Beruflich Dokumente
Kultur Dokumente
In business, words are words, explanations are explanations, promises are promises, but only performance is reality.
Harold S. Geneen
Former President and CEO of ITT
KPI Introduction
What is a Key Performance Indicator? Numerical factor Used to quantitatively measure performance 9 Activities, volumes, etc. 9 Business processes 9 Financial assets 9 Functional groups 9 The entire revenue cycle
SOURCE: BearingPoint, Key Performance Indicators
KPI Introduction
Purposes of KPIs View a snapshot of performance at an individual, group, department, hospital, or regional level Assess the current situation and determine root causes of identified problem areas Set goals, expectations, and financial incentives for any individual or group Trend the performance of the selected individual or group over time
SOURCE: BearingPoint, Key Performance Indicators
To identify revenue cycle characteristics or processes with the most impact on value to consumers and hospitals
HFMAs PATIENT FRIENDLY BILLING Project Standards of Excellence: Findings Must Haves
Organizational culture that elevates the importance of the revenue cycle Be good at what you need to be good at Accelerate improvements take action and execute
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Customer Service
Patient Access
Scheduling Pre-Reg Registration Verification
Revenue Integrity
Charge capture Coding CDM Contracting
Billing
Unbilled control Electronic and manual billing Secondary billing
Follow-up
Largebalance Smallbalance 3rd-party Self-pay
Cash Control
Collection Posting Payment analysis Denials management
Bad Debt
Pre-listing Account placement Agency tracking
KPIs Reporting
ATBs Productivity Unbilled Claim submission Denials reasons
Information Technology
SOURCE: KPMG
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MEDICAL MANAGEMENT
CLINICAL CARE
PRE-REG & PRE-CERT (Authorization) CONTRACT MANAGEMENT PATIENT & INSURANCE SCHEDULING VERIFICATION PATIENT SURGICAL, SUPPLY
(RESOURCE, )
REQUEST FOR SERVICE FINANCIAL SERVICES MATERIALS MANAGEMENT
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Information Technology
PATIENT
Patient
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HEALTHCARE REFORM
Financial Institutions
7 6 CHARGE CAPTURE & ENTRY MEDICAL MANAGEMENT
COST CONTAINMENT
Medicare & Medicaid FIs
10 THIRD PARTY FOLLOW-UP
Information Technology
9 CLAIMS SUBMISSION
FINANCIAL COUNSELING
PATIENT
11 PAYMENT POSTING
Capital Markets
12 REJECTION PROCESSING
1 SCHEDULING
Revenue
HMOs / PPOs
CONSOLIDATION / STANDARDIZATION
Employers
CASH FLOW
QUALITY-DRIVEN REIMBURSEMENT
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Comparing Performance
Manage trends Identify opportunities Prioritize opportunities Indentify successful practices
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Industry trends Performance over multiple time frames Pre-selected peer groups Customized peer groups
4%
3%
1%
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HFMAs MAP Award recognizes healthcare organizations that achieve revenue cycle excellence and serve as models for the healthcare industry
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The MAP application evaluates HFMAs financial-performance MAP Keys, as well as PATIENT FRIENDLY BILLING Project criteria
HFMAs MAP Keys (KPIs) are the primary metrics used in the application Best practices identified in 2009s PFB research are incorporated in the MAP Award application Additional criteria to evaluate patient satisfaction are also included
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Source: HFMAs 2010 MAP Award Data POS Collections Comparable Statistics
27% 43.6% Median Top-Quartile Performance
Successful practices
9 Use of sample scripts 9 Use of dedicated Patient Access trainers
Source: HFMAs
March 2010
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KPI DAYS $
GOAL 20 $20M
M-T-D 10 $11M
% 50% 55%
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MEASUREMENT Total A/R by month % A/R >60 days % A/R >35 days %/$ Underpaid %/$ Denials under appeal %/$ Overpaid
PEER COMPARISONS SHOW Overall A/R trend & direction Claims processing issues Promptness of payment Contract interpretation issues Denial issues Contract interpretation issues
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Bibliography
1. 2. 3. 15 Questions to Ask Before Signing a Managed Care Contract, Private Sector Advocacy, Dec 2002 BearingPoint, Key Performance Indicators, Catholic Health East, 2003 Canfield, David and Scott Johnston, HFMA Patient Revenue Cycle Industry Study, Healthcare Financial Management Association, Westchester, IL, 2002 Clinical Quality Guidelines, NEJM, 348:2635-45, June 26, 2003 Guyton, Elizabeth and Chuck Lund, Transforming the Revenue Cycle, Healthcare Financial Management, Mar 2003 Harris, David, Turning Your Revenue Cycle Into a Hot Rod Using BoltOn Technology, HFMA ANI, Jun 2004 LaForge, Richard and Johnny Tureaud, Revenue-Cycle Redesign: Honing the Details, Healthcare Financial Management, Jan 2003 Managed Care Forum Contracting Checklist, HFMA Wants You to Know, 21 Apr 2004
4. 5. 6. 7. 8.
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Bibliography
9. 10. 11. 12. 13. 14. 15. Miller, Thomas, Conducting a Managed Care Contract Review, Healthcare Financial Management, Jan 1998 Pogue, Neil CMS Program Office, Medicare Policy Update, HFMAs Revenue Cycle Strategies Conference, San Francisco, 09 Oct 2007 Schneider, Robert, Sheldon Mandelbaum, Ken Braboys, and Cynthia Bailey, Process-Centered Revenue Cycle Management Optimizes Payment Process, Healthcare Financial Management, Jan 2001 Stevenson, Paul, Managed Care Cycle Provides Contract Oversight, Healthcare Financial Management, Mar 2002 Walters, Roy, Five Steps to Great Revenue Cycle Management, Healthcare Financial Management, May 2002 Wennberg, John, E. Fisher, T. Stukel and S. Sharp, Use of Medicare Claims Data to Monitor Provider-Specific Performance Among Patients with Severe Chronic Illness, Journal of Health Affairs, 07 Oct 2004 Wilson, David, 3 Steps to Profitable Managed Care Contracts, Healthcare Financial Management, May 2004
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Instructors Bio
David Hammer, Partner, Accenture
Mr. Hammer is a Senior Executive (Partner) in Accenture's Health and Public Services Practice, specializing in revenue cycle management and health reform. He serves many of the largest health systems, MD-led clinics, and academic medical centers in the US. Prior to joining Accenture, David was VP of enterprise revenue management at McKesson, the nation's largest healthcare IT firm, and was previously the chief revenue officer for Charter Behavioral Health, a +100-facility health system. David has over 28 years of professional experience in healthcare, including executive leadership and direction, revenue cycle transformation, information system planning / implementation, and consulting. He has worked for a variety of leading health systems, software vendors, and professional services firms.
Recent Publications
Mr. Hammers most recent publication is Health Reform: Intended and Unintended Consequences, which appeared in the October 2010 issue of HFMAs healthcare financial management journal (hfm). Dont Panic: CFOs React to the New Economic Reality, appeared in hfms March 2009 issue. Mr. Hammer authored the February 2008 cover story in hfm, entitled Beyond Bolt-Ons Breakthroughs in Revenue Cycle Information Systems. He also wrote the July 2007 cover story, called The Next Generation of Revenue Cycle Management, as well as the July 2005 hfm cover story, entitled Performance is Reality: Is Your Revenue Cycle Holding Up? Another one of his articles, UPMCs Metric-Driven Revenue Cycle, appeared in the September 2007 issue of hfm, and Data and Dollars: How CDHC is Driving the Convergence of Banking and Health Care was published in hfms February 2007 issue. His article Black Space Versus White Space The New Revenue Cycle Battleground appeared in the January 2007 issue, and Customer Service Adapts to CDHC appeared in the September 2006 issue.
Contact Information
Mr. Hammer can be reached by telephone at (954) 648-4764 and/or by e-mail at david.c.hammer@accenture.com or at david.c.hammer@gmail.com
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Calculation
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Value
Calculation
Value
Calculation
Calculation
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Calculation
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Value
Calculation
Calculation
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Calculation
Calculation
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Calculation
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Value
Calculation
Value
Calculation
Value Calculation
Value Calculation
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Value Calculation
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Standard
100% 100% 100% 100% 98%
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes Yes
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Standard
98% 98% 98% 100% 98% 99%
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Process
Yes Yes Yes Yes Yes Yes Yes
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Standard
98% 98% 98% 98% 99%
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Process
Yes Yes Yes Yes Yes Yes Yes
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Standard
10 min 10 min 35 40 40 99% 100% 1%
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes
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Standard
100% 65% 75% 50% 98% 98% 05 20%
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Process
Yes Yes Yes Yes Yes Yes Yes
3. Financial counselors interview patients in their rooms? 4. Prompt payment discounts offered?
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Process
Yes Yes Yes Yes Yes Yes Yes
7. All IPs cleared thru financial counselors before discharge? 8. Proof of income / assets obtained from charity applicants?
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Standard
20 - 24 32 - 36 32 36 130 210 130 - 210 5% 10%
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Standard
2 A/R days 2 work days 08 12 1 work day 90 minutes .5% 2% 2%
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes
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Standard
2 4 days 2% 1% 0 0 0 0
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Standard
0 0 0 0 0 0
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes
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Standard
100% 1 A/R day 2 bus days 2 bus days 3% 20 - 25
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes
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Standard
15 - 20% 5% 2% 3% 3% 3% 100%
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Standard
ALOS 4 6 A/R days 50 A/R days 100% 2 - 3%
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes
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Standard
100% 1 bus day 0 bus days 2 A/R days due date
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Process
Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes
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Standard
4% 5% 3% 75% 40 60%
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Standard
75% 100% 20% 25
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes Yes Yes
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Standard
1 bus day 5 min 2 min 2% 75% 85% 5% 95%
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Process
Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes
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Standard
7 11% 15 18% 6 - 10% 10 12% 20 30% 12 18%
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes
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Standard
0% 95% 90% 1 bus day 98% 2 - 3%
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Standard
2 - 3% 40 days 100% 60% 10% 2%
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Standard
0% 2 A/R days 15 minutes
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Process
Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes
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Standard
CPI MCC 5% IRR HR 24 / 7 / 365 90 120 days 90 days 6 months 2 3 years
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Process
Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Managed Care Forum Contracting Checklist, HFMA Wants You to Know
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Managed Care Forum Contracting Checklist, HFMA Wants You to Know
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Process
Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Managed Care Forum Contracting Checklist, HFMA Wants You to Know
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Process
Yes Yes Yes Yes Yes Yes Yes
SOURCE: Managed Care Forum Contracting Checklist, HFMA Wants You to Know
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Process
Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Managed Care Forum Contracting Checklist, HFMA Wants You to Know
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Process
Yes Yes Yes Yes Yes Yes Yes Yes
17. Contract includes warranty of HIPAA compliance? 18. Contract forbids reassignment without mutual consent? 19. Payors reporting requirement duties clearly stipulated?
SOURCE: Managed Care Forum Contracting Checklist, HFMA Wants You to Know
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Process
Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: 15 Questions to Ask Before Signing a Managed Care Contract, Private Sector Advocacy
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Process
Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: 15 Questions to Ask Before Signing a Managed Care Contract, Private Sector Advocacy
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Wilson, David et al, 3 Steps to Profitable Managed Care Contracts, hfm
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Wilson, David et al, 3 Steps to Profitable Managed Care Contracts, hfm
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
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Process
Yes Yes Yes Yes Yes
SOURCE: Wilson, David et al, 3 Steps to Profitable Managed Care Contracts, hfm
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Wilson, David et al, 3 Steps to Profitable Managed Care Contracts, hfm
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Miller, Thomas, Conducting a Managed Care Contract Review, Healthcare Financial Management
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Miller, Thomas, Conducting a Managed Care Contract Review, Healthcare Financial Management
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes
55. Capitation rates / benefits design (if any) clearly stipulated? 56. Flat-rate contracts w/ payors known for excessive bundling? 57. Licensing / JCAHO standards adequate for credentialing? 58. Provider not required to report in accordance with HEDIS? 59. Contract / payment terms administratively feasible? 60. Current HIS adequate to handle contract terms / A/R needs?
SOURCE: Miller, Thomas, Conducting a Managed Care Contract Review, Healthcare Financial Management
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Process
Yes Yes Yes Yes Yes Yes
SOURCE: Miller, Thomas, Conducting a Managed Care Contract Review, Healthcare Financial Management
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes
SOURCE: Miller, Thomas, Conducting a Managed Care Contract Review, Healthcare Financial Management
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Standard
80% 1% DRG avg DRG avg 80% 80% 0%
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Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes
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