Robin Bradbury800.355.0410robin@ereso.com

About re|solutionAbout re|solution

• Founded in 1998

• VHA Preferred Vendor

• Services include:

-Cash Acceleration

-Revenue Cycle Assessments

-A/R Management Training

-Interim Management and Staffing

-Virtual Business Office

-Payment Reviews

-Self Pay Cleanup

Time and EnergyTime and Energy

When performance is measured, performance improves.

Revenue Cycle Revenue Cycle 101101

Objective measures are always better than subjective measures.

Revenue Cycle 102Revenue Cycle 102

PreviewPreview

• Performance Metrics

• Behavioral Competencies

• Interviewing and Selecting

• Performance Management

Patient Encounter

Charge TicketOrder Entry

Coding

EditBilling

Transmission

Follow up

Payment

Reporting

HOSPITALHOSPITAL

The Revenue CycleThe Revenue Cycle

Performance MetricsPerformance Metrics

• HFM Toolbox – Key Revenue Cycle Metrics

• Sample Benchmark Indicator Analysis from re|solution

• Revenue Cycle KPI and Standards

• Take it down to the individual level

• Keep it simple

• Monitor, train and achieve

• Days in Revenue Outstanding

• Cash Collections

• Cash as a % of Net Revenue

• Write-offs as a % of Revenue

• Aged AR Greater than 90 Days

• Days in Discharge to Final Bill

• Up-front Cash Collections

Key MeasuresKey Measures

Free Benchmark StudyFree Benchmark Studyhttp://www.ereso.comhttp://www.ereso.com

  Sample Information:    

Facility Bed Size: 122    

Average Daily Census: 38    

Total Accounts Receivable: $8,000,000    

Cash Receipts per Month $900,000    

Gross Revenue per Month: $2,000,000    

A/R Over 90 Days: $3,500,000    

Monthly Cost of BO: $45,000    

Write Offs per Month: $150,000    

Number of Open Accounts: 19,000    

Number of FTE's in BO: 12    

Percent A/R in Self Pay: 40%    

Gross Days in A/R Outstanding

81.5

56

40

0 10 20 30 40 50 60 70 80 90

Sheridan memorial Hospital

Peer Group Average

Best Practices

Cost to Collect per Dollar

$0.047

$0.036

$0.015

$0.00 $0.01 $0.02 $0.03 $0.04 $0.05 $0.06 $0.07 $0.08 $0.09 $0.10

Sheridan memorial Hospital

Peer Group Average

Best Practices

ValueValue PropositionPropositionActual Example

  Hospital Peer Group DifferenceCash

Opportunity

AR Days Reduction 82 43 39 $1,476,815

Days over 90 Reduction31.7% 24.4% 7.3%

$217,374

DNFB Reduction

24.2

7.2 17.04 $652,439

Cost to Collect Reduction $ 0.027

$ 0.025 $ 0.002

$33,356

Bad Debt Write off Reduction 8.9% 2.3% 6.6%

$855,290

Charity Write off Reduction 1.9% 6.9% -5.0%

NA

         

• Front end, middle and back office resources

• Raise performance level awareness

• Align goals

• Creates healthy competition

• Cream will rise to the top

Expectations and Expectations and Performance StandardsPerformance Standards

ExpectationsExpectations

Estimate, Validate, and Estimate, Validate, and AdvocateAdvocate

• Estimate Charges, insurance coverage and patient portion

• Validate the information

• Advocate for the patient to deal with the obligation– Cash, Check or Credit Card– Payment plan– Medicaid Eligibility– Charity Care– Reschedule?

• Software is available to do this

PeoplePeople

“Our people are our most important asset!”

How does that manifest itself in your organization?

Improving PerformanceImproving Performance

The best way to build a team is to

hire the right people in the first place!

• Conduct a job analysis• Create a structured job-related interview• Use past-event interview questions• Use interview panels• Control our biases and first impressions• Use a rating guide• Use consensus rating

7 Keys to Effective 7 Keys to Effective SelectionSelection

Paradigm ShiftParadigm Shift

Since we all have existing staff – we need to be engaged in engaging

them.

OptionsOptions

• Fire everyone and start over

• Hire employees away from your competitors

• Browbeat the ones you have to get results

• Train and educate the employees you have

• Set expectations and measure results

• Shift the paradigm

Skills vs. BehaviorSkills vs. Behavior

• Fired anybody recently?

• Why?

• Resume and skills questionnaires will determine skill set

• How do we get people to play in the sand box nicely?

Performance Performance EvaluationsEvaluations

• Think of some of your last evaluations

• Positive and negative

Interviewing Keys To Interviewing Keys To SuccessSuccess

• Define competencies you desire to promote

• Ask interviewees to give examples of when they exhibited these competencies

• Interviewing versus evaluation

Identify Key Identify Key CompetenciesCompetencies

Sample Competencies and Performance Expectations:

Patient Financial Services Representative

Gather Action ExamplesGather Action Examples

• Key – they must be verifiable

• Have employees gather examples

• Use negative and positive examples

• Tie back to expectations

Discussion MatrixDiscussion Matrix

R+

R=

R-

A- A= A+

Impact of ProcessImpact of Process

5

4

3

2

0Before After 6 Months 12 months 18 months

SummarySummary

• Set expectations

• Metrics and behavior

• Hire people who have demonstrated those expectations

• Review and coach to expectations

• Succeed

Questions?Questions?

how to measure and improve performance in the revenue cyclehow to measure and improve performance in the revenue cycle