Key Performance Indicators (KPIs): How Do You Know You Survived?

Size: px
Start display at page:

Download "Key Performance Indicators (KPIs): How Do You Know You Survived?"

Transcription

1 HFMA-Florida 2014 Spring Conference & Annual Meeting Tampa, FL 15 May 2014 Key Performance Indicators (KPIs): How Do You Know You Survived? David Hammer, FHFMA Principal Revenue Cycle and Managed Care Healthcare Performance Management Consultants Berkeley Lake, GA

2 Content and Organization Introduction KPI Concepts Today s World... and Tomorrow s Key Performance Indicators Performance Measurement Concepts KPI Hierarchy Level I, II, III, and IV KPIs Metric-Driven Revenue Cycle 1

3 Content and Organization (cont d) Appendices Definitions of HFMA s MAP Keys KPIs by Functional Area Best Practice Performance Standards Best Practice Processes Call to Action Managed Care Contracting 2

4 KPI Concepts Even the VERY BEST Keep Score! In business, words are words, explanations are explanations, promises are promises, but only performance is reality. Harold S. Geneen Former President and CEO of ITT 3

5 KPI Concepts Even the VERY BEST Keep Score! If you can t measure it, you can t manage it. Michael Bloomberg CEO of Bloomberg, Inc. and former New York City Mayor 4

6 KPI Concepts Revenue Cycle Structure and Function Billing Denials & Discrepancies Follow-up Collection Cash Posting Pricing Compliance Contracting Registration Coding Financial Counseling SOURCE: St. Vincent Health System, Indianapolis 5

7 KPI Concepts Revenue Cycle Structure and Function COMPLIANCE HEALTHCARE REFORM Financial Institutions COST CONTAINMENT O.I.G & Other Regulators 5 REGISTRATION & POS CASH COLLECTIONS 6 CHARGE CAPTURE & ENTRY 7 MEDICAL MANAGEMENT Information Technology 8 MEDICAL RECORDS & CODING 9 CLAIMS SUBMISSION Medicare & Medicaid FIs 10 THIRD PARTY FOLLOW-UP RACs & MICs 4 FINANCIAL COUNSELING 3 INSURANCE VERIFICATION PATIENT 12 REJECTION PROCESSING 11 PAYMENT POSTING Capital Markets Affiliated & Employed MDs CONSOLIDATION / STANDARDIZATION 2 PRE-REG & PRE-CERT 1 SCHEDULING Revenue Employers CASH FLOW 14 CONTRACT NEGOTIATION / ADMIN. 13 DENIAL & APPEAL MANAGEMENT HMOs / PPOs QUALITY-DRIVEN REIMBURSEMENT SOURCE: PriceWaterhouse Coopers 6

8 Today s World and Tomorrow s 7

9 Today s World You Know the Trends 8

10 9

11 Today s World If We Can Do THIS 10 10

12 Then Why Can t We Come Up With Something Better Than THIS?!? 11

13 Today s World It s Not Our Fault, But It IS Our Problem! 12

14 Today s World What s the Bottom Line? $ COVERAGE REFORM PAYMENT REFORM Predicting rain doesn't count; building arks does. Warren Buffett 13

15 100% 80% 60% Today s World ACA Readiness Not IF, WHEN! Payment Mix Today Incremental Payment-Mix Shift Under Payment / Delivery Reform Bundling (Episodic) FFS Shared Savings Traditional Capitation Global Payment + Episodic Bundling FFS Shared Savings POV: Market Summary Global Payment + Episodic Bundling 40% 20% Traditional FFS Traditional FFS FFS Shared Savings Traditional FFS P4P: Varying levels of use with Traditional Fee-For-Service Next Generation P4P: ~60% of all payment systems Next Generation P4P: ~80% of all payment systems Government Programs Timeline Hospital value-based purchasing program Shared Savings Program Bundled Payment Pilot Voluntarily meet quality thresholds for ACOs Evaluation until 2016, w/extension Physician Quality Reporting Initiative Individual feedback physician reports 2014-Payments reduced for failure to submit quality measures 14

16 Today s World Fee For Service World Remains Challenging Major Impact of ICD-10 in October 2015 (or not) ICD-10-CM (diagnoses) used for inpatient and outpatient ICD-9 CM Number of Codes ICD-10 CM Number of Codes 13,800 68,000 ICD-9 PCS Number of Codes ICD-10 PCS Number of Codes 3,800 87,000 CPT-4 codes will continue to be used for outpatient procedure coding 15

17 Today s World Fee For Service World Remains Challenging Ten Iron-Clad Rules 1. Just because it has a code, that doesn t mean it s covered 2. Just because it s covered, that doesn t mean you can bill for it 3. Just because you can bill for it, that doesn t mean you ll get paid for it 4. Just because you ve been paid for it, that doesn t mean you can keep the money 5. Just because you ve been paid once, that doesn t mean you ll get paid again 16

18 Today s World Fee For Service World Remains Challenging Ten Iron-Clad Rules 6. Just because you got paid in one state doesn t mean you ll get paid in another state 7. You ll never know all the rules 8. Not knowing the rules can land you in the slammer 9. There s always someone who doesn t get the message 10.There s always someone else who gets the message and ignores it 17

19 Today s World Where to Focus, and WHEN? Comments from Health Insights at Stamford How can we scale for a 28% Medicare cut? Even if we merge it is not scalable We do not think the majority of revenue will be value based only certain products I am a skeptic of population health management when an insurance company wants to off load risk, then we do not want that risk The government is not a good long-term business partner The Pioneer ACOs are not working the juice is not worth the squeeze No incentive for patients to stop smoking, exercise, etc Stick to basics, manage costs, and grow volume We will do an ACO for our employees If we cannot do it there, we cannot do it anywhere (Frank Sinatra) I sat with a bunch of Boston hospitals and they are still fee-for-service Culture is the biggest challenge. Our physician group is not organic, but an amalgamation; the problem is that we are trying to change the tires on a moving car 18

20 Today s World Five New-World Imperatives and Priorities ICD-10 Transition Pricing Transparency Physician & Hospital Alignment Health Care Reform Data Explosion Minimize surprise of new contracts and new denials Deploy defensible pricing and increase upfront collections Integrate physicians into financial operations Manage the transition of fee-forservice to fee-for- value Discover actionable insights to drive clinical and financial advantage 19

21 Where s Your Focus? 20

22 How Should You Measure Performance? 21

23 Key Performance Indicators Performance Measurement Concepts Why Use KPIs? Keep a record and tell a story Benchmark against your goals and industry best practices Identify and manage trends, not singleperiod results Illustrate relationships between KPIs 22

24 Use external, verifiable info sources Share the same data with everyone Board Senior management Peers Key Performance Indicators Performance Measurement Concepts Subordinates Report both good and bad results 23

25 Not All KPIs Are Created Equal 24

26 Key Performance Indicators KPI Hierarchy Level I: Board members, senior execs, financial and clinical directors, and internal reporting for all revenue cycle managers, supervisors, and employees Level II: CFO, finance directors and employees, and internal reporting for all revenue cycle managers, supervisors, and employees Level III: CFO plus internal reporting for all revenue cycle managers, supervisors, and employees Level IV: Internal comparisons of different payors plus external reporting for third party payors 25

27 Key Performance Indicators KPI Hierarchy First-Level Indicators Cash collections Gross and net A/R In-House and D-N-F-B receivables 3 rd -party aging % > 90 days Cash % of net revenue Cost to collect % 26

28 Key Performance Indicators Cash Collections First Level 27

29 Key Performance Indicators Cash Collections First Level KPI GOAL M-T-D % DAYS % $ $20M $11M 55% 28

30 Key Performance Indicators Gross A/R First Level 29

31 Key Performance Indicators Net A/R First Level 30

32 Key Performance Indicators In-House and D-N-F-B A/R First Level 31

33 Key Performance Indicators 3 rd- Party Aging % > 90 Days First Level 32

34 Key Performance Indicators Cash % of Net Revenue First Level 33

35 Key Performance Indicators Cost-to-Collect % First Level 34

36 Key Performance Indicators KPI Hierarchy Second-Level Indicators Net A/R days Allowance for doubtful accounts Bad debt + charity % of gross revenue Denials % of gross revenue Cash % of collection goal Point-of-service cash % of POS goal 35

37 Key Performance Indicators Net A/R Days Second Level 36

38 Key Performance Indicators Allowance for Doubtful Accts Second Level 37

39 Key Performance Indicators B/D + Charity % of Gross Rev Second Level 38

40 Key Performance Indicators Denials % of Gross Revenue Second Level 39

41 Key Performance Indicators A/R Cash % of Cash Goal Second Level 40

42 Key Performance Indicators P-O-S Cash % of Goal Second Level 41

43 Key Performance Indicators KPI Hierarchy Third-Level Indicators Credit balance receivables Clean claims throughput % Collection agency netback % Net revenue Case mix index (CMI) Complaints to Administration Open accounts 42

44 Key Performance Indicators Credit-Balance Receivables Third Level 43

45 Key Performance Indicators Clean-Claim Throughput % Third Level 44

46 Key Performance Indicators Collection Agency Netback % Third Level 45

47 Key Performance Indicators Net Revenue Third Level 46

48 Key Performance Indicators Case Mix Index (CMI) Third Level 47

49 Key Performance Indicators Complaints to Administration Third Level 48

50 Key Performance Indicators Open Accounts Third Level 49

51 Key Performance Indicators Managed Care Report Cards Fourth Level Revenue Cycle KPI reporting sample for: Board of Directors Finance Committee Finance Division Internal reporting Managed Care Report Cards (letters, actually) 50

52 Key Performance Indicators Managed Care Report Cards Fourth Level By Major Payor Category or Plan Code % of Total A/R >60 Days % of A/R >35 Days (No Pmt, No Response) % of A/R in Underpaid Category % of A/R in Appeal Status % of A/R in Overpaid Category 51

53 Key Performance Indicators Managed Care Report Cards Fourth Level MEASUREMENT PEER COMPARISONS SHOW Total A/R by month Overall A/R trend & direction % A/R >60 days Claims processing issues % A/R >35 days Promptness of payment %/$ Underpaid Contract interpretation issues %/$ Denials under appeal Denial issues %/$ Overpaid Contract interpretation issues 52

54 Key Performance Indicators Managed Care Report Cards Fourth Level 53

55 Key Performance Indicators Managed Care Report Cards Fourth Level 54

56 Key Performance Indicators Managed Care Report Cards Fourth Level 55

57 Key Performance Indicators Managed Care Report Cards Fourth Level 56

58 SO... You Think You Want a Metric-Driven Revenue Cycle? 57

59 SO... You Think You Want a Metric-Driven Rev Cycle? Winning Organizational Strategies 58

60 SO... You Think You Want a Metric-Driven Rev Cycle? According to HFMA Key Action Steps Improve cash collections and revenue cycle operations Examine existing processes to identify those that should be re-engineered to take advantage of EHRs Evaluate performance on current quality measures and begin a campaign to improve them Work to understand the causes of preventable readmissions and develop an action plan to eliminate them Strive to continuously improve operating efficiency Develop a more integrated relationship with physicians Begin ACO planning and implementation 59

61 SO... You Think You Want a Metric-Driven Rev Cycle? Planning and Implementing Key Thoughts How do you start? Open the discussion Take time to define / refine KPIs Gain consensus and commitment How do you use KPIs to enact change? Understand processes that generate KPIs Create a culture of accountability and reward Continuously adapt and iterate 60

62 SO... You Think You Want a Metric-Driven Rev Cycle? Planning and Implementing Key Thoughts Take the complexity out; simplify your work View key indicators that provide early warnings Maintain personal involvement in critical areas Access a mix of early-warning and historical data 61

63 SO... You Think You Want a Metric-Driven Rev Cycle? Planning and Implementing Key Thoughts Consider the following questions How do we enter data? How do we get reports? How do we use information to effect change? When / why are things out-of-control? What do we do? 62

64 SO... You Think You Want a Metric-Driven Rev Cycle? Planning and Implementing Call to Action! Open / frame the discussion 5% Define / refine KPIs 50% Gain consensus / commitment 10% Demand accountability / reward results 25% Continuously adapt and iterate 10% Achieve results! 100% 63

65 Where s Your Focus? 64

66 Bibliography Questions to Ask Before Signing a Managed Care Contract, Private Sector Advocacy, Dec BearingPoint, Key Performance Indicators, Catholic Health East, Canfield, David and Scott Johnston, HFMA Patient Revenue Cycle Industry Study, Healthcare Financial Management Association, Westchester, IL, Clinical Quality Guidelines, NEJM, 348: , June 26, Guyton, Elizabeth and Chuck Lund, Transforming the Revenue Cycle, Healthcare Financial Management, Mar Harris, David, Turning Your Revenue Cycle Into a Hot Rod Using Bolt- On Technology, HFMA ANI, Jun LaForge, Richard and Johnny Tureaud, Revenue-Cycle Redesign: Honing the Details, Healthcare Financial Management, Jan Managed Care Forum Contracting Checklist, HFMA Wants You to Know, 21 Apr

67 Bibliography 9. Miller, Thomas, Conducting a Managed Care Contract Review, Healthcare Financial Management, Jan Pogue, Neil CMS Program Office, Medicare Policy Update, HFMA s Revenue Cycle Strategies Conference, San Francisco, 09 Oct Schneider, Robert, Sheldon Mandelbaum, Ken Braboys, and Cynthia Bailey, Process-Centered Revenue Cycle Management Optimizes Payment Process, Healthcare Financial Management, Jan Stevenson, Paul, Managed Care Cycle Provides Contract Oversight, Healthcare Financial Management, Mar Walters, Roy, Five Steps to Great Revenue Cycle Management, Healthcare Financial Management, May Wennberg, John, E. Fisher, T. Stukel and S. Sharp, Use of Medicare Claims Data to Monitor Provider-Specific Performance Among Patients with Severe Chronic Illness, Journal of Health Affairs, 07 Oct Wilson, David, 3 Steps to Profitable Managed Care Contracts, Healthcare Financial Management, May

68 Instructor s Bio David Hammer, Principal Healthcare Performance Management Consultants, LLC Mr. Hammer is a Principal at Healthcare Performance Management Consultants, LLC (HPMC), in Berkeley Lake, GA. In his leadership role at HPMC, he works with hospitals and health systems to optimize revenue cycle and managed care outcomes. Prior to joining HPMC, David was Senior Vice President of Revenue Cycle Advisory Solutions at MedAssets and is a former Partner at Accenture. David focuses on revenue cycle and healthcare reform issues for hospitals, health systems, and related entities. He serves many of the largest health systems, MD-led clinics, and academic medical centers in the US. He was formerly VP of enterprise revenue management at McKesson and previously Chief Revenue Officer for Charter Behavioral Health, a +100-facility health system. David has over 30 years of healthcare experience, including executive leadership and direction, revenue cycle transformation, information system planning / implementation, and consulting. He has worked for a variety of leading health systems, software vendors, and professional services firms. Background and Affiliations Mr. Hammer received an MBA in Management and an MHS in Health Care Administration from the University of Florida. He also received a BBA in Accounting with a minor in Information Systems from the University of North Florida. Mr. Hammer is certified by HFMA as a Fellow (FHFMA) and as a Certified Healthcare Finance Professional (CHFP). He has been repeatedly named an HFMA Distinguished Speaker, and is a 2007 recipient of HFMA s Medal of Honor service award. Recent Publications Mr. Hammer is the author of No Money, No Mission Healthcare Revenue Cycle Best Practices, which will be published in 2014 by Healthcare Performance Press. Mr. Hammer s most recent publication is Health Reform: Intended and Unintended Consequences, which appeared in the October 2010 issue of HFMA s healthcare financial management journal (hfm). Don t Panic: CFOs React to the New Economic Reality, appeared in hfm s March 2009 issue. Mr. Hammer authored the February 2008 cover story in hfm, entitled Beyond Bolt-Ons Breakthroughs in Revenue Cycle Information Systems. He also wrote the July 2007 cover story, called The Next Generation of Revenue Cycle Management, as well as the July 2005 hfm cover story, entitled Performance is Reality: Is Your Revenue Cycle Holding Up? Another one of his articles, UPMC s Metric-Driven Revenue Cycle, appeared in the September 2007 issue of hfm, Contact Information Mr. Hammer can be reached by telephone at (954) and/or by at or 67

69 68

70 Appendices 69

71 Definitions of HFMA s MAP Keys 70

72 HFMA s MAP Initiative MAP Keys: Net Days in A/R Purpose Value Calculation Indicator Purpose Value Calculation Net days in A/R Trending indicator of overall A/R performance Indicates revenue cycle efficiency Net A/R Average Daily Net Patient Service Revenue 71

73 HFMA s MAP Initiative MAP Keys: Aged A/R Percentage of Final-Billed A/R Purpose Value Calculation Indicator Aged A/R as a percentage of Billed A/R Purpose Value Calculation Trending indicator of receivables collectability Indicates RC s ability to liquidate A/R >30,>60,>90,>120 days Total Billed A/R 72

74 HFMA s MAP Initiative MAP Keys: Point-of-Service Cash Collections ($) Purpose Value Calculation Indicator Point-of-Service Cash Collections Purpose Value Calculation Trending indicator of point-of-service collection efforts Indicates potential exposure to bad debt, accelerates cash collections, and can reduce collection costs POS Payments Total Patient Cash Collected 73

75 Indicator HFMA s MAP Initiative MAP Keys: Cost to Collect Purpose Value Calculation Cost to Collect Purpose Value Calculation Trending indicator of operational performance Indicates the efficiency and productivity of RC process Total RC Cost Total Cash Collected 74

76 HFMA s MAP Initiative MAP Keys: Cash Percentage of Net Revenue Purpose Value Calculation Indicator Purpose Value Calculation Cash Collections as a Percentage of Adjusted Net Patient-Service Revenue Trending indicator of propensity to convert net revenue to cash Indicates fiscal integrity / financial health of the organization Total Cash Collected Average Monthly Net Revenue 75

77 Indicator Purpose Value Calculation HFMA s MAP Initiative MAP Keys: Bad Debt (%) Purpose Value Calculation Bad Debt Trending indicator of the effectiveness of self-pay collection efforts and financial counseling Indicates organization s ability to collect self-pay accounts and identify payor sources for patients unable to meet financial obligations Bad Debt Write-Off Gross Patient Service Revenue 76

78 Indicator HFMA s MAP Initiative MAP Keys: Charity Care (%) Purpose Value Calculation Charity Care Purpose Value Calculation Trending indicator of local ability to pay Indicates organization s ability to collect self-pay accounts and identify payor sources for patients unable to meet financial obligations Charity Care Write-Off Gross Patient Service Revenue 77

79 Indicator Purpose Value HFMA s MAP Initiative MAP Keys: Days in Total DNFB Purpose Value Calculation Days in Total Discharged Not Final Billed Trending indicator of local ability to pay Indicates RC performance and can identify performance issues impacting cash flow Calculation Gross Dollars in DNFB A/R Average Daily Gross Revenue 78

80 HFMA s MAP Initiative MAP Keys: Aged A/R Percentage of Billed A/R by Payor Purpose Value Calculation Indicator Purpose Value Calculation Aged A/R as a % of Billed A/R, by Payor Group Trending indicator of receivables collectability, by payor group Indicates RC s ability to liquidate A/R, by specific payor group Billed Payor Group by Aging (>30,>60,>90,>120 days) Total Billed A/R by payor group 79

81 Indicator Purpose Value Calculation HFMA s MAP Initiative MAP Keys: Days in FBNS Purpose Value Calculation Days in Final Billed Not Submitted to Payor (FBNS) Trending indicator of claims delayed by payor / regulatory edits in the claims processing system Track the impact of internal / external requirements for clean claim production, which impact cash flow Gross Dollars in FBNS Average Daily Gross Revenue 80

82 HFMA s MAP Initiative MAP Keys: Days in DNSP (DNFB + FBNS) Purpose Value Calculation Indicator Purpose Days in Total Discharged Not Submitted to Payer (DNSP) Trending indicator of total claimsgeneration / submission effectiveness Value Calculation Indicates revenue cycle performance and can identify performance issues impacting cash flow Gross $ in DNFB + Gross $ in FBNS Average Daily Gross Revenue 81

83 Indicator Purpose Value HFMA s MAP Initiative MAP Keys: Late Charge Percentage Purpose Value Calculation Calculation Late Charges as % of Total Charges Measure of revenue-integrity effectiveness Identify opportunities to improve revenue integrity, reduce avoidable costs, enhance compliance, and accelerate cash flow Charges with posting dates greater than 3 days from final service date Total gross charges 82

84 HFMA s MAP Initiative MAP Keys: Initial Zero-Pay Denial Rate (#) Purpose Value Calculation Indicator Purpose Value Calculation Initial Denial Rate Zero-Pay Claims Trending indicator of percentage of claims not paid Indicates provider s ability to comply with payor requirements and payor s ability to accurately pay claims Number of zero-pay claims denied Number of total claims remitted 83

85 HFMA s MAP Initiative MAP Keys: Initial Partial-Pay Denial Rate (#) Purpose Value Calculation Indicator Purpose Value Calculation Initial Denial Rate Partial-Pay Claims Trending indicator of percentage of claims partially paid (underpaid) Indicates provider s ability to comply with payor requirements and payor s ability to accurately pay claims Number of partial-pay claims denied Number of total claims remitted 84

86 Indicator HFMA s MAP Initiative MAP Keys: Appeals Success Rate (#) Purpose Value Calculation Denials Overturned on Appeal Purpose Value Calculation Trending indicator of provider s success in managing the appeal process Indicates opportunities for payor and provider process improvement and cash-flow improvements Number of appealed claims paid Total number of claims appealed and finalized or closed 85

87 Indicator Purpose Value HFMA s MAP Initiative MAP Keys: Net Days in A/R Credits Purpose Value Calculation Calculation Net Days Revenue in Credit Balances Trending indicator to accurately report A/R values, ensure regulatory compliance, and monitor overall A/R management effectiveness Indicates whether credit balances are managed to appropriate levels and are compliant w/ regulatory requirements Dollars in Credit Balances Average Daily Net Patient-Service Revenue 86

88 Indicator Purpose HFMA s MAP Initiative MAP Keys: Pre-Registration Rate Purpose Value Calculation Pre-Registration Rate Trending indicator of timeliness, accuracy, and efficiency of patient access processes Value Calculation Indicates revenue cycle efficiency and effectiveness Number of patient encounters pre-registered Number of scheduled patient encounters 87

89 Indicator Purpose Value HFMA s MAP Initiative MAP Keys: Insurance Verification Rate Purpose Value Calculation Insurance Verification Rate Trending indicator of timeliness, accuracy, and efficiency of patient access processes Indicates revenue cycle process efficiency and effectiveness Calculation Total number of verified encounters Total number of registered encounters 88

90 Indicator Purpose HFMA s MAP Initiative MAP Keys: Service-Authorization Rate Purpose Value Calculation Service-Authorization Rate Trending indicator of timeliness, accuracy, and efficiency of patient access processes Value Calculation Indicates revenue cycle process efficiency and effectiveness Number of encounters authorized Number of encounters requiring authorization 89

91 Let s Get Down to Details... KPIs by Functional Area 90

92 KPIs by Functional Area Scheduling Pre-Registration / Pre-Authorization Insurance Verification Patient Access / Registration Financial Counseling Health Information Management Charge Entry / Revenue Protection 91

93 KPIs by Functional Area Billing / Claim Submission 3 rd -Party and Guarantor Follow-Up Cashiering / Refunds / Adj Posting Denials Customer Service Collection / Outsourcing Vendors Physician Practice Management Managed Care Contracting 92

94 KPIs by Functional Area Scheduling KPI Description Standard 1. Overall scheduling rate of potentially-eligible patients: 100% Scheduling rate for elective and urgent inpatients 100% Scheduling rate for ambulatory surgery patients 100% Scheduling rate for hi-$ outpatient diagnostic patients 100% 2. Scheduled patients pre-registration rate 98% 93

95 KPIs by Functional Area Scheduling KPI Description Process 1. Use on-line scheduling software house-wide? Yes 2. Have central scheduling unit? Yes 3. Central scheduling answers to Chief Revenue Officer? Yes 4. Surgery uses same scheduling software as other depts? Yes 5. Scheduling system integrated with registration system? Yes 6. Use on-line OP medical necessity system prior to service? Yes 7. Pre-certification requirements shared with MDs offices? Yes 94

96 KPIs by Functional Area Scheduling KPI Description Process 8. MDs and patients able to make on-line appt requests? Yes 9. Non-emergency services scheduled 12+ hours in advance? Yes 10. Process and IT integrated between scheduling and pre-reg? Yes 11. Services postponed if not pre-authorized in advance? Yes 12. Financial counseling part of scheduling process? Yes Patient balances and payment obligations discussed? Hospital policy for point-of-service payment explained? Reminder to bring required payment & insurance cards given? Yes Yes Yes 95

97 KPIs by Functional Area Pre-Registration / Pre-Authorization KPI Description Standard 1. Overall pre-registration rate of scheduled patients 98% 2. Overall insurance verification rate of pre-registered patients 98% 3. Deposit request rate for co-pays and deductibles 98% 4. Deposit request rate for elective admissions / procedures 100% 5. Deposit request rate for prior unpaid balances 98% 6. Data quality compared to pre-established dept standards 99% 96

98 KPIs by Functional Area Pre-Registration / Pre-Authorization KPI Description Process 1. Have dedicated pre-registration / pre-authorization unit? Yes 2. Process and IT integrated between scheduling and pre-reg? Yes 3. Services postponed if not pre-authorized in advance? Yes 4. Financial counseling part of pre-reg / pre-auth process? Yes Patient balances and payment obligations discussed? Hospital policy for point-of-service payment explained? Reminder to bring required payment & insurance cards given? Yes Yes Yes 97

99 KPIs by Functional Area Insurance Verification KPI Description Standard 1. Overall insurance verification rate of scheduled patients 98% 2. Overall ins verification rate of pre-registered patients 98% 3. Ins verf rate of unscheduled IPs w/in one day 98% 4. Ins verf rate of unscheduled hi-$ OPs w/in one day 98% 5. Data quality compared to pre-established dept standards 99% 98

100 KPIs by Functional Area Insurance Verification KPI Description Process 1. Have dedicated insurance verification unit? Yes 2. Process and IT integrated between ins verf / patient access? Yes 3. Use on-line insurance verification system? Yes 4. Financial counseling part of insurance verification process? Yes Alternate arrangements for non-covered patients explored? Hospital policy for point-of-service payment explained? Reminder to bring required payment & insurance cards given? Yes Yes Yes 99

101 KPIs by Functional Area Patient Access / Registration KPI Description Standard 1. Average registration interview duration 10 min 2. Average patient wait time 10 min 3. Average IP registrations per registrar / per shift Average OP registrations per registrar / per shift Average ER registrations per registrar / per shift Data quality compared to pre-established dept standards 99% 7. ABNs / MSPQs obtained when required 100% 8. MPI duplicates created daily as a % of total registrations 1% 100

102 KPIs by Functional Area Patient Access / Registration KPI Description Process 1. Patient Access reports to Chief Revenue Officer? Yes 2. All registrars report to Patient Access or within rev cycle? Yes 3. Use on-line document imaging system? Yes 4. Financial counseling part of patient access process? Yes Patient balances and other payment obligations collected? Policy for payment alternatives explained (credit cards, etc.)? Copies of required payment & insurance cards obtained? Yes Yes Yes 101

103 KPIs by Functional Area Patient Access / Registration KPI Description Process 5. Registrars incentive compensation tied to quality indicators? Yes 6. Registration system integrated / interfaced to PFS system? Yes 7. Use on-line / web-enabled patient self-registration system? Yes 8. Use on-line OP medical necessity system prior to service? Yes 9. Use on-line registration data quality tracking system? Yes 10. Have on-line interface to owned MDs registration system? Yes 102

104 KPIs by Functional Area Financial Counseling KPI Description Standard 1. Collection of elective services deposits prior to service 100% 2. Collection of IP patient-pay balances prior to discharge 65% 3. Collection of OP patient-pay balances prior to service 75% 4. Collection of ER patient-pay balances prior to departure 50% 5. Screening of uninsured IPs and hi-bal OPs for fin assist 98% 6. Pmt arrangements for non-charity eligible IPs / hi-bal OPs 98% 7. Prompt-payment discount percentage(s) 05 20% 103

105 KPIs by Functional Area Financial Counseling KPI Description Process 1. Financial counseling reports to Chief Revenue Officer? Yes 2. Uninsured IPs and high-balance OPs screened for fin assist? Yes Medicaid eligibility? State, local, and hospital charity programs? Grants / studies, etc.? Yes Yes Yes 3. Financial counselors interview patients in their rooms? Yes 4. Prompt payment discounts offered? Yes 104

106 KPIs by Functional Area Financial Counseling KPI Description Process 5. Fin counselors incentive compensation tied to collections? Yes 6. Discuss pmt alternatives w/ non-charity eligible patients? Yes Credit cards? Bank-loan financing? Interest-bearing hospital-funded payment arrangements? Yes Yes Yes 7. All IPs cleared thru financial counselors before discharge? Yes 8. Proof of income / assets obtained from charity applicants? Yes 105

Key Performance Indicators (KPIs): Strategies for a High-Performance Revenue Cycle

Key Performance Indicators (KPIs): Strategies for a High-Performance Revenue Cycle HFMA-Georgia Fall Institute Savannah 09 November 2012 Key Performance Indicators (KPIs): Strategies for a High-Performance Revenue Cycle David Hammer, FHFMA Senior Vice President Revenue Cycle Advisory

More information

Using Key Performance Indicators (KPIs) for Managed Care Contract Re-Negotiation

Using Key Performance Indicators (KPIs) for Managed Care Contract Re-Negotiation Using Key Performance Indicators (KPIs) for Managed Care Contract Re-Negotiation David Hammer Partner Accenture Ft. Lauderdale Caesar s Managed Palace Care Resort KPIs Sunday, 29 January 2012 Key Performance

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management ~Becoming a patient focused but metrics driven Revenue Cycle team~ Presented by: Kimberly Moore Director, Health Care Revenue Cycle Consulting 701.239.8673 kmoore@eidebailly.com

More information

Back 2 Basics: Revenue Cycle: KPI, Risk Factors, and Compliance

Back 2 Basics: Revenue Cycle: KPI, Risk Factors, and Compliance Back 2 Basics: Revenue Cycle: KPI, Risk Factors, and Compliance March 25, 2010 Claudia Birkenshaw Garabelli, MSA President Modern Management Muse, Inc -- the ART of HealthCare Finance 1 Our Time Together

More information

HFMA MAP Keys Patient Access Measure:

HFMA MAP Keys Patient Access Measure: HFMA MAP Keys Patient Access Pre-Registration Rate Trending indicator that patient access processes are timely, accurate, and efficient Indicates revenue cycle efficiency and effectiveness N: number of

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management The Keys to Revenue Cycle Success: Aligning People, Process and Technology Presented by: Marie Murphy Revenue Cycle Manager 701.476.8321 mcmurphy@eidebailly.com Agenda Introductions

More information

Revenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps

Revenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps Common Findings Revealed: Revenue Cycle Review John Bartell, RN, BSN, Partner Tina Nazier, MBA, Director Wipfli LLP Topics for Discussion Revenue Cycle Objectives Challenges Management Goals and Expected

More information

COVER STORY. 8. HIM "PRG development" hold greater than late. 9. Copies of medical records pursuant to. 12. Chart retrieval pursuant

COVER STORY. 8. HIM PRG development hold greater than late. 9. Copies of medical records pursuant to. 12. Chart retrieval pursuant REVENUE CYCLE KEY PERFORMANCE INDICATORS AND STANDARDS Scheduling 1. Overall scheduling rate of potentially eligible patients: 100% > Scheduling rate for elective and urgent inpatients 100% > Scheduling

More information

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013 Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process

More information

5 KPIs That Require Revenue Cycle Managers' Attention. Devendra Saharia FEATURE STORY. healthcare financial management association www.hfma.

5 KPIs That Require Revenue Cycle Managers' Attention. Devendra Saharia FEATURE STORY. healthcare financial management association www.hfma. SEPTEMBER 2014 healthcare financial management association www.hfma.org FEATURE STORY 5 KPIs That Require Revenue Cycle Managers' Attention Devendra Saharia Devendra Saharia REPRINT September 2014 healthcare

More information

Our Journey to the MAP Award. Thursday, March 19, 2015

Our Journey to the MAP Award. Thursday, March 19, 2015 Our Journey to the MAP Award Thursday, March 19, 2015 Mission As a Catholic Healthcare Ministry, we provide comprehensive and compassionate care that improves the health of the people we serve. Snapshot

More information

Granville Health System

Granville Health System Approved by: Granville Health System FINANCIAL POLICY Effective Date: Revised Date(s): FINANCIAL POLICY - DRAFT 09-16-2014 Granville Health System is a not-for profit hospital committed to providing quality

More information

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle Rejection Prevention How Actionable Data Can Drive Results in Your Revenue Cycle Objectives Build a data collection strategy in denials and rejections that drives action and ultimately improved results

More information

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I Your Revenue Cycle It s not just billing anymore Presented by: Candy Edie, MBA, CRCE-I POSITIONS Staff Accountant Chief Financial Officer Financial Systems Analyst Patient Access Director Patient Financial

More information

Top Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com

Top Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com Robin Bradbury 800-355-0410 robin@ereso.com Top Ten Questions 1. What are the key measures for the Revenue Cycle? 2. How do you document and share this information with the Revenue Cycle staff? 3. What

More information

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Matt Seefeld CEO & Co-Founder mseefeld@interpointpartners.com www.interpointpartners.com (404)446-0051

More information

Provider Revenue Cycle Management (RCM) and Proposed Solutions

Provider Revenue Cycle Management (RCM) and Proposed Solutions Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive

More information

The Power of Metrics Part Two. By Rob Borchert, CPAM Altarum Institute: Revenue Cycle Management Practice

The Power of Metrics Part Two. By Rob Borchert, CPAM Altarum Institute: Revenue Cycle Management Practice The Power of Metrics Part Two By Rob Borchert, CPAM July 2009 The Power of Metrics Part Two By Rob Borchert, CPAM Altarum Institute: Revenue Cycle Management Practice July 2009 THE POWER OF METRICS PART

More information

University Healthcare Administrative Policy

University Healthcare Administrative Policy Page 1 of 6 APPROVED BY: Signatures on File FINANCIAL POLICY (UH) is a not-for profit teaching hospital committed to providing quality health care services. In order to provide necessary medical services

More information

The New Vision of Health Care Revenue Transformation

The New Vision of Health Care Revenue Transformation The New Vision of Health Care Revenue Transformation Chuck Lund Mid Atlantic Health Services Financial & Employee Transformation Solution Leader (571) 382-6777 How would you rate your own revenue cycle?

More information

A Measure of Success Using KPIs to Accelerate Revenue Cycle Performance

A Measure of Success Using KPIs to Accelerate Revenue Cycle Performance A Measure of Success Using KPIs to Accelerate Revenue Cycle Performance Sandy Richman, Director of Advisory Services Daniel Bergantz, Director of Advisory Services PNC Healthcare March 23, 2015 Today s

More information

CHAPTER 17 CREDIT AND COLLECTION

CHAPTER 17 CREDIT AND COLLECTION CHAPTER 17 CREDIT AND COLLECTION 17101. Credit and Collection Section 17102. Purpose 17103. Policy 17104. Procedures NOTE: Rule making authority cited for the formulation of regulations for the Credit

More information

Northeastern Pennsylvania Chapter, HFMA February 21, 2014. hfmamap.org

Northeastern Pennsylvania Chapter, HFMA February 21, 2014. hfmamap.org KEYS to Revenue Cycle Improvements: HFMA's Approach Sandra Wolfskill, FHFMA Director, Healthcare Finance Policy Revenue Cycle MAP Healthcare Financial Management Association Northeastern Pennsylvania Chapter,

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

How a Pre-Service Center at MetroHealth System Improved Satisfaction, Efficiency, and Revenue

How a Pre-Service Center at MetroHealth System Improved Satisfaction, Efficiency, and Revenue How a Pre-Service Center at MetroHealth System Improved Satisfaction, Efficiency, and Revenue Craig Richmond The MetroHealth System Associate Chief Financial Officer & Vice President, Revenue Cycle Introduction

More information

Top Performing PFS Sustaining Revenue Cycle Excellence. Greg West COO, Healthcare Resource Group

Top Performing PFS Sustaining Revenue Cycle Excellence. Greg West COO, Healthcare Resource Group Top Performing PFS Sustaining Revenue Cycle Excellence Greg West COO, Healthcare Resource Group Competition target Why so few super bowl repeats Free agents turnover Rule changes laws and regs and industry

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Cycle Dashboard. G2N, Inc. Honest & Healthy Bottom Lines

Cycle Dashboard. G2N, Inc. Honest & Healthy Bottom Lines Managing Operations By A Revenue Cycle Dashboard Mission of G2N We work to ensure America s healthcare providers have honest & healthy bottom lines in order to continue to fulfill their mission of improving

More information

Conifer Health Solutions Tenet Investor Webinar

Conifer Health Solutions Tenet Investor Webinar Conifer Health Solutions Tenet Investor Webinar May 16, 2012 Stephen Mooney President, Conifer Health Solutions 1 2012 Conifer Health Solutions, LLC. All Rights Reserved. Forward Looking Statements Certain

More information

Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit

Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit Protect and Improve Profitability in Your Practice Positioning Your Organization for a RAC Audit 2011 Annual Educational Seminar March 9, 2011 Presented By: Cindy Tipton-Cain, Exec. Director Physician

More information

The ROI of IT: Best Billing Practices

The ROI of IT: Best Billing Practices The ROI of IT: Best Billing Practices 1 R O S E M A R I E N E L S O N M G M A H E A L T H C A R E C O N S U L T I N G G R O U P The information and materials provided and referred to herein are not intended

More information

BILLING COMPANY STANDARDS

BILLING COMPANY STANDARDS BILLING COMPANY STANDARDS ASSESSING PRACTICE VALUE OF OUTSOURCING Cost Saving Efficiencies gained Improved collections Compliance Once a decision to out source is made the following due diligence should

More information

Give Your Revenue Cycle a Boost Techniques to Improve Collections for Your Physician Practices

Give Your Revenue Cycle a Boost Techniques to Improve Collections for Your Physician Practices Give Your Revenue Cycle a Boost Techniques to Improve for Your Physician Practices Presented by: Alta Partners, LLC Stan Kasmarcak Susannah Selnick Lacy Sharratt June 8, 2015 2015 Ohio Hospital Association

More information

Understanding Revenue Cycle Strategy How to Optimize Process and Performance

Understanding Revenue Cycle Strategy How to Optimize Process and Performance Understanding Revenue Cycle Strategy How to Optimize Process and Performance White Paper 1.800.4BEACON BeaconPartners.com BOSTON CLEVELAND SAN FRANCISCO TORONTO The revenue cycle can no longer be seen

More information

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle.

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. This Revenue Cycle Overview training will establish a

More information

The New Gold Standard in PASC s and Regional Service Centers RSC s: Best Practices for Centralizing Operations that Improves Revenue Cycle

The New Gold Standard in PASC s and Regional Service Centers RSC s: Best Practices for Centralizing Operations that Improves Revenue Cycle The New Gold Standard in PASC s and Regional Service Centers RSC s: Best Practices for Centralizing Operations that Improves Revenue Cycle Today s Learning Lab Panel Mary Anne Pace Vice President, Consulting

More information

REVENUE CYCLE IMPROVEMENT

REVENUE CYCLE IMPROVEMENT EVIDENCE-BASED REVENUE CYCLE IMPROVEMENT Suzanne Lestina Director, Revenue Cycle MAP Healthcare Financial Management Association REVENUE CYCLE IMPROVEMENT. It is a violation of federal copyright law to

More information

Revenue Cycle InsIGHTS PRE-REGISTRATION: WORKING THE HEALTH CARE REVENUE CYCLE AT THE EARLIEST PATIENT ENCOUNTER

Revenue Cycle InsIGHTS PRE-REGISTRATION: WORKING THE HEALTH CARE REVENUE CYCLE AT THE EARLIEST PATIENT ENCOUNTER Revenue Cycle InsIGHTS Patient Access PRE-REGISTRATION: WORKING THE HEALTH CARE REVENUE CYCLE AT THE EARLIEST PATIENT ENCOUNTER Executive Summary According to publications from the Healthcare Financial

More information

9/28/2015. HFMA s Patient Friendly Billing Focus. Initiatives: Best Practices. Agenda. Iowa Hospital Association Annual Meeting October 6, 2015

9/28/2015. HFMA s Patient Friendly Billing Focus. Initiatives: Best Practices. Agenda. Iowa Hospital Association Annual Meeting October 6, 2015 HFMA s Patient Friendly Billing Initiatives: Best Practices Iowa Hospital Association Annual Meeting October 6, 2015 Sandra Wolfskill, FHFMA Director Healthcare Finance Policy HFMA Agenda Meet Jack! HFMA

More information

Keeping the Reimbursement Train on Track

Keeping the Reimbursement Train on Track EXECUTIVE BRIEFING Keeping the Reimbursement Train on Track By Kelley Blair MA, vice president at Craneware Professional Services and Linda Corley, MBA, CPC, corporate compliance officer, Dell Services

More information

Patient Access. The Big Opportunity

Patient Access. The Big Opportunity Patient Access The Big Opportunity Evolution of the Revenue Cycle Over the last 10 15 years the industry has Increased Awareness Understanding Recognition Leading to.. Use of Key Performance Indicators

More information

Rural Hospital Performance Improvement (RHPI) Project

Rural Hospital Performance Improvement (RHPI) Project Rural Hospital Performance Improvement (RHPI) Project Best Practice Concepts in Revenue Cycle Management August 8, 2014 600 East Superior Street, Suite 404 Duluth, Minnesota 55802 Phone: 218-727-9390 info@ruralcenter.org

More information

Certified Healthcare Financial Professional

Certified Healthcare Financial Professional Certified Healthcare Financial Professional Certification Basics Friday, February 25, 2016 Courtney Stevenson, MSA WA/AK HFMA Certification Committee Co-Chair Agenda Module I The Business of Healthcare

More information

Revenue Cycle Assessment

Revenue Cycle Assessment Revenue Cycle Assessment Your Challenge Maintaining the status quo can be costly. As health care operating margins shrink, hospitals need to find efficient and innovative ways to capture and collect revenues.

More information

Tennessee Primary Care Association: 2014 Annual Leadership Conference

Tennessee Primary Care Association: 2014 Annual Leadership Conference CPAs & ADVISORS experience momentum // SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE FQHC REVENUE CYCLE Tennessee Primary Care Association: 2014 Annual Leadership Conference

More information

Key Performance Indicators for Physician Practices. Sam Eddy Director, Physician Practice Consulting, QHR

Key Performance Indicators for Physician Practices. Sam Eddy Director, Physician Practice Consulting, QHR Key Performance Indicators for Physician Practices Sam Eddy Director, Physician Practice Consulting, QHR You can ask a question by clicking the blue? icon or through the orange speech bubble icon. 2 Evaluate

More information

The Patient Contact Center: Finding My Way!

The Patient Contact Center: Finding My Way! The Patient Contact Center: Finding My Way! Presented by James Hawkins SVP, Patient Contact Center Convergent 1 For Today s Discussion Market Conditions ANI Survey Results Patient Contact Center Overview

More information

Provider Solutions. Sutherland Healthcare Solutions

Provider Solutions. Sutherland Healthcare Solutions Provider Solutions Sutherland Healthcare Solutions What is your TRUE RETURN? 2 The financial strength you need to offer great patient experience today and tomorrow. Our healthcare experts are ready to

More information

Provider Solutions. Sutherland Healthcare Solutions

Provider Solutions. Sutherland Healthcare Solutions Provider Solutions Sutherland Healthcare Solutions What is your TRUE RETURN? The financial strength you need to offer great patient experience today and tomorrow. Our healthcare experts are ready to partner

More information

treating technology as a luxury?

treating technology as a luxury? FEBRUARY 2007 healthcare financial management Steven H. Berger treating technology as a luxury? 10 necessary tools If you ve been thinking that technology for improving healthcare financial management

More information

Harbor s Payment to Providers Policy and Procedures is available on the Harbor website and will be updated annually or as changes are necessary.

Harbor s Payment to Providers Policy and Procedures is available on the Harbor website and will be updated annually or as changes are necessary. Original Approval Date: 01/31/2006 Page 1 of 10 I. SCOPE The scope of this policy involves all Harbor Health Plan, Inc. (Harbor) contracted and non-contracted Practitioners/Providers; Harbor s Contract

More information

our group Mission Overview Offering

our group Mission Overview Offering ABOUT OUR COMPANY Mission Infrahealth is dedicated to offering cost-effective infrastructure solutions tailored to achieve maximum results for healthcare professionals. We are focused on delivering medical

More information

Patient Resource Guide for Billing and Insurance Information

Patient Resource Guide for Billing and Insurance Information Patient Resource Guide for Billing and Insurance Information 17 Patient Account Payment Policies July 2012 Update Lexington Clinic Central Business Office Payment Policies Customer service...2 Check-in...2

More information

12 16 Memorial Physician Network Billing Cycle Audit Report

12 16 Memorial Physician Network Billing Cycle Audit Report O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12 16 Memorial Physician Network Billing Cycle Audit Report September 2012 O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12

More information

Effective Revenue Cycles Are No Accident

Effective Revenue Cycles Are No Accident Effective Revenue Cycles Are No Accident ICAHN Boot Camp October 10, 2014 Jerrie K. Weith, FHFMA, CMPE, CMOM Learning Objectives Characteristics of Best Performers Efficient Encounters = Revenue Cycle

More information

Using Six Sigma Concepts to Improve Revenue Cycle

Using Six Sigma Concepts to Improve Revenue Cycle Using Six Sigma Concepts to Improve Revenue Cycle Presented by Joseph Koons, MHSA, FHFMA, CRCE-I Managing Director, Revenue Cycle Centra Health Lynchburg Virginia March 4, 2014 Agenda Introduction to

More information

EFFICIENCY UP. COSTS DOWN. The Benefits of an Automated Healthcare Revenue Cycle

EFFICIENCY UP. COSTS DOWN. The Benefits of an Automated Healthcare Revenue Cycle EFFICIENCY UP. COSTS DOWN. The Benefits of an Automated Healthcare Revenue Cycle 1 Executive Summary Do more with less. It s a tall order for healthcare providers facing elevated quality expectations,

More information

Final. National Health Care Billing Audit Guidelines. as amended by. The American Association of Medical Audit Specialists (AAMAS)

Final. National Health Care Billing Audit Guidelines. as amended by. The American Association of Medical Audit Specialists (AAMAS) Final National Health Care Billing Audit Guidelines as amended by The American Association of Medical Audit Specialists (AAMAS) May 1, 2009 Preface Billing audits serve as a check and balance to help ensure

More information

The Power of Revenue Management

The Power of Revenue Management The Power of Revenue Management Presented By Judy Capko Capko & Company www.capko.com The Power of Revenue Management 6/13/07 1 About the Speaker The Power of Revenue Management 6/13/07 2 The Speaker:

More information

February 10 12, 2006 Amanda Mewborn Hardy & Adrienne Jarvis Dickerson

February 10 12, 2006 Amanda Mewborn Hardy & Adrienne Jarvis Dickerson Leading Revenue Cycle Process Improvement February 10 12, 2006 Amanda Mewborn Hardy & Adrienne Jarvis Dickerson Speaker Introduction Adrienne Dickerson Adrienne graduated from the Georgia Institute of

More information

Practice Name. Job Description Billing, Insurance and Coding Specialist

Practice Name. Job Description Billing, Insurance and Coding Specialist Practice Name Job Description Billing, Insurance and Coding Specialist Purpose: The job description of Billing, Insurance and Coding Associate is a written statement that identifies a job title and its

More information

Self-Pay in an ACA World: Optimizing Resources with Soarian Tools, Workflows and Partners

Self-Pay in an ACA World: Optimizing Resources with Soarian Tools, Workflows and Partners Self-Pay in an ACA World: Optimizing Resources with Soarian Tools, Workflows and Partners Kathy Peterson, FHFMA Director of Patient Financial Services October 11, 2015 Our focus today Marketplace changes

More information

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com

More information

Retrospective Denials Management

Retrospective Denials Management Retrospective Denials Management Weaving together the Clinical, Technical, and Legal Components Glen Reiner, RN, BSN, VP of Clinical Operations Nicole Guido, VP Business Development Our goals for our time

More information

The Future Vision of Access Management: Turning the Revenue Cycle Upside Down!

The Future Vision of Access Management: Turning the Revenue Cycle Upside Down! The Future Vision of Access Management: Turning the Revenue Cycle Upside Down! Matt Haynes Administrative Director, Central Business Office Services Baptist Hospitals of South East Texas Hans P. Morefield

More information

December 2011 PRACTICE CHECK-UP. XYZ Anesthesia Group. AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.

December 2011 PRACTICE CHECK-UP. XYZ Anesthesia Group. AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm. December 2011 PRACTICE CHECK-UP XYZ Anesthesia Group AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.com (908)-279-8120 AdvantEdge Healthcare Solutions Anesthesia Practice Check-Up I. Introduction:

More information

Avoiding the Claims Denial Black Hole: Strategies to Accelerate and Maximize Claims Payments

Avoiding the Claims Denial Black Hole: Strategies to Accelerate and Maximize Claims Payments Avoiding the Claims Denial Black Hole: Strategies to Accelerate and Maximize Claims Payments January 30, 2013 Carmen Elliott, MS American Physical Therapy Association Senior Director, Payment & Practice

More information

University of Iowa Hospitals & Clinics: Using Payer Contract Management to Improve Reimbursement

University of Iowa Hospitals & Clinics: Using Payer Contract Management to Improve Reimbursement University of Iowa Hospitals & Clinics: Using Payer Contract Management to Improve Reimbursement June 18, 2013 Mari Anne Ehler Associate Director, Patient Financial Services UI Health Care Cindy Lowe-Johnson

More information

Revenue Cycle Management

Revenue Cycle Management UNITED COLLECTION BUREAU, INC. 5620 Southwyck Blvd. Toledo, OH 43614 866.209.0622 ucbinc.com The Business Case for Outsourcing Revenue Cycle Management Getting reimbursed for services rendered is more

More information

What the New Health Economy Means for your Revenue Cycle

What the New Health Economy Means for your Revenue Cycle www.pwc.com/healthcare What the New Health Economy Means for your Revenue Cycle South Carolina HFMA Annual Institute Our Agenda for Today I. Today s Revenue Cycle The Case for Change II. Healthcare Reform

More information

EMDEON REVENUE OPTIMIZATION SERVICES

EMDEON REVENUE OPTIMIZATION SERVICES EMDEON REVENUE OPTIMIZATION SERVICES TRANSFORM PREVIOUSLY WRITTEN-OFF PAYER UNDERPAYMENTS INTO REALIZED REVENUE Simplifying the Business of Healthcare Simplifying the Business of Healthcare Helping increase

More information

Revenue Cycle. An operational overview and some ideas of how to negotiate the complex roads ahead. HFMA ROAD SHOW SUTTER CENTER FOR HEALTH PROFESSIONS

Revenue Cycle. An operational overview and some ideas of how to negotiate the complex roads ahead. HFMA ROAD SHOW SUTTER CENTER FOR HEALTH PROFESSIONS HFMA ROAD SHOW SUTTER CENTER FOR HEALTH PROFESSIONS Presented by: Steve Thompson and the PFS Revenue Cycle Committee January 7, 2008 Revenue Cycle An operational overview and some ideas of how to negotiate

More information

Management Report Services. Staff Training and Education Services

Management Report Services. Staff Training and Education Services Management Report Services Your management team will receive reports that are clear, well defined and serve as a tool for increased performance. These include a brief description emphasizing how the information

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

BEST PRACTICES IN DENIAL MANAGEMENT

BEST PRACTICES IN DENIAL MANAGEMENT HFMA Northern California Spring Conference March 25, 2010 BEST PRACTICES IN DENIAL MANAGEMENT Triage. Beyond Your Expectations Agenda Presenters: Principal: Shawn Tienken Manager: Chris Clayton Introduction

More information

Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings

Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Huron Healthcare s Performance

More information

The Power of Business Intelligence in the Revenue Cycle

The Power of Business Intelligence in the Revenue Cycle The Power of Business Intelligence in the Revenue Cycle Increasing Cash Flow with Actionable Information John Garcia August 4, 2011 Table of Contents Revenue Cycle Challenges... 3 The Goal of Business

More information

Revenue-cycle management is the hot topic for hospital

Revenue-cycle management is the hot topic for hospital Revenue-Cycle Redesign: Honing the Details The healthcare revenue cycle is not about just billing and collections anymore; hospitals require new revenue-cycle processes that focus on the entire patient-flow

More information

Our clients count on us, and we deliver.

Our clients count on us, and we deliver. Experts in Revenue Cycle Management For Medical Practices and Imaging Centers For over 20 years, we have forged successful partnerships with medical practices and imaging centers to improve their revenue

More information

Revenue Integrity Strategies

Revenue Integrity Strategies Agenda Discuss the key activities performed, risks and typical deficiencies that exist, and various process improvement strategies within the following revenue cycle components: Patient Access Utilization

More information

Our Lady of Lourdes Health Care Services, Inc. and Affiliates Administrative and General Policy POLICY NUMBER: AS0019CCP. PAGE NUMBER: 1 of 9

Our Lady of Lourdes Health Care Services, Inc. and Affiliates Administrative and General Policy POLICY NUMBER: AS0019CCP. PAGE NUMBER: 1 of 9 Administrative and General Policy PAGE NUMBER: 1 of 9 ACCOUNTABILITY: OBJECTIVES: POLICY: President and Chief Executive Officer RELATION TO MISSION: Our Lady of Lourdes, a Catholic Health System a member

More information

Health Care Finance 101

Health Care Finance 101 Alaska Health Care Commission Health Care Finance 101 Ken Tonjes CFO PeaceHealth Ketchikan Medical Center June 20, 2013 Basics: Glossary of Terms Common Financial Terminology Gross Charges (Revenue) Total

More information

EISENHOWER MEDICAL CENTER Financial Assistance Program Full Charity Care and Discount Partial Charity Care Policies

EISENHOWER MEDICAL CENTER Financial Assistance Program Full Charity Care and Discount Partial Charity Care Policies EISENHOWER MEDICAL CENTER Financial Assistance Program Full Charity Care and Discount Partial Charity Care Policies PURPOSE Eisenhower Medical Center (EMC) serves all persons within Rancho Mirage and the

More information

Managing and Enhancing Hospital Revenue Cycles 1

Managing and Enhancing Hospital Revenue Cycles 1 Managing and Enhancing Hospital Revenue Cycles Introduction Though providing high-quality care with improved health outcomes remains the primary concern of hospitals of all sizes, geography, and demographics,

More information

Patient Access Impact on the Patient s Journey. By: Michele Sutherland

Patient Access Impact on the Patient s Journey. By: Michele Sutherland Patient Access Impact on the Patient s Journey By: Michele Sutherland Today s Financial Objectives Vs. Today s Inefficiencies Today s Financial Objectives Today s Inefficiencies Improve Operating Margin

More information

The Joint Commission Page 1 of 6

The Joint Commission Page 1 of 6 The Joint Commission Page 1 of 6 PURPOSE The Regional Medical Center recognizes that as part of its mission, there will be instances where care is provided to individuals that do not have healthcare insurance,

More information

Study Guide: Quality Management

Study Guide: Quality Management Study Guide: Quality Management Outline: Below is a brief outline of the course. Introduction The goal is to reduce the outcome variability of key processes, thus reducing waste, increasing efficiency

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

Accelerating your Revenue Cycle: From Patient Encounter Through Account

Accelerating your Revenue Cycle: From Patient Encounter Through Account Accelerating your Revenue Cycle: From Patient Encounter Through Account Resolution Anders Health Care Webinar Series July 17th, 2013 Jerrie K. Weith, FHFMA, CMPE Chastity D. Werner, RHIT, CMPE, NCP Learning

More information

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice Janice Crocker, MSA, RHIA, CCS, CHP Introduction Reimbursement for medical practices has been impacted by various trends and

More information

NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS

NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS CURRENT AS OF APRIL 1, 2010 I. INFORMATION SOURCES Where is information available for medical providers treating patients with injuries/conditions

More information

Premera Blue Cross Medicare Advantage Provider Reference Manual

Premera Blue Cross Medicare Advantage Provider Reference Manual Premera Blue Cross Medicare Advantage Provider Reference Manual Introduction to Premera Blue Cross Medicare Advantage Plans Premera Blue Cross offers Medicare Advantage (MA) plans in King, Pierce, Snohomish,

More information

Unpaid Claims Management

Unpaid Claims Management Unpaid Claims Management National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX www.nachc.com AGENDA Introduction Clean

More information

Beyond the Basics: Accelerating the Revenue Cycle Through Advanced KPI s

Beyond the Basics: Accelerating the Revenue Cycle Through Advanced KPI s Optimizing the business of healthcare Beyond the Basics: Table of Contents Overview 1 The Importance of Metrics 1 Taking the Next Step 1 Baseline KPI s 2 Why Advanced KPI s 2 Advanced KPI s In Action 3

More information

Seven revenue-driving best practices

Seven revenue-driving best practices NextGen Revenue Cycle Management Seven revenue-driving best practices 1 2 3 4 5 6 7 Self-pay Collections Measuring Performance Claims Scrubbing Track and Prevent Denials Create and Enforce Write-off Policy

More information

How to Incorporate Bundling into the Revenue Cycle

How to Incorporate Bundling into the Revenue Cycle How to Incorporate Bundling into the Revenue Cycle Len Kalm HCA VP Managed Care Shannon Dauchot Parallon Business Solutions SVP Corporate Operations Revenue Cycle 1 Headquarters based in Nashville, TN

More information

Empowering healthcare organizations with data, analytics and insight

Empowering healthcare organizations with data, analytics and insight Empowering healthcare organizations with data, analytics and insight Integrated patient access, claims and contract management and collections products and consultative services for redefining your healthcare

More information