evaluating & managing the lifeline of your practice · 2019-10-24 · maryan hennen, cpco coo....
TRANSCRIPT
EVALUATING & MANAGING
THE LIFELINE
OF YOUR PRACTICE
Maryan Hennen, CPCO
COO
SOLUTION?
Successful Management : Short- and Long-term strategies
Patient Care - Revenue Cycle Management
GET A GRIP
DATA PROCESS PEOPLE
1. DATA
KPIs – Key Performance Indicators
Measure: How is my practice doing today? Can
track efficiency, effectiveness, quality, timeliness, governance, compliance, behaviors, project performance, and resource utilization
Benchmark: How can we do better?
Monthly
Quarterly
Annually
START WITH A BASELINE ASSESSMENT
Pre-Claim
Charge lag
Clean claim %
Billing reconciliation (Scheduled to Billed)
Electronic Claim submission %
Coding accuracy
Post Claim
Net collection %
Reimbursement based on contractual rates
Denials by type
Days in AR
Appeal success rate by type (SBR, IBR)
KPI DASHBOARD
page 7
2. PROCESS
(STANDARD OPERATING PROCEDURES)
• Standardization of Performance Management
• Detailed explanation of process
• Turnaround time
• Accountable Person
• Deliverables
• Improvement of quality and consistency
• Utilize for training
SOP Examples
Appeal process
1. Appeal by procedure type
2. What is the timeline utilized?
3. What triggers follow up
4. Who is accountable for creating the appeal
5. What are the components of the appeal
6. What are the resourced used?
7. What are the deliverables? % of AR that is in each appeal bucket by reason or KPI for success rate can be included
3. PEOPLE
Driving Success for Your TeamGWC ComponentsGet It Establish S.M.A.R.T goals
Specific, Measurable, Action-
oriented, Realistic, and Time-
based)
Want It Measure productivity, more
1:1 check ins and check
for attrition early signs
Have capacity for it Time
Training
Skill set
Mental, Emotional capacity
EVALUATING A BILLING COMPANY
Data
• Transparency of data
• What internal productivity measures do they have in place?
• How often are reports available to you?
• What KPIs are collected/What are the benchmarks/contractual obligations?
Process
• SOPs and Productivity measures – in terms of KPIs (mentioned earlier)
• How are fees calculated?
• Technology and Security Infrastructure in place
• HIPAA & Compliance
People
• Experience in the industry
• Operational Maturity
• Motivation level
• Skillset & Certification
