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Top Performing PFS Sustaining Revenue Cycle Excellence
Greg West COO, Healthcare Resource Group
• Competition – target
• Free agents – “turnover”
• Rule changes – laws and regs and industry shifts
• Complacency
Why so few super bowl repeats
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
Best practices David Hammer and HFMA Members collaboration as published by HIMSS • People • Process • Technology
• Sustained 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.
What is sustained excellence?
• 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
Qualifying organizations
• 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
Breaking it Down *study size is 32 and excellence list is 12
This report is about the differences between great versus marginal and long lasting versus short lived success
The Process and Technology
• 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)
Process at patient access
• 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
Process at billing
• 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
Process at cash posting
• 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
Processes at follow-up
• 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
• Voicemail and email capabilities
• Self-pay policies on payment plans and discounts and steadfast in policy
Processes at patient service
• 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?
Standards – everyone measures
• 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
Common measures in top group
• 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
How the best used KPI’s
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 Time Card Accuracy…………………....(1pt)
Client Satisfaction…………………………...(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 Training Hours Completed…….…….(1pt) 2 Y 4 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 Quality Meets Individual/Team Comments % claims paid due to clean billing …………………. > 80% Team
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
% claim edits hitting due to HRG……………………… < 10% Team
Client Satisfaction- No Material Issues Reported from 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 Monthly Score Time Card Accuracy………………………...……………….. Yes Individual YTD Score Divisional Maturity Training Hours Completed ……………………...……….. > 2 hrs a month Individual
• 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
Robust QA process
The People Part
• 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
Culture
• 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
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
Culture and employees
• 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
Culture and partners
• 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
Leadership
• 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.”
Common comments about the Leaders
Leader remarks were good reminders
• 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
• 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
Personal lessons from my time with the 12 Leaders
• 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
Coming Soon – Part II
What do I do with this??