KEEPING SCORE: Utilizing Key Performance Indicators to ...

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KEEPING SCORE: Utilizing Key Performance Indicators to Transform Your Revenue Cycle

Lori Zindl, President

efficientC, Pewaukee, WI

Lori Zindl does not have a financial conflict to report at this time.

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©2017 MGMA. All rights reserved. - 3 -

Learning Objectives

• Create and implement scorecards that

report key performance indicators

across the revenue cycle

• Recognize the importance and value of

continuous employee feedback

• Identify and set employee goals that

relate directly to the financial goals of

their organization

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The Purpose of Scorecards (WHY)

• Alignment across all departments

• Clear accountabilities

• Early warning system

• Results vs Activities

• Promotes a culture of problem solving

• Provides understanding of personal contributions

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- 5 -©2017 MGMA. All rights reserved.

RYG Status Definition

Why red, yellow, green?

• Visual indicators

• Simple to understand

There are issues and needs corrective action with a planRed

Risk, results are under the target, but within a tolerance interval. They need to be analyzed and monitored.

Yellow

Goal achievement is being met, no action neededGreen


Alignment – How they stack

Corporate

Goal 1

Goal 2

Goal 3

Department*

Goal 1

Goal 2

Goal 3

Team member*

Goal 1

Goal 2

Goal 3

*Each goal aligns to a corporate goal

*Each goal aligns to a departmental goal

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SMART Goals

SpecificS

MeasurableM

AttainableA

RelevantR

Time-boundT

Sample Department Goals

Business Office

Red(Critical)

Yellow(At risk)

Green(As promised)

Super Green(Over achieved)

Budget >101% >100% <100% <95%

GDRO >35 >32 32 <32

Aging over 90 days >20% >15% 15% <15%

Quality Audits/Compliance 92% 94% 95% 100%Go

als

alig

n to

co

rpo

rate


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Staff Member Scorecards

GoalAdditional

Details

Red Yellow Green Super Green

(Critical) (At risk) (As promised) (Over achieved)

#1Work load

completed weekly

Productivity

Standard

ATB

Billing

Standards

are not met

Greater than a day

at the end of the

week OR

Standards not met

with communication

and action plan

Claims assigned in

the WQ on Friday

should not be

greater than 0 and

all productivity

standards are met

WQ at 0 at EOW

#2Accounts

resolved Monthly

85% of accounts

resolved from month

to month

<85% Resolution

rate<85% (Training)

85% Resolution

rate

OR

<85% and 95%

Audit result

>90%

#3Monthly Audit

Score at 92%

Employee will be

audited at a minimum

of 10% of accounts

quarterly

<90% 90% (Training) 92% >95%


Productivity Report

Rejections

Previous

BacklogAssigned Claims

Current

Backlog Total

Resolved

Assigned

Per DayLast Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday This Friday

Biller #1 23 1 1 3 13 2 26 17 4

Biller #2 5 4 2 10 47 11 79 15.8

Biller #3 2 2 0 0

Biller #4 1 1 0 0

Biller #5 6 6 0 0

Biller #6 45 45 0 0

Biller #7 2 1 5 1 10 15 12 46 8.8

Biller #8 162 162 0 0

Total 241 7 10 3 23 75 25 242 142 28.6


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Work/Productivity Standards

• Production standards as a baseline for workload division

• Workload division:

• Payer versus alpha split

• Task splits (billing, follow up, denials)

• Multi-tasking & Selective-tasking


Resolution Rates

• Counting touches alone doesn’t help

• Are touches valuable?

• Measuring quality of touches – results

• Calculating resolution rates

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Results by Staff Member


Business Office Goals

• Maintain GDRO in 30-40’s

• Cash flow optimized

• Reduce number of accounts requiring staff intervention

• Reduce cost to collect (Business Office expense)

• Denial Management solution to reduce denials to under 5%

• High productivity and performance standards

• Reduce unbilled to under 4 days revenue holding

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KPIs for A/R

Insurance A/R Over 90 days

Goal: < 10%

GDRO - Gross Days Receivables

Outstanding

Goal Days In 30’s

Service to Bill

Goal: < 7 Days

Self Pay A/R Over 90 days

Goal: < 30%

Credit Balances

Goal: < 1 Day

Denial Rate

Goal: < 5%


A/R Scorecard

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Cost to A/R

Less A/R to work

Less resources needed

Cost to collect goes down

GDRO down


Higher Costs When A/R Increases

More accounts to work

Cost to collect goes up

GDRO high

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Reduce Cost to Collect

• Monitor Unbilled and Holds

• Automated changes to reduce billing expense

Get Bills out the Door

• Edits to reduce denials

• Efficient follow up systems and work queues (resolution rates)

• Upfront collection and financial counseling

Work Unpaid Claims


Reducing Denial Touches

Rate MTD 6 Months Clients

Resubmission 12.02% 8.62% 4.01%

Denied Dollars 9.97% 10.71% 6.61%

Denied Claims 13.86% 15.75% 5.62%

Clean Claims 64.32% 78.19% 77.01%

Rate MTD 6 Months Clients

Resubmission 5.00% 12.44% 5.68%

Denied Dollars 7.15% 6.87% 7.01%

Denied Claims 8.49% 8.79% 6.31%

Clean Claims 52.47% 61.10% 79.79%

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Reducing Denial Touches – Write Offs

Category # Denied $ Denied % Reduction # Denied $ Denied

Additional info requested - Patient 57 $93,957.77

Additional info requested - Provider 39 $18,790.19

Authorization/Pre-Cert 44 $86,542.83 20% 9 $ 17,308.57

Benefits Exhausted 8 $2,865.76

Billing Related - Edit Review needed 152 $63,215.46 90% 137 $ 56,893.91

Bundling/CCI Edit 23 $2,837.97 40% 9 $ 1,135.19

COB Issue 106 $68,632.84 20% 21 $ 13,726.57

Coding 41 $19,599.50 20% 8 $ 3,919.90

Duplicate/Overlap 259 $456,026.85 40% 104 $ 182,410.74

Eligibility/Coverage 158 $108,381.88 20% 32 $ 21,676.38

Exceeds Frequency 24 $10,766.49 20% 5 $ 2,153.30

Medical Necessity 85 $12,360.20 20% 17 $ 2,472.04

Other 79 $32,446.97 20% 16 $ 6,489.39

Other Facility Overlap 14 $42,948.42

Provider Enrollment 33 $105,806.07 20% 7 $ 21,161.21

Timely Filing 166 $158,378.99 50% 83 $ 79,189.50

Grand Total 1288 $1,283,558.19 447 $ 408,536.69

Number of hours 85.87 29.77



Continuing Education ACMPE credit for medical practice executives…………... 1ACHE credit for medical practice executives…………..…. 1CME AMA PRA Category 1 Credits™……………………….. 1

*CPE credit for certified public accountants (CPAs)……….. 1.2CEU credit for generic continuing education………..……. 1

*CPE CODE: 3 0 1 C

Let the speakers know what you thought!Evaluations will be emailed to you daily.

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Thank You.

MGMA.ORG

Lori Zindl

[email protected]

262-544-4442

efficientC

W237N2920 Woodgate Rd #100

Pewaukee, WI 53072

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