JOHNS HOPKINS MEDICINE PATIENT ACCESS COMPREHENSIVE INSURANCE TRAINING
At Johns Hopkins Medicine, all Patient Access employees—as well as many new hires from seven other Johns Hopkins entities—attend six days of insurance training comprising Foundations of Insurance, Government Insurance, and Commercial Insurance. This program is the first of its kind and is more comprehensive and in-depth than any offered by other healthcare organizations. In fact, other healthcare entities have reached out to Hopkins with offers to purchase the program to duplicate at their organizations. Attendees with experience at other healthcare organizations report a maximum of a one-day insurance class in former jobs, with some reporting as little as an hour of insurance training. They appreciate the value of Hopkins’ six-day program.
Program Details
In the Foundations of Insurance session, participants learn about the healthcare revenue cycle and how it impacts them as schedulers and/or registrars. They learn common mistakes schedulers make and the effects these have on the healthcare revenue cycle.
During Government Insurance, participants learn the different types of government insurance and how to accurately collect government insurance information from patients.
Finally, during Commercial Insurance, participants define “commercial health insurance” and identify its key characteristics.
This program is delivered synchronously online via Zoom and features the use of gamification tools such as Kahoot! and Jeopardy-style games. Exercises to reinforce learning include fill-in-the-blank worksheets, matching games, and crosswords. Learners are taught to interact with tools such as the Office of Managed Care Website to gain hands-on experience practicing the workflows they will need on the job to determine plan participation and avoid claim denials.
After class, Patient Access new hires are paired with an experienced agent, lead, or supervisor in their department. These “peer mentors” reinforce what was learned in insurance and other classes. As soon as new hires begin taking calls independently, they meet regularly with an assigned Quality Partner (QP) to listen to and discuss some of their calls. (All calls are recorded.) The QPs review and score call elements, including confirming the patient’s insurance plan, to ensure the new hire’s workflow reflects what was learned in class. The QP relationship continues throughout the agent’s career as a Patient Access specialist. The average quality score in fiscal year 2024 for all departments was 87.05 percent, with all departments scoring at least the goal of 80 percent.
Insurance knowledge is reinforced constantly. The Training program manager sends a monthly newsletter called Hot Off the Press, which summarizes relevant information from the monthly Office of Managed Care call. These calls communicate new information (such as new insurance products on the market) and refresher information based on recent issues (such as patients who have been scheduled with insurance that Hopkins is not contracted with, resulting in rejected claims and lost revenue). These newsletters then are posted on the Quality Corner SharePoint site for reference. Biweekly one-page newsletters called Did You Know? also are sent. These cover one topic each, reinforcing insurance facts that were associated with evidence of confusion or errors.
The AWARE system (“Awareness and Accountability of Registration Errors”) is used to notify users about the number of warnings bypassed during the registration process. Employees who bypass more than 50 warnings in a month also receive microlearnings prioritized by the number of errors and the impact of those errors on insurance denials.
Former participants are allowed to take refresher training sessions at the request of their manager. Entire business units have required their staff to retake the classes if they had not taken them within a certain time period to reinforce the knowledge long term.
The director of Talent Management, Quality Assurance, and Training was instrumental in the development of the Comprehensive Insurance program. He, along with the assistant director of Training and other Training team members, worked alongside the Office of Managed Care to research, identify objectives, and determine content for the program. This team marketed the program to Hopkins entities and departments in a “road show” format. Enrollments grew as word spread to the point that classes are often full, with employees waitlisted.
Results
The value of training staff on insurance principles has long-reaching consequences that affect both revenue and patient experience. If staff do not understand insurance principles, they could schedule patients with insurance plans that Hopkins does not participate with, causing these patients undue stress. This also can cause claims to be denied, and the site could be forced to absorb the visit costs. Denials enterprise-wide dropped to 4.96 percent in fiscal year 2024, achieving the goal of being below the industry benchmark and equating to a reduction of $3.5 million, which reflects the combined impact of various initiatives.
