…Or the four “must haves” for revenue cycle performance.
So let’s step back for a moment and think about what we want happening in our revenue processing operation. To be effective, don’t we really want to …
Drive productivity and increase transaction throughput? (And this is not just pushing more transactions. It also means handling more transaction dollars every day.)
Increase quality (fewer defects, and the resulting payment delays)?
Employ a management and control system that alerts us when something breaks and needs attention (early warning, process control)?
Increase associate engagement (associates are paying more attention and are more deeply involved).
Operate with integrated, daily routines that are effective day-in and day-out as opposed to special effort “campaigns” that seem to only make temporary improvements?
Yes, these core goals/objectives apply to every healthcare organization’s revenue cycle, from the smallest physician practice through the largest hospital system. The main differences will be in the complexity you must address in their pursuit. If you’ve got these where you want them to be, then you will also have your collections performance where you want it to be (or heading in the right direction anyway.)
So what tools are absolutely critical to pursuing these goals/objectives?
First, you must have better work queues. A clear work list that focuses associates on the highest payoff accounts and transactions is absolutely critical for maximum productivity. Seems obvious, doesn’t it? But you’d be surprised by how many billing offices are still working from less than optimal work lists.
There are many ways to improve your work list. The objective is to select accounts that are most likely to produce the highest dollars per day. (And these aren’t always the highest dollar balance accounts.) Assign these accounts to the associates that are most skilled in addressing whatever that account needs in order to be collected. These associates are more efficient, faster, and make fewer errors than other associates that are not as proficient in that area. This allows your organization to work more dollars per associate-hour expended each day.
Second, you need to watch your payment backlogs. And, more importantly, you need to know in which direction your backlogs are trending. Of all the charges on which you are awaiting payment, where are the delays stacking up? Of all the accounts/transactions that are eligible for some sort of follow up processing, where is the biggest pile of work to be done?
To monitor this, you’ll want a daily backlog analysis report that can show at a glance:
Totals by department and by payer,
Amounts eligible for work and number of days backlog represented by that work,
Components of backlog changes: $’s in less $’s collected,
FTE’s assigned to each backlog, and
Trends to indicate improvement or backsliding.
Armed with this information, you can quickly isolate trouble areas and adjust the assignment rules to more effectively allocate your staff resources.
Third, to know what’s causing the backlogs, you’ll need a payment delay analysis report. This should show you key information about payment delays (denials or system holds/edits):
Total by payer,
Totals by reason or hold/edit type, and
Trends over time.
These metrics allow you to identify the causes of the bottlenecks to payment. Thus you can address the root causes before they grow into major problems.
Fourth, to support associate engagement and continuous learning, you’ll need a solid coaching & performance management system incorporating these key elements:
Top performer visibility,
Structured feedback process, and
Context sensitive help and guidance.
I realize that I’ve made all this sound a whole lot easier than it is to implement. But these concepts provide a mental framework that helps me a great deal when building the pieces of a performance system.