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

What is the Revenue Cycle?

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What is the Revenue Cycle?

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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)

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Proactive Reactive

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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

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Accountability

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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

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Daily Dashboard Components

• Mix of indicators and goals

• It’s up to you!

• Easy to obtain

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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

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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

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Flexibility

• New Jersey clients and charity care

• Pennsylvania client and subscriber name

• New York client and UT authorizations

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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

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Bad Debt and Charity Care

• The uninsured is rising

• Measure as a % of total volume

• Monitor monthly

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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!

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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

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Vendor Performance

• Successful revenue cycles

utilize a combination of internal

and external resources

• Must manage outsourcing

partners performance

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Benchmarking

• Standard by which something can be measured or judged

• Where can we get data?

• The Access Dilemma

• Why benchmark?

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Scheduling Benchmarking

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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

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Item Standard

Pre-registration rate for all scheduled patients >95%

Insurance verification rate for pre-registered patients 100%

Registration Benchmarking

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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)

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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

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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

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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

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Shameless Self-promotion

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

1.877.727.1728

www.hcmarketplace.com

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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: michael.friedberg@apollohealthstreet.com

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.