Metrics represent values to measure an organization’s strategy. Leaders should understand that metrics cannot replace strategy. It can lead to behaviors that undermine the very strategy the metrics expect to measure, resulting in negative consequences for all. Remember the severe negative repercussions the banking giant, Wells Fargo experienced when it aggressively pushed its employees to meet or exceed its “cross-selling” financial products metric?1 Organizations should use a well-defined strategy. As it provides a guiding principle to focus on the pursuit of the metric. Below are seven points of focus an organization should evaluate, identify, and document when it comes to their biggest areas of revenue leaks.
#1: Consider Workflow Process Analysis
Work with your I.T. team or project manager to map out the workflow processes of each role in your revenue cycle team. Visualizing the process will help you identify which processes are running smoothly and which may need work.
#2: Understand Each Key Performance Indicator (KPI) and How It is Calculated
Knowing your numbers is important; however, knowing how your numbers are calculated is more important. KPIs are different for each organization based on their improvement objectives, and KPIs should be re-evaluated periodically and compared to industry published KPIs.
#3: Identify Root Cause of Metrics
Identifying the root cause of metrics is challenging, especially with accounts receivable (A/R). Collection delays and failures from productivity drains on the front line are derived from limited data that many providers currently rely.2 To move the needle in a positive direction, start with measuring productivity.
#4: Identify Systems and Applications Involved – Use Analytical Tools for Tracking
Analytical tools are vital to the integrity of your revenue cycle to ensure complete, accurate coding and appropriate revenue capture. Analytical tools help organizations comprehend positive or problematic trends, predict future occurrences, support decisions that enhance efficiencies and optimize processes, and maximize financial and operational performance.3 Analytical tools help the revenue cycle team measure an organization’s quality scores, CC/MCCs, targeted DRGs, and productivity.
#5: Understand What Makes Up Your HIM Audit
It’s important to understand that the goals and outcomes between retrospective and prebill auditing (100% audit) are different. There are also differences between targeted versus random DRGs regarding return on investment and quality. It’s essential to measure the loss of revenue and quality as well as training regarding coding. Learn more about MRA’s services such as auditing, audit education, and many other services to help support your company.
#6: Consider a Policy and Procedure Review
Perhaps your facility is missing a policy or procedure regarding charge capture. Often acute care departments do not know their role in the process, nor do they have someone properly trained to enter charges. This omission creates unnecessary delays and burdens on your revenue cycle. Policies and procedures provide a guide for day-to-day operations, ensure compliance with laws and regulations, provide guidance for decision-making, and streamline internal processes.
#7: Consider Team Augmentation
Create a denials management committee or hire a coding coordinator to work combined accounts (FTE or consultant) while coders focus their time coding additional accounts. MRA has many experienced coders that can assist your company today. The benefits of staff augmentation complement the knowledge and skills of the existing in-house team, allowing each to perform optimally in their roles, providing an additional value-add to the organization.
Combining a well-defined strategy and following these seven points of focus when your metrics are low will allow you to take newly identified missed revenue opportunities and turn them into realized revenue for your organization—often translating into savings of upwards of thousands to millions of dollars. Contact us today and see how MRA can help your organization.
Brignoni, A. and Darby, M. (2021, October 22). Measuring Organizational Productivity With Metrics [Conference session]. Quad21, Myrtle Beach, SC. United States. https://www.registrationconnex.com/wp-content/uploads/2021/10/Ralph-Morrison-AbnerMichelleJulieQuad21-Analytics-Presentation.pdf
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