Lack of accountability is a primary concern for patient access departments lacking good key performance indicators (KPIs).
“Staff respond to what we measure and communicate to them,” emphasizes Sandra J. Wolfskill, FHFMA, director of healthcare finance policy and revenue cycle MAP (Measure, Apply, Perform) at the Healthcare Finance Management Association (HFMA).
Many patient access leaders use HFMA’s MAP Patient Access Keys to track revenue cycle performance. “These give the patient access director a strategic-level snapshot of patient access performance,” says Wolfskill. The MAP Keys use these KPIs:
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Point-of-service cash collections.
High patient satisfaction scores are related to lower accounts receivable (A/R) days and higher point-of-service collections, according to HFMA’s 2009 report Strategies for a High-Performance Revenue Cycle.
“The key is having the financial conversation with patients prior to service, or at the time of service for non-scheduled patients,” says Wolfskill.
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Service authorization rate.
“Payers are enforcing the preauth rules,” warns Wolfskill. “Providers need to make sure that is done before service, or payers can and will deny the claim.”
A low pre-registration rate could indicate that the organization doesn’t have a lot of scheduled business. More likely, it means that scheduling, clinical areas, and patient access are not working together to pre-register every scheduled patient prior to the patient’s arrival for service.
“To understand the potential impact, one only needs to identify the total volume of scheduled patients across all departments within the organization and compare that to the number of those patients who have been pre-processed prior to service,” says Wolfskill.
The pre-registration rate KPI reveals the gap between those two numbers. “The access director can identify the opportunity to increase this percentage to close to 100%,” says Wolfskill. “This positively impacts patient satisfaction, as well as the financial clearance process.”
Higher percentages mean more patients are financially cleared prior to service. “This also allows staff to conduct their financial communications work with the patients prior to service,” says Wolfskill. “That is the appropriate time for scheduled accounts to be resolved.”
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Insurance verification rate.
“Why would any organization not want to make sure that the correct payer source has been identified before sending a claim to a payer?” asks Wolfskill.
The insurance verification rate shows what percentage of accounts are verified. This step ensures that the provider is sending the claim with the right identification information to the right payer.
“If the provider is experiencing a significant number of payer denials in the ‘unable to identify subscriber’ category, then the current verification process should be expanded to include all accounts,” says Wolfskill. This process will reduce denials in this category.
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Conversion of uninsured patients to a payer source.
“Running batch files of self-pay accounts against the state Medicaid files is one way to quickly identify and confirm coverages,” says Wolfskill.
