CHAA Examination Preparation

1. CHAA Examination Preparation Future Development – Session II Pages 113-127 University of Mississippi Medical Center

2. What to Expect… • This module covers various aspects of Patient Access knowledge found in pages 113-127 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. Staff Education and Competency • KEY PERFORMANCE INDICATORS (KPIs) are created to help an organization DEFINE and MEASURE progress toward organizational goals. • They reflect the CRITICAL SUCCESS FACTORS. • They must be QUANTIFIABLE(measurable). • Examples: 97% Accuracy Rate, Register X amount of patients per hour, Patient wait times less than X minutes, Point of Service Collections, etc.

4. Revenue Cycle KPIs • In the past, hospitals focused a majority of their efforts at the end of the Revenue Cycle. • What is wrong with this process? • Most revenue cycle problems occur when the hospital is collecting and verifying patient information needed to ensure a clean submission claim and receipt of full payment. • So how would you address this problem?

5. Performance Improvement Methods • PROCESS IMPROVEMENT is the act of INCREMENTALLY exceeding the requirements through continual ENHANCEMENTS and REFINEMENTS. • There are SCIENTIFIC and SYSTEMATIC methods, techniques, and tools used to improve performance. • Before you conduct process improvement, the OBJECTIVES and OUTCOMES must be MEASURABLE and WELL UNDERSTOOD.

6. FOCUS - PDCA • The purpose of FOCUS – PDCA is to improve the product or service from the CUSTOMER’S VIEWPOINT. F – Find a process improvement opportunity O – Organize a team who understands the process C – Clarify the current knowledge of the process U – Uncover the root cause of the variation or poor outcome S – Start the “Plan-Do-Check-Act” Cycle

7. Six Sigma • Six Sigma is a process improvement technique using organizational wisdom and statistics to identify and eliminate the “DEFECTS” in a process. • A “defect” is anything outside of customer expectations. • It focuses on making sure we’re doing the right things correctly the very first time.

8. Lean • Lean and Six Sigma are complimentary in nature. • Lean focuses on ELIMINATING NON-VALUE ADDED STEPS in a process. • Lean ensures we are focusing on the RIGHT THINGS.

9. Process Reengineering • This involves FUNDAMENTAL RETHINKING and RADICAL REDESIGN of business processes to achieve DRAMATIC improvements. Changes must be: • Radical • Dramatic • Contemporary

10. Flowcharts & Process Maps • A Flowchart is a graphical representation of activities that make up a process. • Steps taken in registering a patient • A Process Map is a graphical picture of the actual workflow through a company. • This helps clarify who is responsible for a step or a task in the process

11. Patient AccessTraining Models • Hands-On Computer Training • Formal Classroom Training • Peer-to-peer training • Self-paced Training • Role Playing • Experiential • CBT (Computer Based Training)

12. Patient Access Training Modules • Computer systems Training • Customer Service Standards • Insurance Verification • Pre-Certification • Calculating Patient Liability • Overview of healthcare finance • Medicare/Medicaid • Managed Care • Revenue Cycle Ops • Medical Terminology • Scheduling • Regulations: HIPPA, EMTALA, etc.

13. Competence • Competence is a STANDARDIZED requirement for an employee to properly perform a specific job. • It encompasses a combination of skills, knowledge and behavior. • Two Types of Competencies are: • Behavioral and Technical

14. Behavioral and Technical Competencies • BEHAVIORAL COMPETENCIES are learned through life experiences which form our behavior patterns. • The ability to get along with others, adapt, be a team player, have a positive attitude, maintain composure under pressure, etc. • TECHNICAL COMPETENCIES are learned in an educational setting or on the job. • Registering, verifying information, calculating deposits, the ability to read and write, etc.