By Theresa Brandon
Eliminating silos, automating metrics and investigating labor costs – these are just a few of the top revenue cycle tips for hospital CFOs and revenue cycle leaders, according to a recent series by Becker’s Hospital Review. Theresa Brandon, Managing Director and Revenue Cycle Practice Lead of Novia Strategies, regularly contributes to this series. Here, she expands upon a few of the tips she thinks should be foremost in every healthcare CFO’s mind.
Don’t be short-sighted about labor costs.
Labor benchmarks are directional and should always be normalized based on physical layout, as well as effectiveness of available technology. Critical positions which effectively prevent denials and lost reimbursement include 24/7 case managers and registration personnel in busy emergency departments. Identify denials by department and use this information to support the need for retaining or hiring staff into these important positions. Continue monitoring service levels and departmental quality metrics in conjunction with productivity metrics.
Mind those contracts!
Use denial data to monitor trends by payors. Keep a tickler for each payor, but be mindful of the 80/20 rule. Your contracts will never be able to address all issues that arise, so focus efforts on repetitive and large dollar items. Discuss challenges with your contract staff well before time for negotiations begin. Don’t forget to include your case management and utilization review team members in review of contract language. Their day-to-day insight on patient care may prevent costly mistakes resulting from ineffective or impractical restrictions on delivery of care.
Automate and monitor metrics that matter.
Re-evaluate current or long time metrics to determine if they are still appropriate and meaningful. If performance has historically been meeting or exceeding expectations, it may be time to challenge your organization to focus on a different metric. Choose succinct, replicable and timely data with which to measure improvement opportunities. Establish accountability and require action plans when progress lags.
Eliminate the silos.
Maximizing revenue requires a collaborative effort throughout the hospital. If your organization doesn’t currently have a multi-disciplinary team working together to reduce the root cause of denials, consider forming one. Include members of case management, utilization review, CDI/HIM, finance and a physician advisor. Ad hoc members, such as social workers or contract staff, should be included when appropriate. Conduct meetings on a regular basis and stay focused on identifying behavioral changes, such as robust clinical documentation, adherence to clinical protocols and maximizing technology to prevent the occurrence, rather than collection, of unpaid reimbursement.
Improve performance in Patient Financial Services.
With the increased use of sophisticated technology in patient access areas, many organizations have set high goals (e.g., 99%) for accuracy for their pre-registration and registration staff. Moving a poor or even moderately performing department to a standard of excellence is best achieved by setting incremental goals and reasonable timelines for achievement. Engage your staff in development of solutions. Apply improvement methodologies such as Lean and PDCA learning cycles in focused, short-term projects with finite objectives and timetables. Recognize and reward team members to keep them encouraged along the path to improved accuracy.
Do you have a tip to share? Email me at firstname.lastname@example.org.