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Achieving Healthcare’s True Return
Apollo Health Street partners with hospitals and healthcare organizations across the country to achieve healthcare’s True Return – the financial strength to offer excellent patient care today and tomorrow.
Achieving Healthcare’s True Return
Presented by
Michael S. Friedberg, FACHE, CHAMAssociate Vice President, Patient Access Services
Excellence in Access:Let the Data Lead the Way
Background
• Hospitals can benchmark their revenue cycle
performance against other facilities using HARA and
other benchmark data
• The most effective method to identify areas of opportunity
within your revenue cycle is to manage your trends
through Key Performance Indicators (KPI)
Excellence in Access: Let the Data Lead the Way | Page 4
Excellence in Access: Let the Data Lead the Way | Page 6
What are KPI’s?Key Performance Indicators are the
metrics that illustrate how to improve
your revenue cycle
Why We Use KPI’s?
• Keep a record – tell a story
• Proactive – not reactive approach
• Manage trends – not single period results
• Illustrates relationship between certain KPI’s
• Can establish realistic goals based upon real life trends
• Fosters accountability
Excellence in Access: Let the Data Lead the Way | Page 7
How Do You Get Started?
• Keep a record – tell a story
• Begin with a Daily Dashboard – snapshot of your department
• Assign ownership
• If it is important …measure it
• If you decide to measure it – manage what you measure
• Use as a tool at revenue cycle meetings
Excellence in Access: Let the Data Lead the Way | Page 9
Daily Dashboard Components
• Mix of indicators and goals
• It’s up to you!
• Easy to obtain
Excellence in Access: Let the Data Lead the Way | Page 10
Daily Dashboard: Example Part 1
DateDaily Census @ 9:00 am
ER HoldsQA Quality Score MTD
Failed
Bill $Staff Call Outs
POS Cash POS Cash MTD
5/1/06
5/2/06
5/3/06
5/4/06
Excellence in Access: Let the Data Lead the Way | Page 11
Daily Dashboard: Example Part 2
DatePOS Cash as a % of Goal
Complaints to Administration
MPI Duplicates Created
Patients in House >30 Days
% of Eligible Patients Scheduled
5/1/06
5/2/06
5/3/06
5/4/06
Excellence in Access: Let the Data Lead the Way | Page 12
Flexibility
• New Jersey clients and charity care
• Pennsylvania client and subscriber name
• New York client and UT authorizations
Excellence in Access: Let the Data Lead the Way | Page 13
Monthly Denials
• Overall denials
• Clinical denials by reason
• Technical denials by reason
• Denials as a % of net revenue
• Must determine if denials are included in aged accounts
receivable – communicate with the business office
Excellence in Access: Let the Data Lead the Way | Page 15
Bad Debt and Charity Care
• The uninsured is rising
• Measure as a % of total volume
• Monitor monthly
Excellence in Access: Let the Data Lead the Way | Page 16
Point of Service Collections
• CASH IS KING
• Increased co-pays and deductibles
• Now more than ever, hospitals must
focus on POS collections
• Track by month; by area
• Set goals
• The British are coming!
Excellence in Access: Let the Data Lead the Way | Page 17
Clean Claims %
• > 90% of claims are billed electronically
• Clean claim target 95% - 100%
• Claims with errors = manual intervention
• Manual intervention = payment delays or incorrect payment and a
higher cost to collect
• Drill down to reasons for manual intervention
Excellence in Access: Let the Data Lead the Way | Page 18
Vendor Performance
• Successful revenue cycles
utilize a combination of internal
and external resources
• Must manage outsourcing
partners performance
Excellence in Access: Let the Data Lead the Way | Page 19
Benchmarking
• Standard by which something can be measured or judged
• Where can we get data?
• The Access Dilemma
• Why benchmark?
Excellence in Access: Let the Data Lead the Way | Page 20
Scheduling Benchmarking
Excellence in Access: Let the Data Lead the Way | Page 21
Item Standard
Scheduling rate of patients eligible for scheduling 100%
Scheduling for ambulatory surgery patients 100%
Scheduling for high dollar outpatients 100%
Pre-registration Benchmarking
Excellence in Access: Let the Data Lead the Way | Page 22
Item Standard
Pre-registration rate for all scheduled patients >95%
Insurance verification rate for pre-registered patients 100%
Registration Benchmarking
Excellence in Access: Let the Data Lead the Way | Page 23
Item Standard
Average registration interview duration new patient 15 minutes
Average registration interview duration repeat patient
< 5 minutes
Average patient wait time to be registered < 10 minutes
Maximum wait time for any patient 15 minutes
Registration Benchmarking (continued)
Excellence in Access: Let the Data Lead the Way | Page 24
Item Standard
Average inpatient registrations per shift 15 - 20
Average outpatient registrations per shift including emergency department
30 - 40
Advanced beneficiary notice rate where applicable 100%
Denials Benchmarking
Excellence in Access: Let the Data Lead the Way | Page 25
Item Standard
Overall denial rate < 4%
Technical denial rate < 3%
Eligibility denials rate < 75%
Appeals overturn rate 40% - 60%
Benchmarking Sources
• HFM article by David Hammer July 2005
• Aspen Publishing Registration Newsletter 2006
• Local HFMA chapters
• Local NAHAM chapters
Excellence in Access: Let the Data Lead the Way | Page 26
Closing Thoughts
• KPI implementation may be a cultural change for some
• KPI’s do create a culture of accountability – but also reward
• KPI’s do simplify the nature of our work
• Investment in the success of your revenue cycle
Excellence in Access: Let the Data Lead the Way | Page 27
Shameless Self-promotion
Staff Competency in Patient Access: Tools, Tests and Tips for Building a Successful Team
1.877.727.1728
www.hcmarketplace.com
Excellence in Access: Let the Data Lead the Way | Page 28
Achieving Healthcare’s True Return
Michael S. Friedberg, FACHE, CHAM
Associate Vice President, Patient Access Services
Office: 973.233.7644
Mobile: 732.809.0260
Email: [email protected]
Learn more at www.apollohealthstreet.com
Apollo Health Street partners with healthcare
organizations across the country to achieve
healthcare’s True Return – the financial
strength you need to offer excellent patient
care today and tomorrow.