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Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
Purpose:Trending indicator of claims impacted by payer/regulatory edits within claims processing system
Value:Track the impact of internal/external requirements to clean claim production, which impacts positive cash flow
Equation:N: Gross dollars in FBNSD: Average daily gross revenue
Purpose:Trending indicator of claims data as it impacts revenue cycle performance
Value:Indicates quality of data collected and reported
Equation:N: Number of claims that pass edits requiring no manual interventionD: Total claims accepted into claims scrubber tool for billing prior to submission
Purpose:Trending indicator of % claims not paid
Value:Indicates provider’s ability to comply with payer requirements and payer’s ability to accurately pay the claim
Equation:N: Number of zero paid claims deniedD: Number of total claims remitted
Purpose:Trending indicator of % claims partially paid
Equation:N: Number of partially paid claims deniedD: Number of total claims remitted
Purpose:Trending indicator of hospital’s success in managing the appeal process
Value:Indicates opportunities for payer and provider process improvement and improves cash flow
Equation:N: Number of appealed claims paidD: Total number of claims appealed and finalized or closed
Purpose:Trending indicator of final disposition of lost reimbursement, where all efforts of appeal have been exhausted or provider chooses to write off expected payment amount
Value:Indicates provider’s ability to comply with payer requirement and payers ability to accurately pay the claim
Equation:N: Net dollars written off as denialsD: Average monthly net revenue
Purpose:Trending indicator of receivable collectability by payer group
Value:Indicates revenue cycle’s ability to liquidate A/R by payer group
Equation:N: Billed payer group by aging (0-30, >30, >60, >90, >120 days)D: Total billed A/R by payer group
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Dale Hockel, senior vice president of operations, and Jim Fanelli, CFO, TriMedx, share strategies for elevating clinical engineering through innovative management programs.
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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