MilwaukeeRegional HealthSystemREVENUE CYCLE MANAGEMENTRashida ShoemakerGoals1 Choose
Milwaukee
Regional Health
System
REVENUE CYCLE MANAGEMENT
Rashida Shoemaker
Goals
1. Choose one additional performance metric and choose defect metrics.
2. Why these particular metrics?
3. Compare MRHS metrics to national metrics.
4. List corrective actions to improve MRHS metrics.
5. "Asses the fairness and efficiency of the current fragmented payment system to providers, insurers, patients and society."
6. Calculate average expected payment for the MRI and joint replacement procedures. Revenue Cycle Metrics
Metrics
Metric
Metric Definition
Performance
Cost to Collect
Total revenue cycle costs/ Total cash collected
Defect- Scheduling
Insurance Verification
No. of verified encounters/ No. of registered encounters
Defect- Registration
Registration Quality Score
No. of correct patient demographics and insurance data elements input/Total data elements required at registration
Defect- Case
Management
Preauthorization Denial Rate
No. of claims denied for no preauthorization/ No. of claims submitted Defect- Clinical Charge
Processing
Charge Lag Days
Days between service date and posting of charge/
Encounters billed
Defect- Medical Records
Days in Discharge Not Yet Billed
Gross dollars in A/R (not final billed)/ Average daily gross revenue Defect- Billing
Clean Claim Rate
Number of claims that pass edits requiring no manual intervention/ Total claims accepted into claims scrubber tool for billing prior to submission
Defect- Payment Posting
Net Days Revenue in Credit
Balance
Dollars in credit balance/Ave daily net patient service revenue Why These Defect Metrics?
Insurance Verification Rate: Determines early on who has insurance and what kind of payments can be expected from that particular insurance. Knowing this information upfront will give a realistic expectation of payments. Listed in MAP Keys.
Registration Quality Score:
The alternative was POS Cash Collection rate, which was not listed as a defect in the original revenue cycle
Regional Health
System
REVENUE CYCLE MANAGEMENT
Rashida Shoemaker
Goals
1. Choose one additional performance metric and choose defect metrics.
2. Why these particular metrics?
3. Compare MRHS metrics to national metrics.
4. List corrective actions to improve MRHS metrics.
5. "Asses the fairness and efficiency of the current fragmented payment system to providers, insurers, patients and society."
6. Calculate average expected payment for the MRI and joint replacement procedures. Revenue Cycle Metrics
Metrics
Metric
Metric Definition
Performance
Cost to Collect
Total revenue cycle costs/ Total cash collected
Defect- Scheduling
Insurance Verification
No. of verified encounters/ No. of registered encounters
Defect- Registration
Registration Quality Score
No. of correct patient demographics and insurance data elements input/Total data elements required at registration
Defect- Case
Management
Preauthorization Denial Rate
No. of claims denied for no preauthorization/ No. of claims submitted Defect- Clinical Charge
Processing
Charge Lag Days
Days between service date and posting of charge/
Encounters billed
Defect- Medical Records
Days in Discharge Not Yet Billed
Gross dollars in A/R (not final billed)/ Average daily gross revenue Defect- Billing
Clean Claim Rate
Number of claims that pass edits requiring no manual intervention/ Total claims accepted into claims scrubber tool for billing prior to submission
Defect- Payment Posting
Net Days Revenue in Credit
Balance
Dollars in credit balance/Ave daily net patient service revenue Why These Defect Metrics?
Insurance Verification Rate: Determines early on who has insurance and what kind of payments can be expected from that particular insurance. Knowing this information upfront will give a realistic expectation of payments. Listed in MAP Keys.
Registration Quality Score:
The alternative was POS Cash Collection rate, which was not listed as a defect in the original revenue cycle