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Welcome...
Today’s topic
Why benchmark the revenue cycle?Objectives and best practices in measuring revenue-cycle performance
During today’s discussion, feel free to submit questions at any timeby using the questions box. A follow-up e-mail will be sent to all
attendees with links to the presentation materials online.
Sheila KuenzleNetwork vicepresident of revenue cycle,SSM Health Care
Vivian BoydVice president of revenue cycle,Iowa Health System
HousekeepingHousekeeping1. Viewer Window 2. Control Panel
Vivian BoydVice president of revenue cycle,
Iowa Health System
Now presenting...Please use the questions box on your webcast dashboard
to submit questions/comments to our moderator.
Why benchmark revenue cycle performance?
T- Transparency
O- Opportunities and Ownership
P- Performance Trends internal and external
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
HFMA Map Keys• Aged A/R as a Percentage
of Billed A/R> 90 Days- 14% Reduction
> 180 Days- 16% Reduction
• POS Cash Collections7% Increase
• Denial Rate 6% Reduction
Operational Metrics• Avoidable Claim Edits
< 1% Reduction
• Charge Capture within 3 Days
Reduced IP Bill Hold by 1 Day
• Gross AR DaysImproved 2 days- 45.7
• ED POS Collection Rate209% Increase
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Iowa Health System
Calculation Trends Jan-11Front End Accuracy
# of Accounts without a Billing Edit 97% H1 95.83% H2 95.66% 93.2%Number of Accounts
Charge CaptureCharges Posted >3 Days from the Date of Discharge 98-100% H6 98.59% H2 96.94% 97.0%
Total Dollar Amount of Charges Posted
ED POS Expected H4 23.8% H1 24.2% 12.8% Collected
Percent CollectedDenials
# of Accts w/ Denials Posted 4% H4 2.93% H7 3.09% 4.32%# of Claims Remitted
Write OffsTotal Write Offs 0.60% H4 0.28% H7 0.23% 0.43%Gross Charges
Gross Days in ARGross AR
Average Daily Charge (3 months)
Medicare H1 31.64 H1 26.35 37.33Blue Cross H2 44.57 H3 38.01 40.57
Commercial/Managed H1 41.18 H1 40.74 51.33
Green: Above IHS Target
IHS Targets
IHS Top Performer
CY 11
IHS Top Performer
CY 10
Sample Benchmarks
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Human Capital• Vice President of Revenue
Cycle• Revenue Cycle Project
Management Office• Revenue Cycle Analytics• Revenue Cycle Governance
Technology• Implementing New Practice
Management System• Eligibility Verification
External Resources• Clinical Documentation
Improvement• Medicare Underpayment Review• Medical Necessity Compliance• Charge Master Standardization
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Next stepsS- Stabilize the metrics
U- Utilize Technology
C- Communicate
C- Challenge Base Performance
E- Education & Training
S- Standardize to Best Practice
S- Six Sigma & Lean Process Improvement
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Sheila KuenzleNetwork vice president of revenue cycle,
SSM Health Care
Now presenting...Please use the questions box on your webcast dashboard
to submit questions/comments to our moderator.
Agenda• SSM Overview/History
• Alignment of Revenue Cycle Goals with St. Louis Regional Goals
• Measure and Monitor with Metrics
• Assessing revenue cycle operations through the Metrics and taking Action
• Metric Proven Key Wins
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
SSM Overview / History• Headquartered in St. Louis, Mo
• System began with five sisters from Germany in 1872
• First heathcare recipient of Malcolm Baldrige Award
• “Through our exceptional healthcare services, we reveal the Healing presence of God.”
• Located in Wisconsin, Oklahoma, Illinois and Missouri
• SSM System Statistics: 23,000 employees, 5,800 physicians
• St. Louis Region is largest region within SSM Health Care System.
• St. Louis Statistics: 11,200 employees, 2,500 physicians, $1.3 billion net patient revenue 2010
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Alignment of Revenue Cycle Goals to St. Louis Network Goals
• Patient Satisfaction
• Physician Satisfaction
• Financial Performance
• Growth
• Quality
• Employee Satisfaction
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Metrics• Transparency
• Measure every Function within Revenue Cycle
• Need to be Actionable
• Need to be Understandable by all Levels in Organization
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Scheduling Verification Pre-Reg Financial Clearance
CBO All Revenue Cycle
Total Call Volume Elective volume Inflow Total Volume to qualify
Accounts Receivable Aging
Cash to Net Revenue
Hold Time Urgent Volume Outcomes Reasons for Non-completion
Cash DNFB by functional area
Voice Mail Secure At Admit POS (registration)
Reasons for Non-Attempt
Denials – various (initial, open, closed, Recovery)
Collections (including POS)
Abandoned Call Rate
Add on Post Discharge Statistics
Follow-up Activity Delinquencies (including Physician)
Handle Time Pending - various Approvals volume
Aging by Payer, Aging by Work Group
% Increase in Cash
% greater or less than previous metrics given
Urgent Inpt. & Outpt. Due Diligence Complete
Approvals $$ Days inA/R Late Charges as % of Total Charges
Conversion Rates
Net Days Revenue Credit Balance
Bad Debt & Charity to Gross Revenue
Productivity and Quality Across all Patient Access and CBO Functions
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Assessing the Current Situation Using Metric Base Line Data
• Scheduling (Goal: Physician & Patient Satisfaction, Growth)
a. Implement Robust call tracking systemb. Implement full centralized Function in North and Decentralized in Southc. Eliminate Redundant questions
• Insurance Verification (Goal: Physician & Patient Satisfaction, Financial)a. Implement Automated Work-Driver Toolb. Implement Automated reporting with reasons for non-receiptc. Implement virtual centralization
• Pre-Registration (Goal: Physician & patient Satisfaction, Financial)a. Move from partial Outsource to full In-sourceb. Implemented Automated Work Driverc. Implement virtual centralization
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
• Financial Clearance (Patient, Employee, Financial)a. In-source all “bedded” patientsb. Create work-driver toolc. Implement automated reportingd. Reorganize financial counseling with Medicaid Eligibility
• Centralized Business Office (Patient, Employee, Financial)a. Implement automated work driverb. Implement Network Denials Team and involve operationsc. Convert all remittances to electronicd. Implement robust denials tracking
• All Revenue Cycle (patient, employee, growth, financial, quality)a. Implement automated Failed Bill and Failed Claim work-driverb. Implement real-time productivity trackingc. Standardize quality tracking
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Metric Proven Key Wins
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Cash and Denials
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Why benchmark the revenue cycle? Objectives and best practices in
measuring revenue cycle performance
Melanie EvansNew York bureau chief,
Modern Healthcare
QAPlease use the questions box on your webcast dashboard
to submit comments/questions to our moderator.
&
Thank you...... for attending today’s editorial webcast on benchmarking the revenue cycle in healthcare.
We also thank our panelists, Vivian Boyd, vice president of revenue cycle at Iowa Health System,and Sheila Kuenzle, network vice president of revenue cycle at SSM Health Care.
Expect a follow-up e-mail within several days. For more information,send an e-mail to [email protected].
To register for our next editorial webcast, “Staying productive: Best practices for reducing operating costswithout jeopardizing clinical or financial performance,” set for 10 a.m. Central/11 a.m. Eastern time
on Wednesday, May 25, 2011, please visit modernhealthcare.com/webcasts.
