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

Transcription

1 Managing Operations By A Revenue Cycle Dashboard

2 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 community health. 2

3 CPE Certificates This webinar qualifies for 1 CPE credit. Please complete our short survey of 8 questions that t will appear at the end of the webinar in order to receive your certificate. t Your certificate will be ed to you.

4 Kathy L. Hughes, CHFP, FHFMA Kathy has 35 years of healthcare revenue cycle experience in both health systems and independent hospitals MBA from Southern Illinois University Past President, Greater St Louis Chapter, HFMA Certified Healthcare Financial Professional Fellow in HFMA 4

5 Kathy L. Hughes, CHFP, FHFMA Senior Client Partner for G2N, Inc. G2N provides coding, chargemaster, and other revenue cycle consulting services 5

6 Agenda What is a dashboard? Examples HFMA MAP Keys Definitions/Formulas for revenue cycle indicators Current benchmarks and averages Managing to a dashboard d 6

7 Agenda A good work plan to improve your numbers Questions 7

8 Dashboards

9 Why a Dashboard? 9

10 What is a dashboard? It is not the same thing as a numerical report It can also be different than a scorecard It is a visual tool that provides at-a-glance views into key measures relevant to a particular objective or business process in our case, the revenue cycle. 10

11 What is a dashboard? A way to improve understanding of revenue cycle results through h a series of pictures, tables, or graphs A way to identify variances between goals and actual results A way to guide taking appropriate action 11

12 What is a dashboard? 12

13 What is a dashboard? 13

14 What is a dashboard? Revenue Cycle Task Force Dashboard Key Performance Indicator Target Jul-09 Variance Aug-09 Variance Sep-09 Variance Days in A/R 44 Bad Debt % of Gross Revenue 4.70% % of Net Revenue 8.00% Charity Care % Gross Revenue 0.90% %N Net trevenue 2.00% Denials as a % of Gross Revenue 0.9% Cash Collection as a % of Net Revenue 100.0% Cash Collection as a % of Gross Revenue 94.00% Total DNFB Days of AR 7 14

15 What is a dashboard? Revenue Cycle Task Force Dashboard Key Performance Indicator Target Jul-09 Variance Aug-09 Variance Sep-09 Variance Days in A/R 44 Bad Debt % of Gross Revenue 4.70% % of Net Revenue 8.00% Charity Care % Gross Revenue 0.90% % Net Revenue 2.00% Denials as a % of Gross Revenue 0.9% Cash Collection as a % of Net Revenue 100.0% Cash Collection as a % of Gross Revenue 94.00% Total DNFB Days of AR 7 15

16 What is a dashboard? 16

17 What is a dashboard? Revenue Cycle Task Force Dashboard Key Performance Indicator Targ Jul- Varia Aug- Vari Sep- Vari et 09 nce 09 ance 09 ance July Point of Service Cash Days in A/R 44 Bad Debt % of Gross Revenue % of Net Revenue Charity Care % Gross Revenue % Net Revenue 4.70 % 8.00 % 0.90 % 2.00 % Denials as a % of Gross Revenue 09% 0.9% Cash Collection as a % of Net Revenue Cash Collection as a % of Gross Revenue % % Radiology Surgery Admitting ED Total DNFB Days of AR 7 17

18 Polling Question #1 Does your organization produce a revenue cycle scorecard or dashboard? d? Yes No We are working on producing one I m not sure 18

19 Basic Net Days in AR (update monthly) Previous days total cash (daily) % aging g over 90 days (update monthly) Previous days point of service cash (daily) DNFB (weekly) 19

20 More Advanced # or $ of denials (daily) % of clean claims (daily) % of bad debt (monthly) % of charity (monthly) % of patients pre-registered(daily) registered(daily) 20

21 For the Over-Achievers Conversion rate inpatient uninsured to payer source Days in total discharged not submitted to payer (DNSP) Net days revenue in credit balances Initial denial rate for zero pays Initial denial rate for partial pays Denials overturned by appeal 21

22 Polling Question #2 If you have a dashboard or scorecard, how many revenue cycle indicators do you include? 5 or less 6 to 10 More than 10 We don t have one yet or I m not sure 22

23 Industry Indicators

24 HFMA MAP Keys Healthcare Financial Management Association Several years ago convened a task force of industry experts to examine industry key performance indicators Software application in which you load your data and have access to a dashboard 24

25 HFMA MAP Keys MAP=Measure, Apply, Perform Hundreds of healthcare entities participate Your dashboard compares your data to your selected peer group and national averages and benchmarks Get more information at 25

26 Definitions for Revenue Cycle Indicators 25 different indicators Insurance Verification Rate Total number of verified encounters/total number of registered encounters A high percentage should indicate that your first billing going out the door is going to the correct insurance company Less rework 26

27 Definitions for Revenue Cycle Indicators Conversion Rate of Uninsured Inpatient to Payer Source Total inpatient discharges converted that were registered as uninsured/total t initially iti uninsured inpatient discharges Good indicator of the success of your financial counselors Could also mean that registration staff are not asking enough questions about insurance 27

28 Definitions for Revenue Cycle Indicators Days in Total Discharged Not Submitted to Payer (DNSP) (gross $ in DNFB+ gross $ in Final Billed Not Submitted)/average daily gross revenue DNFB indicator of delays in medical record coding or registration areas Even after the account gets coded and drops, it may hit billing edits 28

29 Definitions for Revenue Cycle Indicators Initial Denial Rate for Zero Pays # of zero paid claims/# of claims billed Indicates your ability to comply with payer requirements or the payer s ability to adjudicate claims correctly Could calculate across all payers or for each major payer 29

30 Definitions for Revenue Cycle Indicators Initial Denial Rate for Partial Pay # of partially paid claims/# of claims billed Indicates your ability to comply with payer requirements or the payer s ability to adjudicate claims correctly Calculate across all payers or for each major payer 30

31 Definitions for Revenue Cycle Indicators Denials Overturned by Appeal Number of appealed claims paid/total number of claims appealed and finalized or closed Use both technical and clinical appeals Success of your appeal process Could break down further to determine success of clinical or technical 31

32 Definitions for Revenue Cycle Indicators Cost to Collect Total revenue cycle costs/total cash collected New definition Revenue cycle now includes access, business office, medical records Benchmark was 2% or less Per HFMA, now 3% or less 32

33 Benchmarks and Averages

34 Don t Do This 34

35 HFMA High Performers in Rev Cycle 2012 Awardees 17 hospitals with measurable revenue cycle excellence Diverse size, payer mix, and markets Top quartile performance 35

36 HFMA High Performers in Rev Cycle Net Days in AR 33.2 Point of Service Cash Collection 22% Aged AR 90 days and greater 11.3% Days in Discharged Not Final Billed 4.9 Days in Final Billed Not Submitted.37 Bad Debt Write Offs 1.3% of gross revenue 36

37 Medians in 2012 Net Days in AR 39.0 Point of Service Cash Collection 13.6% Aged AR 90 days and greater 22.9% Days in Discharged Not Final Billed 6.0 Days in Final Billed Not Submitted.77 Bad Debt Write Offs 2.1% of gross revenue 37

38 Most Submitters 90 th Percentile Net Days in AR 57.2 Point of Service Cash Collection 1.4% Aged AR 90 days and greater 39% Days in Discharged Not Final Billed 10.8 Days in Final Billed Not Submitted 3.2 Bad Debt Write Offs 5.4% of gross revenue Lots of room for improvement! 38

39 Polling Question #3 Where do your Net Days in AR fall? 33 or below 34 to to to 57 Above 57 I m not sure 39

40 Managing g to a Dashboard

41 Managing to a Dashboard

42 Managing to a Dashboard All revenue cycle participants (CFO, medical records, patient t access, patient t accounts staff) should know the goals and results Helps build the revenue cycle team when all are aware and know how they fit into the result Keeps people p motivated

43 Managing to a Dashboard Communicate, Communicate, Communicate You don t have to do all of the work! Having other staff members or departments contribute data is an education for them and builds commitment to the goal of improving the revenue cycle The more indicators you have, the more you will know, but BALANCE is the key. 43

44 Managing to a Dashboard Get support from administration Pull members of the team together Get input on dashboard and what they would like to see What, Who, When 44

45 Managing to a Dashboard Daily Weekly Monthly All

46 Managing to a Dashboard Who? What? Source Formula Result When? Sue in Finance Net Days in AR Financial Statement Net AR Ave daily net revenue Number Dale in Point of Daily POS % 3 rd Registration Service Cash Collections Collection Report Total for payments Total patient Billing team lead FBNS 15 th of month business day after end of Month cash month Sara in HIM DNFB AR system Gross $ in NFB Ave daily gross rev Claim $ in FBNS Number End of day scrubber Ave daily each report gross rev Friday Number End of day each Friday 46

47 Dashboard Graph for POS Collections 47

48 Managing to a Dashboard 48

49 Managing to a Dashboard Facilitator role Key person in revenue cycle CFO Reviews dashboard, communicates to others, facilitates meetings for improvement Doesn t have to be on-site Administration i ti support 49

50 Polling Question #4 If your facility has a dashboard or scorecard for revenue cycle, have you found it difficult to get everyone to take ownership for it? No, several different departments or people contribute to it Yes, it all falls to me! We don t have a revenue cycle dashboard I m not sure 50

51 A Work Plan To Improve

52 A Work Plan to Improve Action Plan Holds people or departments accountable Keeps everyone on track Another communication tool 52

53 Setting Goals for Specific for Measurable for Attainable for Relevant for Time-specific

54 A Work Plan to Improve Dashboard starts the plan What are the targets and how do we get there Everyone is involved and knows the goal Action plan breaks down the get there into logical parts Assign the parts and get their input on due dates 54

55 A Work Plan to Improve Action plan is documented and readily accessible to group Revisions and changes are captured (dates, reason), documented, and communicated Should be an ongoing g process Celebrate your successes! 55

56 Example Action Plan Item # Revenue Cycle Goal 1 Increase clean claim rate from 85% to 90% by 12/31/2013 Action Item Updates Assigned To Due Date Run error report from claim scrubber for past month Team Lead, Billing Bring copies for next meeting on 7/9/2013 Bring to 7/9/2013 meeting 12/31/2013 for past month meeting on Run list of edits we are using in scrubber Claim scrubber administrator from IS 56

57 Example Action Plan Item # Revenue Cycle Goal 2 Increase POS cash collections from 1% to 2% by 6/30/2014 Action Item Updates Assigned To Set up window cash for 6/30/2014 radiology department and train Lead in cash posting Due Date 7/15/2013 Add Sueincash 7/15/2013 radiology to daily cash posting logs posting Develop and hold training for all POS staff Collection Manager 9/1/

58 Polling Question #5 Does your facility currently have an action plan and group that t is working on improving i your revenue cycle indicators? Yes No I m not sure 58

59 Summary Dashboards are just one form of communication Benchmarks and averages are available if you want them or just track progress against your own history Dashboards and action plans for improvement keep everyone on task and focused on the goals 59

60 Questions?

61 For More Information Kathy Hughes G2N, Inc

62 For More Information This webinar qualifies for 1 CPE credit. Please complete our short survey of 8 questions that t will appear at the end of the webinar in order to receive your certificate. t Your certificate will be ed to you.