Patient Account Services Evolution

Of Quality Assurance

Aqueelah Hardin

Independence

Historically Patient Account Services (PAS) and the Patient Contact Center (PCC), had a combined Quality Assurance (QA) department and scorecard. In November of 2014, PAS and PCC decided to separate their QA resources. This was due to an increase in PCC staffing along with the Revenue Cycle realignment. This also was an agreed upon need that both groups required a more targeted focus on their own business lines for coaching and training purposes. This would require an independent scorecard for both groups to properly direct their focus on what each department held of value. In addition, this would free up PCC resources to continue to score the same amount of calls for their increased staff size.

Creation of the PAS QA Scorecard

This new found independence required a PAS specific QA scorecard. The new scorecard was created through a collaboration of the leadership team in PAS (Manager, Supervisor, Leads, QA Specialist, and the Operations Analyst). The scorecard was designed using Core Elements and Collection Elements. The Core Elements consist of Aurora Health Care’s culture, values and expectations. The Collection Elements are specific to what PAS holds of value. The creation of this scorecard defined in detail for the PAS caregivers provides the expectations they would be held to, along with examples of what to say and how to say it.

New Quality Assurance Specialist

In September of 2015, Aqueelah Hardin became the new QA specialist. Aqueelah, having had collection experience, believed the best way to make the caregivers successful was to ensure they had a full understanding of how and WHY they were being scored on the specific scorecard elements. Aqueelah’s vision was to create a scorecard that was black and white for the caregivers to understand. This was done in an effort to bridge the gap between the frontline caregivers, QA and the PAS leadership team.

Revised PAS QA ScorecardCategory Description Weight

Core Elements

Core elements are used throughout Aurora’s Revenue Cycle and are consistent with Aurora’s culture, values and expectations. 50%Proper Greeting 5 pointsPlease and Thank you 5 pointsRate, Pitch and Tone 5 pointsUse of the Patient/Individuals name 3 pointsVerification 7 pointsInformation Stated is Accurate and True 5 pointsComplete and Accurate Documentation 5 points

Take Proper Action 10 points

Closing Statement 5 pointsCollection Elements

Collection elements are specific to PAS and the collection culture found in PAS. 50%Stating the Balance 3 points

Top Down Negotiations when we do not get a Payment in Full (PIF) 15 points

Stressing Payment Plan 8 pointsStressing a Phone Payment Option 8 pointsStressing Recurring Auto Withdrawal 8 pointsPayment Plan Summary 8 points

Collaboration

Through this process change many discrepancies were unveiled in scoring within the leadership team. For two months the QA specialist along with the leadership team would meet weekly (sometimes daily) to listen and score calls. This continued until the PAS Leadership team were all in agreement with scoring the scorecard.

Quality Control

To ensure the accuracy of the QA Specialist, an additional step was put into place for quality control. The Collection Manager randomly pulls 25 calls per month, scores the calls and verifies that the scores match the QA Specialist’s scores. This allows PAS to quickly rectify any discrepancies or misunderstandings that would arise.

QA Process/ Override ProcessQA Scores Call

Score was 90% or GreaterLead Lead and Supervisor

Caregiver

Agree/Dispute

Yes/Passed

No/Failed

Agree Supervisor

Dispute

Agree/DisagreeLeadCaregiver

Agree/DisagreeOr

Undecided

Disagree with dispute

Agree with dispute

Score stays the same

QA tracks and Changes

the score

Disagree with dispute

Agree with dispute

QA Specialist and ManagerDispute form is filled out

LeadCaregiver

QA and Manager review call with

leads and supervisor

Agree to change Or

Keep the same

Lead and supervisor

CaregiverLeadCaregiver

Unde

cided

Review Review

The QA process requires all scored calls to be released to the lead of the caregiver for review and then to the caregiver. This process flow explains this process and the dispute process if a disagreement in scoring is uncovered.

Getting Onboard

Now that a clear vision had been set for PAS and a newly defined QA scorecard the next step was to ensure all PAS caregivers were onboard and shared the leadership teams beliefs and vision for this process. This change provided more communication, training and overall a more transparent relationship with the PAS caregivers.

More than just scoring

The QA Specialist role consists of more than just scoring, there are side by side coaching as well as training with 2 caregivers per week. This provides the caregivers more one on one coaching and development. It also provides a new voice, reinforcing what the leads have already trained. The main focus is typically on caregivers struggling to meet the minimum QA requirements.

Caregiver Scorecard

0.0%20.0%40.0%60.0%80.0%

100.0% 91.7%100.0%100.0%100.0%100.0%100.0%91.7%100.0%91.7%100.0%91.7%91.7%100.0%100.0%

75.0%

Caregiver

82%86%90%94%98%

99%98%98%98%96%96%96%96%95%95%95%94%93%93%92%89%

PAS Quality Scores

$0.00 $60,000.00

$120,000.00 $180,000.00 $240,000.00

Dollars Collected

$30,000.00

$80,000.00

$130,000.00

$180,000.00

$230,000.00 Caregiver

At the end of each month the QA Specialist provides the leads with a scorecard for each caregiver. The scorecard shows the individual’s quality score and dollars collected along with where they ranked among their peers.

Bad Habits Document

While listening to calls the QA Specialist identifies bad habits that are taking place on the collection floor. For a bad habit to qualify on the list, it must be a trend by more than one caregiver on the collection floor. The QA Specialist will document these trends and provide the leads with examples and suggestions for correction, as an additional tool for coaching and training.

Bad Habit/ Phrase used Reasons Solutions/Suggestion phrases Month Status # of Months

Advising the individual that auto withdrawal is an option. For auto withdrawal: If you like we can set you up on auto withdrawal / It is your choice/ were given an option

Auto withdrawal will help you with your cash. This should offered as a requirement not an option.

1. I can break this up into an affordable payment plan, but I would need $300 down followed by auto withdrawal.

June Current

12

Asking yes or no questions. Will you be able to pay half of the balance now and the remaining at a later date?

Avoiding yes or no questions can lead to a better possibility of the caregiver controlling the call not the individual.

1.The account is past due for the balance of $1000. I can take your payment with credit card or check.2. I can take your payment of $500 and set the remaining balance for next month.

Febuary Current

4

Advising the individual to call back to set up plan when the patient prefer to mail the first payment or is unable to pay by phone at that time.You will need to call back to set up your plan after payment post.

When the individual declines to make the first payment by phone the caregiver can enter a promise to pay to have the plan set up once the payment has posted, or offer to post date the payment. There is no need for the individual to call back unless they plan to mail the payment outside of the 30 day window allowed.

1. If you perfer to mail the first payment I can have the plan set up once the payment post to the account as long as it post within 30 days.

2. I can post date your first payment for your next payday.

May Current

1

Call Calibrations with the caregivers

The QA Specialist meets once a month to listen and score calls with the caregivers. The groups are comprised of no more than 5 caregivers. Each group is compiled with caregivers from different skill sets, collection styles and experience levels. Calls are discussed from a QA perspective and from a preferred collection perspective. The calls selected are used to show examples of different collection styles and taglines to assist in correcting bad habits.

QA Workshop

In addition to the call calibrations, the QA Specialist facilitates a QA workshop that is held bimonthly. The workshop is used to discuss different QA topics and struggles based around the bad habits. The groups are kept to a small number of individuals, to allow the caregivers to engage and express their concerns comfortably. This also gives the caregivers a chance to provide feedback or ask questions where there are gray areas. Through dialog and sometimes-healthy debates, resolutions are reached within the groups.

Executive Summary and Group Snapshot

The QA specialist also provides statistics from the Executive Summary report. This report gives leadership a high-level snapshot of how PAS is performing as a group month over month.

Task % Scored YesProper Greeting 97.9%

Please or Thank You 97.9%

Rate, Pitch and Tone 97.9%

Use of the patients/callers name 96.8%

Verfication 89.5%

Accurate Information Stated 94.7%

Accurate Documentation 82.1%

Take Proper Action 96.8%

Closing Statement 91.6%

Stating the balance 97.4%

Top Down Negotians 89.5%

Stressing Payment Plan 95.3%

Stressing Phone Payment 96.8%

Stressing Auto Withdrawal 96.8%

Payment Plan Summary 96.8%

Average 94.5%

May - 2016 Quality Results

Encouragement

Small contests are ran monthly as a means to motivate and encourage the caregivers. The contest criteria is set by the Collection Manager and target QA, dollars collected and eliminating bad habits. This is another tool used to keep the staff motivated and improve the caregivers collection style and their quality.

Survey

Survey monkey is utilized to gain feedback from the caregivers in a confidential manner on topics they may not be comfortable vocalizing. The information obtained is used to improve PAS quality process.

Q1 What are the strengths of your QAspecialist? What does she do well?

Q2 What can your QA Specialist improve upon?

Q3 How effective do you feel the callcalibrations are for the department?

Q4 What other topics if any would you liketo see covered in the QA Workshops?

Q5 Is there a clear understanding of howyour QA specialist presents the informationto you?

Example Questions

Leadership Advice

As the PAS Team continues to strive for success. Feedback is welcomed from leaders of different departments with an open invitation to attend the PAS department call calibrations. The feedback attained is used to continue the improvement process throughout PAS and the QA department.