Transcript To Improve Revenue Cycle Outcomes

Revenue Cycle Benchmarking
Going Beyond…
To Improve Revenue Cycle Outcomes
Presented by:
Frank Giannantonio
President
Objective
• Understanding of some Standard Revenue
Cycle Management Key Results Indicators
(KRI).
• Difference between internal reporting of
these figures versus externally measuring
against others.
• How to utilize the results of benchmarking
to improve Revenue Cycle Outcomes.
Going Beyond…
To Improve Revenue Cycle Outcomes
• Pressure for Metrics to Measure
Performance.
• Relevant Performance Measures are
Dependent on a Clear Definition of Your
Goals.
Going Beyond…
To Improve Revenue Cycle Outcomes
What is the Goal of Going Beyond To
Improving Revenue Cycle Outcomes?
• Reduce Outstanding and Unpaid claims!
• Increase Cash Flow!
Metrics = Key Result Indicators (KRI)
Indicators are Measures That Certain
Outcomes Have Been Achieved.
They Tell You How Much Progress You
Have Made Toward a Particular Goal
(Outcome).
Going Beyond…
To Improve Revenue Cycle Outcomes
Patient Accounts Staff
•
•
•
•
Focused on Getting Bills Out the Door
Posting Cash Timely and Accurately
Minor Follow-up
Do it all over again!!!
Going Beyond…
To Improve Revenue Cycle Outcomes
Not Going to Discuss:
•
•
•
•
Maximizing HHRG Scores
Episode Profitability
Improving Case Mix Weights
Retrospective Claim/Chart Audits
Metrics = Key Result Indicators (KRI)
• A/R Turnover Days = Days Sales
Outstanding (DSO)
• A/R >120 days by Major Payer
• Collection as Percentage of Revenue
• Write-offs as Percentage of Revenue
• Days from Beginning of Episode to RAP
• Days from End of Episode to Final Claim
This List Can be as Expansive
as You Like
•
•
•
•
Late Billing to Current Billing as a ratio
Medicare RAP Take Backs
Medicare Episodes on Hold
Denials by Reason
Days Sales Outstanding (DSO)
Net Revenue last 3 Months (90 Days)
Divided by Number of Days
Equals Net Revenue Per Day
Net A/R Last 3 Months:
Month 1
Month 2
Month 3
$ 450,000
90 Days
$ 5,000
$ 600,000
225,000
180,000
195,000
Average Net A/R last 3 Months
Divided by Net Revenue Per Day
Avg. Days Sales Outstanding
$ 200,000
$ 5,000
40 Days
Others
• A/R >120 days by major payer
– Measures the % of total A/R >120 days
• Collection as percentage of Revenue
– Measures the % of cash received to Revenue billed
• Write-offs as percentage of Revenue
– Measures the % of Write offs to Revenue billed
• Days from Beginning of Episode to RAP
• Days from End of Episode to Final Claim
Going Beyond…
To Improve Revenue Cycle Outcomes
Frankie Fact
If You Can Measure the Results of an
Activity…..
You Can Improve its Outcome!
Going Beyond…
To Improve Revenue Cycle Outcomes
• At best, agencies have created their own
core of acceptable norms for internal
reporting of some of these KRIs.
• Baseline – “A specific value that can serve
as a comparison or control”
Going Beyond…
To Improve Revenue Cycle Outcomes
We may meet our baseline, but how do we
know if our numbers are acceptable?
How can we improve if we don’t know what
is good?
Until recently there were no industry
standards to compare to!
How can we improve if we don’t know
what is good?
Benchmarking
Benchmark – Any standard or reference
which others can be measured or judged.
Benchmarking provides context to the
measure by allowing us to measure
ourselves against others.
How can we improve if we don’t know
what is good?
Benchmarking is the process of
determining who is the very best,
who sets the standard and what
that standard is!
How is a Benchmark Determined?
How is a Benchmark Determined
Usually for Revenue Cycle Purposes it is
determined with the help of a
mathematical concept called the Median.
Median: is the middle number in an ordered
set of data that marks the center, above
which 50% of the data falls and below
50% of the data resides.
How is a Benchmark Determined
Quartiles: For a more detailed analysis in
Benchmarking you may also use this
concept.
How is a Benchmark Determined
Once you apply these concepts to the
reported KRI’s of the participating
agencies in a Benchmarking database you
can begin to provide the upper quartile,
lower quartile and median and compare a
single agency’s performance to these
figures to identify their performance.
How Are Benchmarks Presented?
Benchmarking is Good
Good because once established, they are
easy to measure and report and to know
where you stand.
….and “Not so Good”
 Because they are retrospective and a
snapshot in time.
They don’t shed light on “why”
The Goal of Benchmarking
To
figure out how the best
performers got to be the best and
determine what we have to do to
get there!
The Goal of Benchmarking
If an organization is serious about
Benchmarking it will usually be
utilized as part of a larger effort of
a Process Improvement Initiative.
“If you can’t recognize failure,
you can’t correct it”
Going Beyond…
To Improve Revenue Cycle Outcomes
Patient Accounts Staff
•
•
•
•
Focused on Getting Bills Out the Door
Posting Cash Timely and Accurately
Minor Follow-up
Do it all over again!!!
Going Beyond…
To Improve Revenue Cycle Outcomes
• Focused on getting bills out the door
- Claims/Episode “On Hold” Analysis
- Unsigned or No Interim Order
- Authorization Issues
- Other Clinical Documentation Issues
- Claim/Chart Inconsistencies
Going Beyond…
To Improve Revenue Cycle Outcomes
• Posting Cash Timely and Accurately
- Blindly Posting Cash Electronically
- Misapplied Payments within Health
System
- Not Reconciling Cash Posted to
Cash Receipts (Deposits)
- Not Able To or Don’t Post Denials
Going Beyond…
To Improve Revenue Cycle Outcomes
• Minor Follow-up
– Must be re-conditioned to On-Going
Comprehensive Follow-up
– Develop a Payment/Denial Analysis
Methodology
Going Beyond…
To Improve Revenue Cycle Outcomes
Frankie Fact
If You Can Measure the Results of an
Activity…..
You Can Improve its Outcome!
Going Beyond…
To Improve Revenue Cycle Outcomes
Payment/Denial Analysis Methodology
• Eligibility Issues
• Incorrect Payer Source (Initial Submission)
• Authorization Issues
• Incorrect Payments for Services
• Additional Documentation Requests
• Clinical Appeals
In Summary
Key Result Indicators (KRI)
• Provide a way to see if our strategy is working.
• Focus attention on what matters most to
success.
• Provide a common language for communication.
• Are Valid, to ensure measurement of the right
things.
So To Go Beyond…
To Improve Revenue Cycle Outcomes.
• Implement Benchmarking
• It Provides Context to Your
Performance Measures by
Allowing you to Compare
Yourselves Against Others.
Objective
• Understanding of some Standard Revenue
Cycle Management Key Results Indicators
(KRI).
• Difference between internal reporting of
these figures versus externally measuring
against others.
• How to utilize the results of benchmarking
to improve Revenue Cycle Outcomes.
Thank You For Your Time!
Questions?