By standardizing and centralizing the registration process, Crozer-Keystone Health System has improved registration accuracy, reduced claim denials, and increased revenue.

It used to be when a patient was scheduled for a procedure at one of Crozer-Keystone Health System's hospitals, patient access staff at each separate facility would call the patient two days before the procedure for preregistration. 

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In 2009, Crozer-Keystone began moving toward a more standardized process for registration that involved centralizing registration activities for all five hospitals into one pre-encounter unit.

"With this new unit, we try to finish preregistration and obtain financial clearance for a scheduled service no later than five days out," says Richard Madison, vice president of revenue cycle operations, Crozer-Keystone, Chester, Pa.

Advantages of a Pre-Encounter Unit

Before the pre-encounter unit was implemented, each of the health system's five hospitals had its own patient access staff, process, and paperwork dedicated to registration.

"Our approach was not only fragmented and inefficient, but it frequently resulted in incomplete, inconsistent, and inaccurate registrations," says Madison. "It also caused delays in procedures because the patient access staff often had to spend critical time on the day of a procedure gathering administrative information. If there were problems obtaining this information, we sometimes performed the procedure without having the complete payer documentation in hand."

The pre-encounter unit now offers Crozer-Keystone the following advantages to standardizing the registration process:

  • Improves efficiency and productivity
  • Consolidates staff
  • Allows issue mitigation before the date of service
  • Minimizes treatment delays
  • Enhances patient flow
  • Improves patient, physician, and other customer satisfaction
  • Increases point-of-service collections
  • Reduces bad debt
  • Reduces claim denials

Overcoming Challenges

The implementation of the pre-encounter unit was not without some challenges that the health system had to overcome.

Consolidating staff. "When we went to staff the pre-encounter unit, we found that other departments-such as preclinical testing-were relying on patient access staff to help with the workload," says Madison. "By moving patient access staff to the new centralized unit, we were depriving these other departments of an extra pair of hands. We had to address this issue to smoothly move staff to the off-site location."

Scheduling procedures. "The concept of scheduling patient procedures with enough time to finish registration five days in advance was not one that existed in our organization," Madison says. "We had to shift the culture so this became an expectation for all those involved."

Proactive communication was the key to overcoming these and other challenges, he adds.

"When we recognized obstacles, we worked with the departments involved and tried to respond to the issues," says Madison. "We also maintained a steering committee of senior executives to keep leadership informed and highlight operational problems that needed to be addressed for the project to move forward."

The organization also launched a communication campaign about the new unit that included internal newsletters, visits to physicians' offices, and one-on-one communication with staff.

Since implementing the pre-encounter unit, Crozer-Keystone has seen an increase in registration accuracy and staff productivity, which has led to a decrease in administrative denials. According to Madison, creating the new department has helped lay the groundwork for cultural change within the organization, showing how a systematic, centralized approach can help improve revenue cycle performance.

Interviewed for this article: Richard Madison, vice president of revenue cycle operations, Crozer-Keystone Health System, Chester, Pa., and a member of HFMA's Metropolitan Philadelphia Chapter (

Publication Date: Monday, May 09, 2011