December 05, 2016 – The healthcare industry’s changeover to value-based treatment will not end with clinical patient treatment. The change also expands into healthcare providers’ revenue-cycle management processes. For effective promises management within the new treatment panorama, organizations can and really should utilize key performance indications (KPIs) with insights from business intelligence (BI) tools to identify potential improvement areas for operational change.
Part one of this two-part series devoted to why a broad project focus can result in significant improvement within the claims management process. Part two of this two-part series will provide guidance on claims management KPIs associated with particular income cycle phases. Three patients onboarding (registration) KPIs – preregistration rate, insurance verification rate, and service authorization rate – can reveal how much a business truly values the initial connection with patients. Improving onboarding KPIs aren’t necessarily tedious; an insurance plan as simple as needing preregistration through the appointment process can reduce patient wait times while enhancing check-in workflow and collection rate.
Ideally, insurance confirmation should be required in every service, and really should be performed 10 to 14 days to patient appearance prior. Advance verification allows patients to make self-pay arrangements if insurance plan cannot be validated, or if an individual has a high-deductible plan. If performed far in advance too, however, insurance verification will need to be repeated in case of changes or lapses in coverage. At check in, insurance cards should be scanned with patient identification to avoid fraud incidents.
More facilities now recognize the labor, cash flow and potential write-off costs if they neglect to integrate the payer-authorization step before performing expensive procedures, like an MRI or any non-emergent entrance. Ten more minutes from front-end sign up staff can save three to four hours in the business office obtaining authorization figures and resubmitting statements. A charge-capture policy, including a turnaround timeframe, prevents lost dollars. Charges should be posted within 3 to 5 times of the date of service. Going beyond that timeframe places a facility vulnerable to writing off past-due charges because of their claim lag days setting or losing the charge.
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Late-charge write offs impair financial performance, so treatment should be studied in determining the value for lag days. If lag days are established too low, a false elevation lately charges shall take place. If set too high, claims are delayed and cash flow is impeded. The worthiness for lag days should enable 95 percent of charges to post prior to state era roughly.
BI tools are crucial for charge-capture monitoring, and for tracking department codes and total service income amounts easily. When data visualizations include historical trending and service-volume levels, trends are easy to identify. BI data can also determine each division’s typical turnaround time for posting charges. Patient staffing and quantities levels need to be included within this analysis.
The four claim era KPIs are like stair steps, in that they need to be tackled in sequence in order to ensure BI data has discovered the most time-sensitive conditions that must take concern. Did not final costs (DNFB) is first in the sequence, accounting for the right time frame from the idea after lag days have elapsed to declare generation.