Excellence In Access Let The Data Lead The Way Hfma Philly 2 16 10

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.


Presented by

Michael S. Friedberg, FACHE, CHAMAssociate Vice President, Patient Access Services

Excellence in Access:Let the Data Lead the Way

What is the Revenue Cycle?

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)



Proactive Reactive


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


Accountability


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


Daily Dashboard Components

• Mix of indicators and goals

• It’s up to you!

• Easy to obtain


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


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


Flexibility

• New Jersey clients and charity care

• Pennsylvania client and subscriber name

• New York client and UT authorizations



Drilling further down

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


Bad Debt and Charity Care

• The uninsured is rising

• Measure as a % of total volume

• Monitor monthly


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!


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


Vendor Performance

• Successful revenue cycles

utilize a combination of internal

and external resources

• Must manage outsourcing

partners performance


Benchmarking

• Standard by which something can be measured or judged

• Where can we get data?

• The Access Dilemma

• Why benchmark?


Scheduling Benchmarking


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


Item Standard

Pre-registration rate for all scheduled patients >95%

Insurance verification rate for pre-registered patients 100%

Registration Benchmarking


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)


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


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


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


Shameless Self-promotion

Staff Competency in Patient Access: Tools, Tests and Tips for Building a Successful Team

1.877.727.1728

www.hcmarketplace.com



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.

Excellence In Access Let The Data Lead The Way Hfma Philly 2 16 10

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