her repetitive and time consuming tasks so she could handle more of her work load.  She met with and brought in experts in the fields of the hospital revenue cycle to gain more "hands-on" knowledge and experience of the common bottle necks we have all come to be frustrated with.  They devloped a Charge Master maintance program, then advanced to a DNFB Recovery program and later was approached to develop a Registration QA tool process.  Through the discussions and requested need for these types of services, PARS became one of the first PRE-BILL revenue cycle based companies available.  At the time, very few companies in the healthcare industry where looking at the front end as part of the problem of the revenue cycle.  Since then, more and more companies have come out with Registration QA software and processes as part of the revenue cycle monitoring initiative. 

PARS Registration QA process has been groomed continuously since it's implimentation in 2002, and will continue to be groomed to the needs of our clients...... as the healthcare industry is ever changing.