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

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

2 Competition target Why so few super bowl repeats Free agents turnover Rule changes laws and regs and industry shifts Complacency

3 Why this topic Revenue Cycle is the life blood of your organization Patient care begins and ends with the rev cycle Sustaining success is the hardest thing to do Generate ideas to push innovation and improvement Learning and building from other s success is the easiest innovation

4 Best practices David Hammer and HFMA Members collaboration as published by HIMSS People Process Technology

5 What is sustained Sustained excellence? 1. To keep in existence; maintain. 2. To supply with necessities or nourishment; provide for. 3. To support the spirits, vitality, or resolution of; encourage. 4. To keep up, competently Excellence 1. The state, quality, or condition of excelling; superiority. 2. Something in which one excels.

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7 Qualifying organizations AR days at 50 or better Cash as a % of net revenue at 100% Aging at 90 days below 20% Credit balance = 1 day or less Turnover rate of less than 10% No poor scores on patient surveys re: billing 5 years minimum of this performance No significant unexplainable performance decrease

8 Breaking it Down *study size is 32 and excellence list is 12 Hospital Size 2 CAH (25 bed) 4 under 100 beds 4 over 200 beds 2 Large CBO organizations Location 6 West Coast 2 Mountain 2 Midwest 2 East Coast Hospital Type 3 For Profit 9 Non-profit 4 Religious affiliation 4 are HRG clients Not included (yet) Case Management Charge Capture/CDI CDM HIM This report is about the differences between great versus marginal and long lasting versus short lived success

9 The Process and Technology

10 Process at patient access Always confirm patient Identity and financial information Use financial counseling in patient access Check patient s other account balances All have eligibility tool strong insurance verification Many have implemented patient out of pocket estimators (more recent) Process to copy and store cards (Ins/ID) and other financial documents Strong up front payment processes (policies, training, tracking)

11 Process at billing Manage billing edits constantly Dedicated team or individual for billing Bill daily don t tolerate backlogs Measure billers performance Track clean claim rate Focus on automation

12 Process at cash posting Focus on automation All used lockbox service Dedicated cashiering team or person Refunds are never put aside for other priorities Process to find underpayments All payments are reconciled daily All partial payments and zero pays are posted and set to work

13 Processes at follow-up Stratified account follow-up (dedicated high balance team) Priority work queue process Denials are tracked and appeals are tracked done timely Some type of reminder system is used for follow-up Teams are empowered for adjustments to dollar thresholds Closely monitored for accounts nearing untimely reported and watched Outsourcing ugly accounts is norm

14 Processes at patient service Dedicated team or individual Outsourced or have predictive dialer phone system with tracking Call monitoring system or manual tracking Placement of early-out and bad debt with separate vendors 120 day collection period standard projection of bad debt was accurate Web based payment system and after hour phone payments Voic and capabilities Self-pay policies on payment plans and discounts and steadfast in policy

15 Standards everyone measures Days in revenue outstanding Gross to net revenue ratio Discharged not final billed Days in credit balances Denial % Accounts receivable % over 90 days Bad debt Top performers tracked and knew them What s wrong with these measures?

16 Common measures in top group More detailed in the standards Point of service collections Added registration error reporting - details Timelines between stages both self and payer management Discharge to billed Billed to adjudicated Paid to posted Work the gaps Measure of exceptions the 80/20 rule Cash projections timely look into cash shortfalls

17 How the best used KPI s Scorecards Organization, department, leaders, staff All scorecards supported each other Measured weekly/monthly/ytd Accountable Reported to team by team Gaps in performance at each level was immediately handled Action items were reported on

18 Billing Monthly Scorecard Name Month Key Performance Indicators (KPI) Quality Month Yes/No YTD Yes/No Effective Time Management Month Yes/No YTD Yes/No % claims paid due to clean billing (2pts) 76% N 81% Y Unexcused Absences.....(2pts) 0 Y 0 Y Clean claims rates..(2pts) 14% N 9% Y Client Satisfaction...(1pt) Time Card Accuracy...(1pt) Productivity Month Yes/No YTD Yes/No Divisional Maturity Month Yes/No YTD Yes/No # of claims billed...(2 pts) 4014 Y 9001 Y Billing queue cleared daily..(1pt) Y Y Y Y Monthly client cash goal... (2pts) 110% y 104% y Standards of Performance Goals and Objectives Training Hours Completed..(1pt) 2 Y 4 Y Quality Meets Individual/Team Comments % claims paid due to clean billing. > 80% Team % claim edits hitting due to HRG < 10% Team Client Satisfaction- No Material Issues Reported from Client Working to move "% claims paid due to clean billing" & "# of claims billed" into an individual score, but can currently only get the data by client Productivity # of claims billed... > 2000 Team Billing queue cleared daily.. Yes Individual Monthly Cash Goal.. Effective Time Management Yes No Unexcused absences < 6 a year Individual Time Card Accuracy..... Yes Individual Monthly Score Divisional Maturity Training Hours Completed..... > 2 hrs a month Individual YTD Score

19 Robust QA process Quality process was documented Individual accountable for QA commitment QA corresponded to training program QA celebrated success as well as located gaps Employees viewed QA as a positive program QA was calibrated for consistency

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21 The People Part

22 Culture Patient service is focus of entire organization Focused training on the patient experience Administration has made revenue cycle departments part of the patient experience Setting of standards for service was the norm High accountability for service

23 Culture and employees Strong hiring process Team interviews/trained interviewing to leaders Background and reference checks Strong training program from first day (dedicated area and training accounts) Sense of purpose mission Feedback loop on performance Turnover was low Rewards were often/recognition was evident

24 Culture and employees Employees were engaged the huddle was a standard Teams met and helped create plan Employees were encouraged to stretch Interpersonal skills and maturity was evident Several had social committees/others not but friendships were evident staff turnover and sick time were not issues All did employee surveys and acted on them

25 Culture and partners Partnered with payers Collaborative approach Shared innovation Open sharing of data Vendors were treated as partners Community partners Revenue cycle team had sense of community

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27 Leadership Revenue cycle was lead by one person Weekly leadership meetings was norm No one type of leader evident Average tenure of the leader was 7 years No standard education level

28 Common comments about the Leaders Passion for the job - She loves the organization and she loves the staff and she love AR Walk the walk She works hard and expects the same from us Care for the people I ve never had a boss so caring about me as an individual Fair We are all held to the same standards Communicate He let s us know what s going on and more importantly how I am doing.

29 Training and QA Peer review of accounts as a team Accountability is paramount Stay in touch with industry Be involved in associations Network with peers Stay in touch with staff Sit with your team Invite and reward innovation Empowerment is consistent culture Calm process Schedules of tasks Consistent expectations Leader remarks were good reminders

30 Personal lessons from my time with the 12 Leaders Never stop learning -HFMA Network with peers HFMA Allow yourself time for strategy (Hippie Tree Time) Take time for your priorities besides work Build process to sustain success watch our for the flash fix Acknowledge your and your team s accomplishments Have fun Be passionate about you work

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32 Coming Soon Part II Added areas charge capture/coding/cdm 15 more top performers Deeper dive into culture and leadership of organizations Some top crashes and why Region 10 in August

33 What do I do with this??