1 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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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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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
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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%
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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
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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
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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%
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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
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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
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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
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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
262-544-4442
efficientC
W237N2920 Woodgate Rd #100
Pewaukee, WI 53072