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Question: What productivity measures are available for auditing staff in a managed care department? In my organization, their responsibilities include reviewing and identifying variances, as well as collecting confirmed underpayments. I also have a staff member who handles technical denials and another who handles clinical details. This question was submitted by Allison Stevens, manager, managed care and payer relations, Lexington Medical Center, West Columbia, S.C.
Answer 1: The productivity measures would be similar to third-party follow-up standards. We use a standard of 50 accounts per day per representative, but high performers will process approximately 60 accounts per day. Those numbers may vary based on your systems, how much of the remittance data is electronic, and the efficiency of your managed care system.This question was answered by: Steve Marshall, director of patient financial services, Margaret R. Pardee Memorial Hospital, and a member of the HFMA North Carolina Chapter.
Answer 2: I agree with Steve that an estimated amount is between 50 and 60 accounts per day. However, the healthcare industry is moving toward measuring outcome-based productivity, not volume-based productivity, and managing results through the actual cash a staff person collects per account touched. I am also seeing weighting by type of action taken.This question was answered by: Christine Fontaine, vice president of revenue cycle solutions, OptumInsight, and a member of the HFMA Maryland Chapter.
Answer 3: I agree that 60 accounts a day is a reasonable number to expect for technical underpayments, including denials. This number can be significantly higher if the application being used allows for bulk appeals and has integrated tools to facilitate a paperless environment. For clinical denials, the daily output is typically less because of complexities of the cases; our expectation is 25 – 30 per day.
I agree with the other contributors that activity-based measures are being replaced by results-based measures. Collections is turning into a less restrictive environment to allow staff to prioritize their work. Instead of clicking “next in queue,” staff are more effective when allowed to control their work by handling similar claims and issues at a time. This helps staff identify trends and complete more accounts in less time, as well as build relationships and credibility with their counterparts at payer organizations.
Sonia Franklin is president & CEO, Palette Health, Kansas City, Missouri, and is a member of HFMA’s Heart of American Chapter.
Share your views on this question or pose another question to our Revenue Cycle Forum experts.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
Scott Schmidt, vice president, Cerner RevWorks, LLC, shares insights on best practices for maximizing a revenue cycle management partnership.
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