Revenue cycle measurement strategies

Transcription

1 Revenue cycle measurement strategies Thursday, Oct. 3, 2013 To download slides: Click the Content button and then Files in the lower left-hand corner of your screen.

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5 Today s presenters Dan Clark Director, Health Care Advisory Services (office) (cell) Dan.Clark@mcgladrey.com Lilly Hodewa Supervisor, Health Care Advisory Services (office) (cell) Lilly.Hodewa@mcgladrey.com Jim Constantine Manager, Health Care Advisory Services (office) (cell) Jim.Constantine@mcgladrey.com Rani Patel Supervisor, Health Care Advisory Services (office) (cell) Rani.Patel@mcgladrey.com 5

6 Agenda Objective Provide an overview of how business intelligence and analytics tools can be utilized to improve process and performance across the revenue cycle Discuss market pressures and trends leading to revenue cycle focus McGladrey s revenue cycle assessment approach The importance of data to process improvement Demonstrate QlikView data analytical tools Staff performance monitoring tools Closing remarks and questions 6

7 Major contributors to increased focus on revenue cycle System conversions System upgrades - Work queue environment Increasing patient liabilities Lean efforts Competition for resources Staff turnover Regulatory issues and changes ICD 10 transition 7

8 Polling question number one What do you believe is your organization s primary pain point and cause for revenue cycle improvement efforts? - New systems, leading to process issues - System reporting/information capabilities - High turnover - Revenue cycle staff knowledge/education - Lack of accountability - Increased focus on self/private pay - Regulatory/ICD 10 transition - Other 8

9 Examples of revenue cycle KPIs Key performance indicator Example performance Target range Days revenue outstanding in total accounts receivable Percent of billed accounts receivable aged over 90 days (DOS versus final billed date) Bad debt write-offs as a percentage of gross patient revenue 90 days 55 days 39.0% 20% 4% 3% Clean claim rate 94% 97% Denial rate (as a percentage of gross revenue) 4% 1% Cash to net patient service revenue 94% 100% Front end process Point-of-service collections Prior authorization rate Insurance verification rate of scheduled patients Declining 95% 100% 80% 98% Note: Target ranges are for example purposes 9

10 Revenue cycle functional area examples atient Acc cess P 1) Scheduling 2) Preregistration 3) Verification and eligibility 4) Authorization 5) Check-in/ registration Middle Revenue Cycle 1) DNFB management 2) WQ redesign and reconciliation 3) WQ monitoring tool 4) Coder productivity tool 5) Coder quality audit Patien nt Accoun nting 1) Billing and claim edits 2) Cash acceleration 3) Accounts receivable clean up 4) Work queue build 5) Staffing and productivity 6) Account activity code 6) Point-of-service collections 6) Staffing and productivity 7) Denial management 8) Payment posting 7) ICD- 10 9) Self-pay collections 10

11 Example assessment Key observations Recommendations Expected benefits Preregistration Insurance verification is not Develop expectation to conduct Reduction in the number of nonconducted during registration. insurance verification during verified appointments and insurance preregistration of 100% of scheduled eligibility-related denials Currently, there is a lack of appointments and build metrics and financial policy discussions during performance targets for each individual preregistration for insured patients. and by department. Insurance verification All insurance verification is completed on a case-by-case basis. There is no batch eligibility verification process currently being utilized. Explore batch insurance eligibility capabilities within system to enhance the preregistration work flow process. Reduction in the number of eligibilityrelated denials, resulting in increased cash flow. Insurance follow up There are currently no productivity standards, quality measures or related reporting in place for the insurance follow-up function. Implement formal productivity goals, priority guidelines and a quality assurance program for this function. Increased staff productivity and quality. Denial management There are no productivity standards or quality measures in place for denial management. Design and implement a formal denial management reporting package to track trends, chronic issues, etc. Create a Denial Management Committee to analyze denials and implement corrective action plans for chronic denials. Formal mechanisms to track, report and remediate denial issues and trends. Over time, a reduction in the overall volume of denied claims resulting from Denial Management Committee efforts and implemented corrective actions 11

12 The real question How do we identify and dtarget t areas for process improvement leading to improved performance across the revenue cycle? Meaningful reporting Actionable information Targeted performance improvement Cash acceleration and expense reduction 12

13 Challenges to measuring revenue cycle performance System limitations Lack of automation Lack of system knowledge and expertise No defined owner or resource Limited detail provided Time consuming to build correctly Static/not in real time 13

14 Polling question number two How would you rank your organization s access to reporting that drives performance across each functional area (patient access, HIM, patient accounting)? - Very strong every report we need, automated - Strong good reports, but not all inclusive - Weak limited reporting available, manual - Very weak extremely limited and very manual 14

15 The key to unlocking your organization s potential improved reporting and data analytics The power of reporting Identifies revenue risk opportunities Not only driving, but sustaining performance Improving performance indicators requires real-time analytics Focus on productivity, it quality, and accountability Provides organizational value Actionable real-time information 15

16 Characteristics of meaningful reporting Team Work and Integration Transparency Strategic direction Staff leadership and task force(s) across functional areas Efficiency Real time Current state t Simplistic and graphical Prioritization Easily replicated Accountability Clearly identified ownership Removes noise Accurate and validated 16

17 Power in creation and flexibility QlikView: A self-serve business intelligence tool that empowers business users by driving innovative decisions ( 17

18 Polling question number three Does your organization utilize business intelligence software to augment system reporting? - Yes - No 18

19 Revenue cycle reporting examples Patient access Middle revenue cycle Patient accounting Insurance verification Point-of-service cash collections Precertification or authorization percentage Performance monitoring Quality audits Unbilled charges (DNFB) Pricing Coder productivity ICD 10 translation Daily cash collections Denial management Insurance follow-up productivity Biller productivity Quality audits Analyze Design Build Validate Implement Monitor 19

20 Behind the scenes There is a lot of time spent reviewing reports to ensure the integrity of the data as well as obtain optimal results from the tool. Major ANSI/reason codes Code classification Remit code group Minor Financial class Area of responsibility Patient type Location 20

21 Creating a foundation Structure around the tool - End users - Key stakeholder - Front to back meetings Purpose - Taking a retrospective look at denials for previous months, to prioritize and take a proactive approach in driving denials down in the current and future months 21

22 Denial management Overview 22

23 Polling question number four Does your organization currently have access to denial management tools or reporting? - Yes, very robust - Sort of, lacks detail - No, no denial reporting available 23

24 Denial management Insurance eligibility example 24

25 Insurance verification report 25

26 Revenue report examples Driving work 26

27 Denial management Insurance follow-up example 27

28 Denial management Insurance follow-up example 28

29 Polling question number five In addition to denial management, which of these areas does your organization desire to improve measurement reporting tools? - Performance monitoring - Point-of-service collections - Insurance verification - Unbilled reporting (DNFB) - Staff work queue productivity 29

30 Monitoring staff performance Establishing gquality measures across functional areas is key to uncovering new ways to improve performance and take production to a new level It establishes accountability and creates a platform to set goals It is critical to understand the results from these audit and translate them to actionable next steps 30

31 Performance audit examples Patient access 31

32 Performance audit Insurance follow-up QUALITY ASSURANCE MEASUREMENT GUIDE (DENIAL FOLLOW UP) Employee: Reviewer: Date: # Visit ID# Activity Balance Reporting Period to COMMENTS KEY: 1=CORRECT 0=INCORRECT Blank=NOT APPLICABLE Appropriateness of action taken Was the appropriate denial identified? Was the letter clear? Were details included (template letter was not sent)? Timeliness of follow up Was the defer date set to the correct date based on activity code and queue Completion of Account Contact notes Was account documented correctly? (includes all needed documentation) Was appropriate activity code used? Was the appropriate action performed for account resolution? Resolution of accounts Was the entire balance addressed for that claim? Payor Plan ACCT #1 ACCT #2 ACCT #3 ACCT #4 ACCT #5 ACCT #6 ACCT #7 ACCT #8 ACCT #9 ACCT #10 TOTAL SCORE APPLICABLE QUESTIONS ACCOUNT AUDIT SCORE % AUDIT RESULT Great Job or N I (Needs Improvement) OVERALL AUDIT % Employee Supervisor Great Job or N I (Needs Improvement) Signature Signature 95% Or Greater for Great Job Overall Audit = Average of all scores 32

33 Polling question number six Does your organization routinely utilize staff quality monitoring tools to measure performance? - Yes - No 33

34 Success story: Background Organization overview - $100 million community hospital - Staffing issues: Interim CFO Newly hired director of revenue cycle No director of HIM Large staff turnover - Recent system conversion - Outsourced patient collections - Basic monthly reporting around cash and accounts receivable numbers - Limited education and training around follow up - Looking at possible acquisition or merger Organization goals - Drive immediate cash - Lower accounts receivable - Help train and implement transition plan to address staffing issues 34

35 Success story: Results Accounts receivable trending - Overall reduction in accounts receivable 25% Accounts receivable aging > 90 days Prior to project 33% Post project 17% Cash collection yield (six months) 2012 NPSR: 89.5% 2013 NPSR: 107% 35

36 Final thoughts Data analytics identify opportunities to improve process and increase revenue - Reduce finger pointing and work as a catalyst for departments and individuals to work together - Provide focus and priority - Establish transparency at the sub-process level - Function as a training i tool Staff performance audits drive continuous improvement - Powerful evaluation tool for use in annual reviews 36

37 Questions? Dan Clark Director, Health Care Advisory Services (office) (cell) Lilly Hodewa Supervisor, Health Care Advisory Services (office) (cell) Jim Constantine Manager, Health Care Advisory Services (office) (cell) Rani Patel Supervisor, Health Care Advisory Services (office) (cell) Thank you! 37

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