MHA 505 Week 5
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Running head: ROOT CAUSE ANALYSIS |
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Record documentation contains spelling and grammar errors making it difficult to understand and causing unnecessary client escalations.
why
R&D budget was spent on items that would prevent extra work for staff such as rules engines.
why
Microsoft Word also does not correctly identify and spell some medical terms correctly. We also use abbreviations and Word does not recognize common medical abbreviations.
why
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Three significant system enhancements in 2016-2018 took priority over adding a spelling and grammar check.
Development resources previously denied for this project.
There is no integrated spelling or grammar check in the system
Some representatives copy/paste their notes into Microsoft Word to check spelling and grammar, but there often is not enough time to complete this and make quotas, so reps skip this step leaving the grammar and spelling mistakes in the notes.
English is the second language for overseas employees, so grammar and spelling mistakes are common due to where the work is being performed
Invest in development time to build a spelling and grammar check into the system for the precertification team.
Incomplete clinical documentation faxed to carriers on the first submission.
To counter the lack of medical experience athenahealth previously provided extensive new hire training to the offshore team. Due to the recent influx in the number of new offshore employees, the length of the new hire training was reduced to accommodate more classes and onboard the staff faster.
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We partner with an offshore vendor that has high customer service ratings but most of the employees have technology, but no medical office experience.
Many of the reps have no clinical experience, so they do not understand what is being requested from a carrier when it comes to clinical documentation.
Patients may be seen for multiple visits each with different medical needs, so the reps pull incorrect documentation or submit only the last visit to the carrier.
Representatives are confused on what medical records need to be pulled from a patient’s record and think they are pulling the correct documents.
Utilize stateside staff to help cover work queues and rotate offshore employees in for additional training on what clinical documentation from athenaclinical to submit to carriers based on the CPTs ordered.
Recent delays in imaging order turnaround time.
why
English is a second language for most offshore reps, so when the athena rep can’t answer the payer’s questions, we must fax over clinical documentation. This process results in longer turnaround times for precertification decision.
Language barriers between rep at carrier and athena offshore rep.
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athena terminated the contract with one offshore center recently and had been ramping up staffing in the remaining offshore center to replace the number of lost employees.
The recent number of new hires have resulted in faster onboarding and less training for offshore staff.
The number of requisitions in the queue is 2 times larger than usual.
Representaives are spending an average of 15 minutes per order on the phone.
Representatives struggle with finding and interpreting information when nurses at the payer ask them medical questions found on clinical documents on the patient's record.
Part 1 - Use stateside staff to help relieve queue volumes. Part 2- Complete additional training for offshore staff on clinical information.