Registration Accreditation Standards

Revenue Integrity Standards and Accreditation in Healthcare

REGISTRATION Summary

Measuring performance helps hospitals assess revenue cycle efficiency and effectiveness. Monitoring the Registration standards will ensure compliance with CMS guidelines and with the regulations under the Affordable Care Act (ACA). These standards will help increase effectiveness by helping to create a solid foundation on which the entire revenue cycle is built.

Registration staff must confirm patient identities, accurately obtain patient demographic information, check for medical necessity on outpatient services and conduct initial financial conversations with patients who did not process through the scheduling department. Identifying patient financial responsibility for the current visit and for any prior balances will need to be discussed at this point and monies requested and collected.

Communication with physicians and their staff is critical in obtaining completed orders and any additional patient information needed.

All payer requirements must be met at the point of registration including notifications, prior authorizations, pre-certifications and medical necessity determinations.

All of the registration responsibilities should be monitored on a continuous basis, daily if needed, to determine areas for improvement in flow and/or accuracy. Patient satisfaction can be measured and feedback given to staff and management for a constant evaluation of quality of service.

Successful registration departments have integrated tools available for use such as document scanning, estimation tools for financial responsibility and price transparency, online verification tools and order tracking systems.

Monitoring standards will help hospitals identify areas of improvement needed and will assist in establishing measurements for progress.

RG-01The Registration department uses a system for determining outpatient medical necessity for all Medicare patients prior to service.

RG-01.01All Medicare outpatients will be screened for medical necessity prior to or at the time of registration. If testing is not medically necessary an ABN will be obtained according to Medicare guidelines.

RG-01.02The hospital will show evidence of medical necessity screening using documentation in the record and with data collected.

RG-01.03Best Practice Standard is 100% of registered outpatients will be screened for ABN requirements prior to or at time of service.

Rationale for RG-01

Issuance of an ABN, as required by CMS, protects patients and healthcare providers from unexpected liability for charges associated with services not covered by Medicare. It’s important for all outpatient Medicare tests and services to be screened for medical necessity. CMS requirements can be found at the link below.

Note:This standard should be measured concurrently and not as a random audit. If data confirms that the process is efficient and compliant, data may be collected as a random audit at that time. Surveyors may ask for record of prior data collected.

Equation:N: Registered Medicare outpatient accounts screened for medical necessity

D: Total of Medicare outpatient accounts registered

Surveyors will request documentation of tracking these patients and may request charts for random accuracy reviews. It is the responsibility of the hospital to collect and maintain data with documentation to verify the data collected.

RG-02Average registration interview duration

RG-02.01Hospital will monitor the time to complete the registration interview and document results.

RG-02.02Results will be monitored and tracked by individual registrar or by a process determined by the hospital.

RG-02.03Best Practice Standard is 10 minutes per registration interview.

Rationale for RG-02

The registration interview should be as short as possible, while obtaining all pertinent data. Shorter interviews lead to increased patient satisfaction and improved flow in the hospital process. Whenever possible, when a patient encounter is expected or scheduled, the pre-registration process should be initiated or completed prior to the patient arriving in registration.

Note:This standard should be tracked by measuring the average minutes spent in the registration interview by registrar. Surveyors will request documentation of data collected and any improvements completed.

Surveyors will request the data for analysis and may do random observations of the interview process. It is the responsibility of the hospital to collect and maintain data with documentation to verify the data collected.

RG-03Percent of accounts on hold for registration errors.

RG-03.01Hospital will have process in place for monitoring registration data errors.

RG-03.02Concurrent monitoring is done and documented to promote communication and feedback to staff regarding errors to continuously strive for performance improvement.

RG-03.03The billing department will communicate with the registration department regarding accounts on hold for errors.

RG-03.04Best Practice Standard is <1/16 of a day of total net revenue will be on hold. Hospital will document revenue goal for performance and survey monitoring.

Rationale for RG-03

Accounts with registration errors affect every step in the revenue cycle and create issues that will extend a hospital’s A/R days. Tracking this issue on a concurrent, minimum weekly, basis will allow hospitals to educate staff, evaluate processes and decrease further errors.

Note:This standard should be tracked by measuring the dollar amount of claims on hold for registration errors on at least a weekly basis to continuously improve data flow in the revenue cycle. Surveyors will request documentation of set goals, data collected and any improvements completed. Net revenue calculation will be determined by the individual hospital.

Equation:N:Total $$ amount of claims on hold for registration errors

D:Total $$ day of net revenue

Surveyors will request the data for analysis and will request random charts for accuracy reviews. It is the responsibility of the hospital to collect and maintain data with documentation to verify the data collected.

RG-04Medicare Secondary Payer (MSP) forms will be completed on Medicare patients at every registration encounter.

RG-04.01MSP forms are required at every registration encounter with a Medicare patient.

RG-04.02The hospital will show evidence of MSP screening using documentation in the record and with data collected.

RG-04.03Best Practice Standard is 100% of Medicare registrations will have an MSP completed.

Rationale for RG-04

Completing the Medicare Secondary Payer (MSP) form is important in the coordination of benefits that CMS requires. It determines which insurance pays primary and which is secondary. Sequencing of payers helps hospitals avoid fraudulent billing and decreases liability of false claims. Further information on the CMS guidelines for the MSP can be found at the link below.

Equation:N:The number of MSPs completed for Medicare patients

D:The total number of Medicare patients