IHP 630 7-2 Project Preparation ML
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7-2 Project Preparation
Meredith Lindberg
Southern New Hampshire University
IHP 630
DR. ARSNAULT
August 20, 2023
2
7-2 Project Preparation
Key Performance Indicators: Key performance indicators are critical benchmarks. Showing a healthcare organization, it is strength and weaknesses in the revenue cycle management process. One significant KPI is claim denials. The KPI will supply data on the inefficiencies and issues when sending and the processing of claims. Claims that are rejected take more time to resubmit and correct any changes needed. Payment delay is affected by the time needed for resolving the claims through resubmission. An alternative way to view this data would be to process the daily average of claims submitted and that are excepted alternatively reviewing the rejected claims. (Powell, 2020) This can affect patient experience by the patient receiving a denial letter at their home. This tends to be a stressful experience. A key performance indicator is the amount of time spent in account receivables. This data
will show how long it takes the average claim to be paid. This information helps to discover the effectiveness in obtaining payment for healthcare services. Pulling this information from the balance sheets and income statements. Having an estimate on how long it takes from each third-
party payer to pay a claim sets the organization up for success to predicts income cash flows. This KPI could change a patient experience because the delay in payment from the payer will delay a statement being sent to the patient. Accurate patient demographics are to be collected at the time of registration. This helps to ensure correct spelling of the patient’s name, DOB, address, and phone number are correct. This should be verified on the day of service. Inaccurate patient demographics put into the EHR system will stay with the patient incorrectly unless someone finds the error, or the claim is
3
rejected. This affects the patient experience as it is frustrating when your demographics are incorrect. Clinical documentation to be completed within 5 days of the patient visit and or discharge. This is an important key performance indicator because the sooner the patient’s clinical documentation is complete is ensured accuracy. If a provider waits to long to complete the patients visit notes, they may leave something out due to the length in time from visit to documentation. This can affect the patient experience as they may be charged for a service they did not receive. Have an inaccurate diagnosis on file and this can all delay the coding and submission of claim process. If a patient needs their medical record sent to another doctor to follow up and the current doctor has not completed dictation this can delay care for the patient. Complete coding within five business days of clinical documentation completion of the medical record is a key performance indicator. There are times coding can not be complete due to waiting on pathologies or specimens to be resulted which can delay the encounter from being coded and then sent to the third-party payer. It also can take the medical coder some time to review the patient’s chart to correct code for the patients meet. This can affect the patients experience by delaying the submission of the claim. A key performance indicator to measure is how the patient without insurance and with high out-of-pocket cost are presented for payment obligations at the time of registration. Making sure the patient knows their options interns of payment plans, care credit, financial help. This can
affect the healthcare organization cash flow and delay of payments. Having the revenue cycle staff member call the patient to inform them of their expected costs to set up a plan to be in place. This can affect the patient if these details are not provided. If they are overwhelmed by the
cost of the care. If they can not afford it but need the care.
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QUANTITY
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I
11
I
16
II
17
II
23
III
25
III
27
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IV
18
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II
III
IV
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Y =
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18
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THIS YEAR
I
II
III
IV
QUANTITY
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