Master Study Guide V

Future Development

  1. Data Integrity refers to the process of ensuring that data is ______and ______.
  2. In order to verify information, patient access must develop a consistent ______to measure the ______and verify the ______of the data collected.
  3. The PRIMARY ROLE of patient access is to create the basis of the ______through the capture of specific information prior to the Encounter.
  4. Patient Access Staff gather data classified into to broad (widespread) categories: ______data and ______data.
  5. ______data is divided into three sub categories: Demographic, Socioeconomic (Culture/Income), and Financial data.
  6. Such data has a direct relationship to patient care and to the ______integrity of the healthcare facility.
  7. The most common elements of Patient Identification are ______and ______of ______.
  8. Due to a heightened awareness of protecting patient’s identity, some facilities no longer require ______as a patient identifier.
  9. The data collected provides valuable statistical, ______, and ______information.
  10. Proper ______ will have processes in place to verify that the administrative data captured during the registration process are consistent and accurate.
  11. The main repository (database/warehouse) for Patient Access is the ______, ______, and ______system.
  12. The most important patient tracking link and resource in a healthcare facility is the ______. It is used to minimize duplicate records by matching patients being registered for care to their previous medical records.
  13. Failure to link patients to the correct existing medical record number may compromise patient ______and negatively impact the ability of the organization to obtain ______for services.
  14. Through searching the scheduling information and/or the physician order, patient access must capture the ______for the encounter and if appropriate, the ______information.
  15. List six components of physician orders:
  16. ______
  17. ______name
  18. ______
  19. ______or ______ordered
  20. diagnosis, signs, or symptoms; and ______signature.
  21. Data Accuracy can be measured by a ______system (by hand), but in recent years ______/automated Quality Assurance processes have been designed to provide real time feedback. UMHC’s system is known as ______.
  22. Some benefits of Automated Quality Assurance Programs are: ______% of registrations audited
  23. Registrars receive feedback on errors and ______
  24. Errors are corrected earlier in the ______cycle
  25. Clean data before ______; etc.
  26. Internal auditing provides a snap-shot of the results produced by current ______.
  27. Accuracy of the registration data results in fewer ______, rejected ______, and other delays.
  28. The data measured is used to implement ______initiatives designed to meet the revenue cycle goals of reducing Accounts Receivable (A/R) and improving cash flow for the organization.
  29. Resource Management is the efficient and effective ______and ______of an organization’s resources when they are needed. Resources include financial, supplies, human resources, and information technology (IT).
  30. One of our most valuable resources is ______.
  31. The largest expense item in the patient access budget is ______.
  32. This expense can be managed by hiring ______staffing levels and using ______staffing to cover inconsistent volumes.
  33. Customer Service impressions are the result of staff ______and ______.
  34. According to the Press-Ganey survey, “satisfied patients become ______patients,” who will ______their friends and family to our facility.
  35. Patient Access Staff must provide ______and ______registration services.
  36. Demonstrate a high level of understanding concerning ______payer requirements
  37. ______of ______expenses
  38. ______programs, and government regulations and guidelines.
  39. They must also be able to ______this info to the patient.
  40. Compassion is as significant as ______in creating a positive healthcare experience.
  41. Simple gestures such as ______and making ______show genuine care and concern.
  42. Avoid referring to patients using slang terms such as ______or ______.
  43. Instead, ask the patient their ______way to be addressed.
  44. Evaluating Customer Satisfaction results from obtaining ______and ______feedback.
  45. ______feedback occurs when the provider requests information from the patient.
  46. ______feedback is the formal and informal process of obtaining and responding to patient compliments and concerns.
  47. Customer surveys, comment cards, and call back programs are examples of ______feedback.
  48. Letters from patients and families and conversations with patients and families are examples of ______feedback.
  49. Both positive and negative feedback have a purpose in health care surveys.
  50. ______feedback provides an opportunity to practice positive employee engagement.
  51. ______feedback is an opportunity to apply quality improvement principles within the organization.
  52. Survey Results are the best way to find out if a customer is ______.
  53. Surveys can be written or ______.
  54. The survey should be conducted ______after the encounter while the experience is fresh in the patient’s mind.
  55. Survey Results are used to measure ______and engage in quality ______initiatives.
  56. Survey Results also have an effect on patient selection of the hospital and financial reimbursement for services rendered. For example, many consumers are turning to published surveys to see which providers ______or ______expectations.
  57. Insurance companies are also moving towards only reimbursing services and treatments from providers who meet or exceed a level of ______.
  58. Customer Service Survey information is used for public relations (______scores) and performance improvement (______scores).
  1. When initiating a customer satisfaction survey, you must determine:
  2. What data measurements are ______
  3. What data measures are important to the organizations ______process
  4. What data measures are important in day to day ______.
  5. The sample survey questions relating to service by individual care givers show compassion, concern, and empathy more than ______competence.
  6. Healthcare Facilities also use ______surveys to gain feedback concerning employee engagement and loyalty to initiate programs to impact employee ______and customer service scores.
  7. The purpose of any Quality Improvement program is to:
  8. ______and ______data
  9. initiate ______or ______action
  10. and to ______actions.
  11. TJC defines quality control as the performance processes through which actual performance is ______and compared with ______and the difference is ______on.
  12. TJC defines quality assurance as the continuous study and improvement in providing healthcare to meet the needs of ______.
  13. TJC defines performance improvement as: the continuous study and ______of a healthcare organizations ______and ______to increase the probability of achieving desired outcomes.
  14. Key Performance Indicators help an organization define and measure progress toward organizational ______.
  15. KPI’s must be quantifiable (______) measurements
  16. Agreed to ______
  17. And reflect the critical ______factors of an organization.
  18. There are a number of KPIs involved in the healthcare ______.
  19. In the past, hospitals tended to focus their efforts at the ______of the cycle (on billing and collection).
  20. But most revenue cycle problems originate early on when the hospital is ______and ______patient information needed to ensure a clean claim.
  21. Therefore, hospitals have shifted their focus on ______processes to help ensure problems do not arise in the first place.
  22. Lack of alignment between ______and ______functions is a leading cause of revenue-cycle problems for many hospitals.
  1. Proper alignment and focus on:
  2. ______
  3. ______, and
  4. ______functions will positively affect revenue-cycle results as monitored by KPIs.
  5. The following Key Performance Indicators generally monitored in patient access are:
  6. Pre-registration ______
  7. Scheduling and arrival ______
  8. ______rate
  9. ______/POS ______
  10. ______dollars
  11. ______/______satisfaction
  12. The following KPIs are generally monitored for various departments in the revenue cycle:
  13. Days in ______Receivable/ A/R Days
  14. Total ______collections
  15. ______(DNFB)
  16. ______claims/______claim percentage
  17. ______percentage
  18. ______balances
  19. ______to collect ratio
  20. ______expense
  21. ______expense
  22. Performance Improvement Methods are used in the act of incrementally (small steps) exceeding the expectations or requirements of a process through continual ______and ______.
  23. FOCUS – PDCA
  24. F – ______a process improvement opportunity
  25. O – ______ a team who understands the process
  26. C - ______ the current knowledge of the process
  27. U – ______the root cause of the poor outcome
  28. S – ______the ‘P- D-C-A’ cycle
  29. P- ______
  30. D- ______
  31. C- ______
  32. A- ______
  33. Six Sigma is a process blending ______wisdom with proven ______tools.
  34. The ultimate goal is to create ______for the customer and provider.
  35. It measures ‘defects’ and attempts to eliminate them to get as close to “______” as possible.
  36. A defect is defined as failing to deliver what the ______/______wants.
  37. Lean focuses on eliminating ______-______added steps and activities in a process.
  38. Process Reengineering is an improvement technique that involves the fundamental rethinking and radical ______of business processes to achieve ______improvements.
  39. Its goal is to be ______(extreme)
  40. ______(not incremental)
  41. ______(non-traditional).
  42. Performance Improvement Tools include ______and ______maps.
  43. ______are graphical representations of activities that make up a process. By identifying each step in a process, you can analyze and possibly improve it.
  44. ______is a graphical picture of the actual workflow of a company. This helps clarify who is responsible for a step or task in the process.
  45. Patient Access Training Models for patient access staff are:
  46. ______computer training
  47. ______classroom training
  48. ______to ______training
  49. CBT ______
  50. Self ______
  51. ______Playing
  52. ______.
  53. Patient Access Training Modules help staff learn various systems and processes. Helpful topics are:
  54. Computer ______training
  55. ______Service Standards
  56. ______verification
  57. Pre- ______
  58. ______patient liability;
  59. overview of healthcare ______
  60. ______/Medicaid
  61. ______Care
  62. ______Cycle Operations
  63. ______Terminology
  64. ______
  65. Regulations such as ______
  66. ______, etc.
  67. Due to the complexities of the content, most training should be conducted in a ______with ______systems and role playing.
  68. After training, competence should be demonstrated though ______and ______exams.
  69. ______will assist in identifying additional training needs or areas of focus.
  70. A standardized requirement for an employee to properly perform a specific job is known as ______.
  71. It encompasses knowledge, ______, and ______utilized to improve performance.
  72. It is the state or quality of being adequately ______to perform a specific role.
  73. The two types of Competencies are B______and T______.
  74. ______competencies include registering, verifying, calculating deposits, etc and are typically learned in an ______environment or on the job.
  75. ______competencies are adaptability, decisiveness, integrity, dealing with pressure, etc and are learned though ______experiences and our ______patterns.
  76. ______competencies encompass knowledge, skills, attitudes, and actions that distinguish ______performers;
  77. identify behaviors that enable employees to achieve ______performance
  78. and provide a ______to understanding how to achieve success as a patient access associate.

Label the following as either a Behavioral Competency (BC) or a Technical Competency (TC):

  1. ______Knowledge of regulatory standards such as EMTALA, HIPPA, etc
  2. ______Knowledge of basic CPT/ICD coding
  3. ______Uses time wisely and knows how to prioritize tasks accordingly and accomplish several tasks at once.
  4. ______Proficient at using Microsoft Word, Excel, and PowerPoint
  5. ______Pays attention and understands when others are talking. Gives the patient nonverbal and verbal signs they are listening.
  6. ______Able to stay calm and professional and maintain a positive manner during difficult or stressful situations.
  7. ______Knows and understands medical/insurance terminology and requirements
  8. ______Able to work without close supervision by ensuring that tasks are finished on time without error and up to quality standards.
  9. ______The ability to develop, maintain, and strengthen partnerships with others inside or outside the organization
  10. ______Identifies what needs to be done and does it before being asked or the situation needs it.
  11. ______Possesses good writing and verbal communication skills
  12. Benchmarking is an improvement tool where a company ______its performance or processes against other ______best practices.
  13. It determines how those companies ______their performance levels, and uses the information to improve its own ______.
  14. Benchmarking is a ______process where a company measures and ______all its functions, systems, and practices against strong competitors, identifying ______gaps, and striving to achieve a ______advantage.
  15. Benchmarking should be used on a ______basis because best practices are always ______.
  16. Benchmarks that compare different departments within the same organization are called ______benchmarking.
  17. When a company benchmarks or compares itself with another company that provides the same service, it is known as ______benchmarking.
  18. Benchmarking that compares a similar function or process in another industry is known as ______benchmarking.
  19. Balanced Scorecard is an organizational framework for implementing and managing ______at all levels by linking OBJECTIVES, INITIATIVES, and MEASURES to an organizations strategy.
  20. Upfront Cash Collections
  21. Admission/Registration Productivity
  22. Patient Satisfaction
  23. Denial Rate
  24. Physician, Patient, and employee satisfaction
  25. The measure of labor output or production is known as ______.
  26. A ______measurement measures QUANTITY such as number of registrations completed per hour.
  27. A ______measurement measures the QUALITY of registrations completed such as accuracy rate.
  28. Productivity Measuresshould measure both ______and ______.
  29. Every day, it becomes more obvious that excellent ______outcomes alone DO NOT increase the likelihood of repeat customers. (Think about restaurants)
  30. Great care includes the complicated series of ______connections between staff and patients.
  31. In summary, increasing the ______and ______(number) of human interactions improves healing.
  32. The federal government has realized that ______to and ______on patients’ feedback improves the quality of healthcare.
  33. Hospitals that have ______-______care will have a business advantage as transparency (newspapers publishing reports) and public reporting garner more attention.
  34. ______are also adopting patient satisfaction quality metrics and are moving toward reimbursing hospitals with low patient satisfaction LESS than hospitals with higher rates.
  35. The national trend in patient satisfaction has continued its steady upward climb, and in the face of ______and heavy ______, it becomes a competitive necessity for individual hospitals to continually improve the ______of care they provide.
  36. Studies show that satisfied patients are more likely to adhere to medical ______and that emotional stress during the healthcare experience can ______recovery.
  37. The primary goal of a healthcare provider is to establish ______which leaves the patient with a positive feeling about the care they received.
  38. ______more so than satisfaction is statistically linked to an organization’s financial and growth metrics and overall success.
  39. ______referral patterns drive patient admissions and revenue and significantly impact a hospital’s reputation.
  40. ______ is a process for checking the work performed by one’s equals to ensure it meets specific criteria.
  41. The goal is to verify whether the work satisfies the ______for review, identify any ______, and provide ______for improvements.

ANSWERS

  1. Consistent, accurate
  2. Processes, quality, accuracy
  3. Medical record
  4. Administrative and clinical
  5. Administrative
  6. Financial
  7. Legal name and date of birth
  8. Social Security Number
  9. Clinical, financial
  10. Quality Measurement Programs
  11. Admission, Discharge, and Transfer (ADT)
  12. Master Patient Index (MPI)
  13. Safety, payment
  14. Reason, procedure
  15. Answer
  16. Legible
  17. Patient name
  18. Date
  19. Test
  20. Therapy
  21. Physician
  22. Manual, electronic, AccuReg
  23. 100%
  24. Self-correct
  25. Revenue
  26. Bill drops
  27. Processes
  28. Denials, claims
  29. Performance improvement
  30. Utilization and deployment
  31. Time
  32. Salary
  33. Core, flex
  34. Behavior and attitudes
  35. Loyal, recommend
  36. Timely and accurate
  37. Third party
  38. Out of pocket
  39. Financial assistance
  40. Communicate
  41. Competence
  42. Smiling, eye contact
  43. Honey or sugar
  44. Preferred
  45. Active and passive
  46. Active
  47. Passive
  48. Active
  49. Passive
  50. Answer
  51. Positive
  52. Negative
  53. Satisfied
  54. Verbal
  55. Soon
  56. Satisfaction, improvement
  57. Meet or exceed
  58. Performance benchmark
  59. Positive, negative
  60. Answer
  61. Required
  62. Decision making
  63. Management
  64. Clinical
  65. Internal, retention
  66. Answer
  67. Collect and analyze
  68. Education or remedial
  69. Evaluate
  70. Measured, goals, acted
  71. Individuals
  72. Adaptation, functions and processes
  73. Goals
  74. Measurable
  75. Beforehand
  76. Success
  77. Revenue cycle
  78. End
  79. Collecting and verifying
  80. Patient access
  81. Clinical and financial
  82. Answer
  83. Patient access
  84. Clinical
  85. Patient financial services
  86. Answer
  87. Percentage
  88. Wait times
  89. Accuracy
  90. Upfront/ Collections
  91. Unbilled
  92. Patient/employee
  1. Answer
  2. Accounts
  3. Cash
  4. Discharged Not Final Billed
  5. Rejected claims/clean claim percentage
  6. Denial
  7. Credit
  8. Cost
  9. Charity
  10. Bad debt
  11. Enhancements and refinements
  12. FOCUS
  13. Find
  14. Organize
  15. Clarify
  16. Uncover
  17. Start
  18. Plan
  19. Do
  20. Check
  21. Act
  22. Organizational, statistical
  23. Wealth
  24. Zero defects
  25. Customer/patient
  26. Non-value
  27. Redesign, dramatic
  28. Radical
  29. Dramatic
  30. Contemporary
  31. Flow charts, process
  32. Flow charts
  33. Process Map
  34. Answer
  35. Hands on
  36. Formal
  37. Peer to peer
  38. Computer Based Training
  39. Self-paced training
  40. Role
  41. Experiental
  42. Answer
  43. Systems
  44. Customer
  45. Insurance
  46. Certification
  47. Calculating
  48. Finance
  49. Medicare
  50. Managed
  51. Revenue
  52. Medical
  53. Scheduling
  54. HIPPA
  55. EMTALA
  56. Classroom, hands-on
  57. Written and practical
  58. Quality Reviews
  59. Competence
  60. Skills, behaviors
  61. Qualified
  62. Behaviorial and Technical
  63. Technical, education
  64. Behaviorial, life, behaviorial
  65. Behaviroial, excellent
  66. Superior
  67. Road map
  68. TC
  69. TC
  70. BC
  71. TC
  72. BC
  73. BC
  74. TC
  75. BC
  76. BC
  77. BC
  78. TC
  79. Measures, companies, achieved, performance
  80. Achieved, performance
  81. Continuous, compares, quality, competitive
  82. Continual, evolving
  83. Internal
  84. External
  85. Functional
  86. Strategy
  87. Productivity
  88. Quantitative
  89. Qualitative
  90. Quantity (output) and Quality (accuracy)
  91. Clinical
  92. Human
  93. Quality and frequency
  94. Listening and acting
  95. Patient centered
  96. Payers
  97. Transparency, competition, quality
  98. Advice, hinder
  99. Patient Loyalty
  100. Loyalty
  101. Physician
  102. Peer Review
  103. Specifications, deviation, suggestions