1. Implementing Quality Benchmarks within Patient Financial Services
Benchmarking for Improvement
Implementing Quality Benchmarks within Patient Financial Services

2. Reasons for Benchmarking
Compare to industry standards where applicable
Identify current state and reasonable expectations
Establish facility specific benchmarks
Set goals for progress

3. Overall- Standard Indicator Standard Net AR Days <55 Days
Pt Cash As A % Of Cash Goal
>100%
Total POS Cash As A % Of Cash Goal
>2%
Bad Debt Write Offs As A % Of Gross Revenues
<3%
Charity Write Offs As A % Of Gross Revenues
Patient Cash As A % Of Net Revenue
DNFB AR Days
<5-6 AR Days

4. POS Cash
ED rate
Ancillary
Set realistic standard

5. (Excluding S/P and Pending Medicaid)
A/R Days
Patient Financial Services
Hospital Report Report-November
Previous Fiscal YR
195,756,157.60
Avg. Daily Revenue
536,318 AR
Total AR
Credit Balances
Weekday
Date
Gross AR Days
(Excluding S/P and Pending Medicaid)
Self Pay
Pending Medicaid $ #
Tue 1
74.41
41,730,884
4,104,301
17,586,518
20,040,066
1,823,072
2,381
Wed 2
74.67
41,875,272
4,104,433
17,776,552
19,994,287
1,829,586
2,386
Thur 3
74.86
41,982,531
4,092,725
17,885,489
20,004,317
1,831,458
2,390
Fri 4
74.17
41,636,243
17,595,862
19,947,656
1,855,325
2,406
Mon 7
75.04
42,090,399
4,092,620
18,097,546
19,900,234
1,842,459
2,410 8
74.11
41,610,072
4,091,934
17,618,968
19,899,170
1,863,930
2,400 9
74.52
41,778,757
4,091,932
17,808,395
19,878,430
1,814,700
2,392 10
74.70
41,814,156
4,091,927
17,851,498
19,870,730
1,751,225
2,368 14
76.67
42,773,539
18,771,738
19,909,874
1,653,004
2,321 15
75.54
42,126,042
4,095,430
18,109,083
19,921,529
1,615,149
2,301 16
75.81
42,314,384
4,077,915
18,301,416
19,935,053
1,657,317
2,275 17
76.42
42,545,125
18,493,594
19,973,616
1,561,401
2,243 18
76.05
42,300,787
4,077,354
18,241,781
19,981,653
1,515,282
2,219

6. Business Office Indicator Standard Late Charge Hold Period 2-4 Days
Late Charges As A % Of Total Charges
< 2%
First Time Billing From Discharge
5 Days
Medicare Suspense File (RTP)
< 1 Day
Claim Re-Billings After Denial/Rejection
15 Days
Secondary Billings After Payment/Rejection
Re-Billings % Of Claim Total
< 5%
HIPPA Compliant Electronic Claim Submission
100%
Final Billed/Claim Not Submitted Backlog
< 1 AR Day

7. Business Office Third Part Follow-up
Indicator
Standard
Insurance AR Aged 90+ Days From DOS
<15-20%
Insurance AR Aged 180+ Days From DOS
<5%

8. Late Charges Track by department for process improvement
Volume as percentage
Dept. #
3660
3665
4760
Name
Operating Room
Recovery Room
Pharmacy Chemo
Total
Date 1 -
(1,081.00) 2
2,621.00 3
1,533.70
(3,521.00)
(1,740.30) 4
4,038.95
584.00
5,759.21 5
14,795.15
464.00
15,488.41 6
0.00 7
(317.00) 8 9
(1,372.00) 19
25,028.15
1,048.00
26,338.31
45,395.95
2,096.00
(4,893.00)
48,727.38 %
93.2%
4.3%
-10.0%
100.0%

9. Held Accounts
Held Accounts
Medicare RTP ($)
Held/Failed ($)
Clearinghouse ($)
Total ($)
Medicare RTP (#)
Held/Failed (#)
Clearinghouse #
Total (#)
36,593
573,342
318,394
928,329 6 68 61
134
3,126
561,864
510,266
1,075,256 2 70 78
149
20,571
543,261
527,843
1,091,675 1 88
21,062
681,174
512,395
1,214,631 69 94
164
20,894
556,480
460,438
1,037,812 81
143
21,679
531,884
464,751
1,018,314 84
146
20,404
537,048
401,672
959,123 54 66
120
553,200
356,908
930,512 58 55
113
716,653
439,022
1,176,078 71 76
148
513,855
392,805
927,063 57 63
431,974
410,016
862,394 52 60
112
411,145
479,007
910,555 49
495,338
438,805
954,546 50
121

10. Unbilled Inventory Unbilled Accounts 1 7,727,629 6,199,826 1,527,803
Unbilled Accounts
Date
Total Un-Billed ($)
0-6 Days ($)
>6 Days ($)
Total Un-Billed (#)
0-6 Days (#)
>6 Days (#) 1
7,727,629
6,199,826
1,527,803
2,265
2,123
142 2
7,288,339
5,962,452
1,325,887
2,138
2,015
123 5
7,728,247
6,416,224
1,312,024
2,070
1,954
116 6
7,431,374
6,114,118
1,317,255
2,065
1,942 7
7,162,342
5,768,893
1,393,448
2,006
132 8
8,579,356
5,999,473
2,579,883
2,511
2,031
480 9
8,337,156
6,952,058
1,385,098
2,385
2,250
135 12
7,335,272
5,971,465
1,363,807
2,017
1,860
157

11. Discharged not final Billed
Summary by Department
Department
# Accounts
Sum of Chgs
Oldest Account (Days)
?? Vet 1
26.00
359
Cardiology
1,622.00 9
COMMUNITY 16
185,787.23 24 ED 18
47,009.70 34 ER
112
110,807.05
197
General Surgeon 7
29,491.10
HemOnc 8
71,899.72 37
HOSPITALIST
142
2,902,423.47 39
LOCUM
212
276,402.58 21
OB/GYN 28
151,711.28 50
Psych
27,740.05 25
546

12. Denials Indicator Standard Overall Denials Rate <4%
Clinical Denials Rate
<5%
Technical Denials Rate
<3%
Under Payments Additional Collection Rate
>75%
Appeals Overturned Rate
40-60%
Electronic Eligibility Rate
Physician Precertification Double Check Rate
100%
Case Manager's Time Securing Authorization Rate
<20%
Total Denial Reason Codes
<25

13. Follow up Production Indicator Standard Account review per employee
per month
Account review period
Every days

14. Denials Clinical denials Medical Necessity MUEs NCCI Technical Denials
File Limits
Incorrect insurance
Incorrect Patient identification
Failure to respond to payor request for additional information

15. Contract Management Contract Management software Percent of Charge
Adjustment code analysis

16. Eligibility/Precert Who preforms Eligibility checks? Precert
Registration
When is Precert performed
Before Radiology review?

17. Customer Service Indicator Standard Correspondence Backlog
<1 Business Day
Walk In Patients Wait Time
<5 Minutes
Automatic Call Distribution Hold Time
<2 Minutes
ACD Abandon Call % of Calls On Hold > 30 Seconds
<2%
ACD % of Calls Resolved in <5 Minutes
>85%
ACD % of Calls not resolved in >10 Minutes
<5%
Calls Resolved W/O Complaint/Referral to PFS Director
>95

18. Collections/Outsourcing
Indicator
Standard
% of Accounts < 90 days of Gross AR
80%
% of Accounts 91 to 180 Days of Gross AR
17%
% of Accounts Over 181+ Days
<3%
Bad Debt Expense of Gross
<4%
Bad Debt Expense of Net
<2%
Bad Debt Fee %
15-18%
Third Party Extended Business Office
6-10%
Self-Pay Extended Business Office
10-12%
Legal Collections Fee %
20-30%
Medicaid Eligibility Fee %
12-18%
Cost to Collect Ratio 2%

19. Reporting Metrics Develop reports to support metrics
Use reports to drive change
Create expectations that reports be reviewed by department leaders and acted upon
Re-establish expectations

20. Investigate Outliers What happened here? Root causes
What can be corrected?
What is the future action plan?
Other Metrics
TODAY
MTD DAILY AVG
ACTUAL
AVAILABLE BED OCCUPANCY %
76.51%
OUTPATIENT REGISTRATIONS
187
129
ER VISITS
132
116
ER ADMISSIONS 15 20
ER LWBS 8
OBSERVATION HOURS 85
277
OBSERVATION PATIENTS 6 19

21. Thank You
Stroudwater Revenue Cycle Solutions was established to help our clients navigate through uncertain times and financial stress. Increased denials, expanding regulatory guidelines and billing complexities have combined to challenge the financial footing of all providers.
Our goal is to provide resources, advice and solutions that make sense and allow you to take action.
We focus on foundational aspects which contribute to consistent gross revenue, facilitate representative net reimbursement and mitigate compliance concerns. Stroudwater Revenue Cycle Solutions helps our clients to build processes which ensure ownership and accountability within your revenue cycle while exceeding customer demands.
Contact us to see how we can help.
John Behn, MPA