Registration Concepts

Registration Concepts

A Domain and Solution Overview

Participant Guide

Cerner Millennium Enterprise Registration Management

[Course Name] Participant GuideOwner: [CVU - CEE]

Tracking: [25TPL00006]Version: [1] Effective date: [07/12/2002]

To obtain permissions to modify, copy or reproduce this document contact:

or call

(888) 334-1024, then choose option 3.

Table of Contents

1.Introduction

Overview and Objectives

Length

What to Expect

Evaluation

Project Code

Task Summary

Domain Overview

Solution Overview

Workflow Activity

Online Assessment

2.Domain Overview

Facing the Facts:

Financial Problems are plaguing health care organizations

Revenue Cycle

Overview

How Does It Work?

3.A look into Patient Registration

What is Patient Registration or ADT?

Registration Information

Demographic Information

Payer Information

Patient and/or Encounter Type

About the Registration Department

Registration Models - Centralized vs Decentralized

Key Registration Processes

Pre-Register Patient

Transfer Patient

Update Patient Information

Patient Discharge

Report

Patient Privacy

Patient Opt Out

4.ERM Solution Overview

Introduction to ERM

ERM WBT Completion Instructions

How Long Will it Take?

Is There an Additional Charge?

How Do I Get Started?

Introduction to ERM Design Considerations

5.Work Flow Activity

Pre-Registration Workflow Scramble

Registration Workflow

Transfer Workflow

Discharge Workflow

6.Online Assessment

Complete the Registration Concepts Assessment via your Learning Plan in MyMedEd.

1.Introduction

Overview and Objectives

Registration Concepts is a self-study, introductory course that focuses on basic workflow and terminology within a typical clinical registration department. As part of this event, you will be briefly introduced to Cerner Millennium Enterprise Registration Management.

Participants will:

Become familiar with Clinically Driven Revenue Cycle (CDRC) concept
Develop basic understanding of Registration Department terms and processes
Correlate basic Registration Department knowledge to ERM (Tools and Application)

Length

Depending on your previous knowledge of the content, plan to spend between 5 to 12 hours completing this self-study.

What to Expect

In this self directed learning event you will be expected to think through concepts and complete tasks which may be new to you. Using your resources, you will be successful.

Evaluation

Participants will complete the online readiness assessment.

Project Code

The project code to use for your time spent on this self study learning event is 172998/5847.

Task Summary

Domain Overview

Read the Domain Overview included within this packet

Solution Overview

Read the ERM Introduction in the CMSG

From the Cerner Millennium Support Guide page, select ERM – Enterprise Registration Management, from the Overview category, select the Introduction [M2003].

Complete the Enterprise Registration Management WBT including the assessment
Read the suggested sections in the ERM Design Considerations in the CMSG

From the Cerner Millennium Support Guide page, select ERM – Enterprise Registration Management, from the Design category, select Design Considerations [M2003].

Workflow Activity

Complete the Workflow Activity included within this packet.

Online Assessment

Complete the assessment from your learning plan within MyMedEd.

2.Domain Overview

Facing the Facts:

Financial Problems are plaguing health care organizations

Over 70% of bills require manual intervention
LOST: $155,000 per year
70% of business office functions driven by errors in other departments
LOST: $1.12 million per year
21% of claims rejected by payer on first submission
LOST: $224,000 per year
20% of those rejected claims never resubmitted
LOST: $5 million per year
40% of collectors’ time spent tracking paper trail
LOST: $911,000 per year

Revenue Cycle

Overview

Revenue Cycle refers to the sequence of events that facilitate income generation for the healthcare organization.

Scheduling/Admitting/Registration, Health Information Management, Clinical departments and Patient Accounts are vital parts of the revenue cycle and work in concert for the fiscal well being of the institution.

How Does It Work?

Scheduling typically starts the patient care process by coordinating and booking all procedures /orders written by the patient’s physician. In a perfect scenario, basic demographic information, as well as insurance information, is also captured here. This allows facilities to verify insurance coverage and benefits prior to treatment.

When the patient arrives for treatment, Admitting/Registration is responsible for obtaining and/or verifying information necessary for hospital, ancillary and clinic patients. This includes patient and guarantor demographics, financial information and medical information.

Clinical departments are responsible for placing orders and / or applying charges on the encounter and documenting the patient care. Examples of clinical departments include: Lab, Radiology, Surgery, Physical, Speech and Occupational Therapy.

Health Information Management (HIM) provides the diagnosis and procedural codes and information and ensures the accuracy of supporting documentation and other data elements appearing on the bill or claim form, such as the patient’s discharge/transfer status.

Finally, Patient Accounts is responsible for applying/validating charges and billing the appropriate payers for services rendered and collecting outstanding receivables.

Because the vast majority of receivables are paid by third-party insurance, accuracy and timeliness in submitting a claim is critical to the hospital’s fiscal performance. It is essential that all departments work in concert, sharing information, etc. in order to achieve this goal.

3.A look into Patient Registration

Remember your last visit to the doctor’s office? Or maybe your most recent healthcare encounter was with the hospital. In either case, you most likely were involved with the patient registration process. You know the drill, you arrive at the facility to spend the next 10 to 20 minutes filling out forms and answering questions related to your demographic and insurance information.

What is Patient Registration or ADT?

Patient registration refers to the collection and ongoing maintenance of the crucial, non-clinical information related to each admission, discharge and transfer of a patient within a healthcare organization. Within an automated registration or ADT (Admission, Discharge, Transfer) system, this person level information is housed within the Master Patient Index (MPI).

At its most basic level, the Master Patient Index (MPI) is a database listing of all persons known to have been a patient at a given facility. The MPI should include all patients for which the HIM/Medical Records department has a legal responsibility for maintaining a medical record.

It is very important to understand that the data captured/validated during the registration process begins the processing of a patient’s financial information. What does this mean exactly? In a nutshell, it means that the insurance and demographic information collected here is used to bill the patient and/or his or her insurance carrier for services provided.

Inaccurate or incomplete information may result in inadequate or untimely reimbursement which, overtime and across multiple patients, will negatively impact the organization’s bottom line. As a preventative measure, organizational policy/procedure typically mandates that the patient demographic and insurance information be reviewed with the person each time they present, even if they were just in the facility earlier the same day. In addition, each employee is held accountable for the accuracy of information related to the registrations that they complete.

Registration Information

As discussed above, patient registration refers to the collection and ongoing maintenance of the crucial, non-clinical information related to each admission, discharge and transfer of a patient within a healthcare organization. But exactly what type of information are we talking about? The following are some data elements that are typically captured.

Demographic Information

Personal Identifiers

This will include such things as Name, Birth date and Social Security Number.

Next of Kin and Emergency Contact

Emergency contact can be any individual that the patient specifies, however there are typically very specific rules about who should be listed as Next of Kin. Next of Kin for a child, for example, should be the mother of she is living with the child. If at all possible, the individual listed as Next of Kin should not be the same individual listed as Emergency Contact.

Payer Information

Guarantor

This is the individual who will be financially responsible for the encounter. It may or may not be the same as the patient. Personal identifiers such as name, birth date and social security number are collected on the guarantor.

Financial Class

This is a classification indicating the patient’s method of payment. It is mainly used for reporting purposes. For example, the organization may want to understand the percentage of their patient population which is self pay vs the percentage that has commercial insurance or Medicare.

The following Financial Classes are common:

Self Pay (used when the patient is not insured and will be paying out of pocket)
Commercial
TriCare
Medicare
Medicaid
Workers Compensation (used when the fee for service will be covered under workers comp)

Insurance Subscriber

This is the person who carries insurance on the patient. It may or may not be the same as the patient. It may or may not be the same as the guarantor.

Insurance Plan Information

When collecting insurance information, the registrar must indicate the hierarchy of the plans in terms of responsibility for payment. This ranking/ordering of insurance coverage is referred to as Coordination of Benefits and requires knowledge of the rules of coverage. For example, a particular patient may be covered under Medicare as well as a Blue Care. The registrar will need to list each plan appropriately as either primary or secondary.

The main categories of insurance coverage are as follows:

Commercial

Commercial insurance provides health care benefits to beneficiaries. There are two basic types of commercial insurance coverage:

Group Health Care Plans – Employers normally provide coverage through group health plans administered by commercial payers

Individual or Direct Pay Health Care Plans – Plans purchased by beneficiaries may only pay a fixed amount per day for inpatient visits and may pay directly to the beneficiary instead of the provider

Commercial plans can be primary, secondary or tertiary. If the patient is eligible for Medicare and is of working age with coverage through an employer, the commercial plan is primary.

Medicare supplements are commercial plans purchased by Medicare beneficiaries to cover cost of deductibles and co-pays not covered by Medicare. Medicare supplements are never primary.

TriCare

TRICARE (formerly Champus) is a regionally managed health care program for active duty members and families, retirees and their families, some former spouses, and survivors of deceased military members. The uniformed services include the Army, Navy, Air Force, Marine Corps, Coast Guard, Public Health Service, and the National Oceanic and Atmospheric Administration.

All active duty uniformed service members are enrolled in TRICARE Prime and have no premiums. The United States is divided into ten or more regions. Each region has a different address for submitting claims.

The following types of coverage are primary to TRICARE and must pay first:

Commercial health plans, including HMO & PPO plans

Worker’s Compensation
Personal injury protection under patient’s own automobile policy
Coverage under the no-fault or uninsured motorists provisions of the patient’s own auto policy
Student insurance

Medicaid is not considered a double coverage plan, so TRICARE is always primary over Medicaid.

Workers’ Compensation

Workers’ Compensation is a state-regulated program providing employees and employers with a fair and objective review of claims related to work related incidents. Workers’ Compensation programs are funded by employers and processed by the commercial insurance carrier chosen by the employer.

Employers are responsible for notifying the state of all work-related injuries. It is general practice when a patient is identified as an “injured worker” the liability of paying medical bills is the responsibility of the employer. Prior to admission, documentation should be requested from the employer verifying that services will be covered by Workers’ Compensation.

Medicare

Medicare was created by Title XVIII of the Social Security Amendment of 1965 and is administered by the Centers for Medicare and Medicaid (CMS) [formerly Health Care Financing Administration (HCFA)]. Medicare benefits are available for the following:

Individuals 65 years and older
Certain disabled individuals
Individuals with a diagnosis of end-stage renal disease

Medicare Part A covers inpatient visits, while Part B covers outpatient services as well as physician fees. Insurance companies contract with CMS to process Medicare claims. Medicare Intermediaries for Part A and B are different for each state.

Medicaid

Medicaid is a federal/state program, established by Title XIX of the Social Security Act, which matches federal dollars to the states to provide health insurance for categories of the poor and medically indigent.

Medicaid programs vary from state to state and operate within federal guidelines. Hospitals must obtain provider numbers and follow all state regulations for submitting out-of-state Medicaid claims.

Medicaid is always the payer of last resort. If the patient’s Medicaid card indicates other coverage, that plan must be billed as primary.

Patient and/or Encounter Type

Hospitals categorize each patient and/or encounter based upon the care needed during the visit. Organizations may choose to classify at the patient level, the encounter level or both.

Depending on the processes of the facility, the encounter is added to the patient record during either the scheduling or the registration process. A unique financial number is automatically assigned by the system to each encounter. An encounter classification (type) is manually assigned by the scheduler or registrar at the time the encounter is added, but may change throughout the patient stay as a result of treatment or other circumstances. The patient/encounter type typically will help determine how services are charged/billed. Different classifications may require different types and degrees of supporting documentation. Since registration staff are responsible for assigning/validating the initial patient and or encounter type as well as for maintaining it, it is very important that they be familiar with the rules of patient/encounter classification, i.e. when to use what.

There are two main classes of patient/encounter types. Within each of these classes are various subtypes.

Inpatient

An inpatient meets criteria, whether emergent, urgent or elective, for admission to an acute care facility, as determined by his or her physician. An inpatient occupies a bed and receives services such as room and care, diagnostic and therapeutic services and medical and/or surgical services. An inpatient may be further defined and Skilled Nursing is one example of this.

Skilled Nursing: patient requires a qualifying three-day stay in an acute care facility within 30 days. A patient must be discharged from an Inpatient status prior to being admitted to a Skilled Nursing bed in the same facility.

Outpatient

An outpatient is classified as not meeting inpatient criteria and receives services other than room and care. An outpatient is further defined in one of the following classifications:

Observation: patient requires the use of a bed and periodic monitoring by nursing or other staff. Observation services usually do not exceed one day. Services exceeding 48 hours of observation charges will be denied by the majority of payers, specifically Medicare.
Outpatient Surgery: patient requires a surgical procedure and the use of a bed and periodic monitoring by nursing or other staff.
Routine: requiring no special care
Diagnostic: patient requires diagnostic treatment or services but not the use of a bed and/or monitoring.
Emergency: patient requires services in an Emergency Department for a life-threatening or emergent situation.
Urgent: Patients that must be admitted within 48 hours due to health reasons are the next step towards less severity.
Elective: In this category the patients are not in immediate danger and registration can be postponed.
Reoccurring or Series: a patient may have reoccurring encounters as a result of a long treatment process. A patient on kidney dialysis would be representative of this. Remember that each encounter is identified by a unique financial number which is used to bill for services. Recurring encounters all share the same financial number and will be billed together on the same insurance claim or patient statement.

The five most common hospital patient/encounter types are:

Emergency
Inpatient
Outpatient
Observation
Reoccurring or Series

Following are examples of possible transfer scenarios:

Emergency > Observation
Emergency > Observation > Inpatient
Observation > Inpatient
Outpatient Surgery > Observation
Outpatient Surgery > Observation > Inpatient
Outpatient Diagnostic > Observation
Outpatient Diagnostic > Observation > Inpatient