7-1 Activity- Analyzing KPIs - Aug

.docx

School

Southern New Hampshire University *

*We aren’t endorsed by this school

Course

630

Subject

Health Science

Date

Jan 9, 2024

Type

docx

Pages

8

Uploaded by meredithLindberg

1 7-1 Activity: Analyzing KPIs Meredith Lindberg Southern New Hampshire University IHP 630 DR. ARSENAULT August 20, 2023
2 7-1 Activity: Analyzing KPIs Revenue-Cycle Dashboard: Revenue-cycle dashboards are data driven which is used to monitor key performance indicators or KPI. By gaining the ability to gather, organize and analyze the metrics that are most important to your organization, a data-driven environment where an organization will be able to view the data solutions that will increase productivity and save countless dollars.(Calzon, 2022) Front-end KPI’s that need to further examined is patients without insurance and or high out-of-pocket costs are given information about the healthcare organization financial assistance program and payment plan options at the time of patient registration. At this time this healthcare organization is not meeting the KPI in this area with a range of 30-51% accuracy. This needs great improvement. Another front-end key performance indicator is obtaining required prior authorizations before the procedure is scheduled. This has an accuracy of 85-99%. This is good place to be but still shows room for improvement. The question remains why are we doing the procedure without authorizations? Middle revenue cycle KPI’s include charges that are captured for services provided for each patient. In this area the accuracy is 85-92% which is good but still room for improvement. Middle revenue cycle is important because it collects all the clinical information together to be able to submit proper coding and claims. Another KPI for the middle revenue cycle is members of the medical staff are notified within 2 days of any delinquent greater than 5 days clinical documentation which is needed to complete the chart and be able to accurate bill for the service provided. In this area the healthcare organization is at 98-100% accuracy which is one of the highest standard on the dashboard.
3 The Back-end revenue cycle KPI’s claims being scrubbed for errors prior to be sent to the third party payer. This is an additional software that shows finds error in claims and rejects them back to the healthcare organization prior to submission. Another KPI is denied claims are reviewed / accepted / appealed within 21 days of claims denial which on the dashboard demonstrates an area for big improvement. Having claims resubmitted and or corrected in a timely manner is beneficial to the financial security of the organization. Front-End KPIs: Patients are increasingly worried about healthcare costs. Receiving a large healthcare bill is one of the largest worries expressed by Americans.( Calculating Your Patient’s Out-of-Pocket Expenses Accurately – Cleargage , 2022) Providing information to patients who are self-pay without insurance or patients with large deductibles and out-of-pocket costs. These patients need to be informed of the healthcare organizations policies and resources available to them prior to date of service. An informed patient who understand the possible charges, cost and patient responsibility upfront can better anticipate those expenses and create a plan to pay them, which in turn increases patient post payments. ( Calculating Your Patient’s Out-of-Pocket Expenses Accurately – Cleargage , 2022) Increase in awareness of patient responsibility along with information provided at the time of registration about these programs will increase the cash flow. If patients receive a bill for a service they were expecting to be covered by their insurance the patient is more likely to challenge the bill. Adding to this challenge is the fact that over half of people (57%) have received an unexpected healthcare bill they thought would be covered by health insurance. ( Calculating Your Patient’s Out-of-Pocket Expenses Accurately – Cleargage ,
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
  • Access to all documents
  • Unlimited textbook solutions
  • 24/7 expert homework help