7-2 Project Preparation - Aug

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Southern New Hampshire University *

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630

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Jan 9, 2024

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1 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’s strength and weaknesses in the revenue cycle management process. One significant KPI is claim denials. The KPI will provide data on the inefficiencies and issues when submitting and the processing of claims. Claims that are rejected take considerable more time to resubmit and correct any changes needed. Payment delay is impacted by the time required 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 impact 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 anticipates income cash flows. This KPI could impact 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 patients 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 identifies 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 patients 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 effect 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 5 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 submitted to the third party payer. It also can take the medical coder some time to review the patients chart to accurate code for the patients encounter. This can effect 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 know their options interns of payment plans, care credit, financial assistance. 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 establish 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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