Just as hospitals are becoming more transparent about costs and the quality of clinical care, the same is true for revenue cycle staff performance evaluations. “We are a very open book with our staff,” says Jennifer Cox, MBA, revenue cycle director at Brewer, ME-based Northern Light Health.

Staff can check on how many registrations they have completed and the accuracy of each. They also can see how the overall department is performing — speed of calls, wait time duration, and how many calls are going to voicemail. “We are a team. Why keep it a secret?” Cox asks.

Clinical areas are used to publicly reporting quality measures. By following suit in revenue cycle areas, says Cox, “it provides an opportunity to offer support.”

Registrars can see each other’s current call times on their computers. If a registrar notices someone is on an unusually long call, it is an opportunity to help. The co-worker can offer assistance, either by taking over the call or providing a piece of information. If a supervisor notices an employee spends more time on calls than colleagues, extra training may be needed.

“Maybe they are struggling with how to get off a phone call, or maybe they get confused about insurance,” Cox offers.

But just because call times are visible does not mean everyone has to be equally fast. “We look at what can we do to help staff be the best they can be for the job. We don’t need every team member to be the same,” Cox explains.

One registrar logged long call times and low registration volumes, but it was because she was going above and beyond for patients. One patient in a wheelchair described how the registrar escorted him all the way to his appointment location. “Patients were always praising how kind she was,” Cox reports.

Transparent metrics call attention to department stars. One registrar always pulled up a list of patients who needed registrations and organized the workload with colleagues. “As lead of a pod, she now updates the spreadsheet and pushes the group to get it all done,” Cox says.

Patient access leaders no longer have to guess how to help struggling registrars. “Maybe they need help in getting through the system, collecting money, talking to patients, or how to schedule,” Cox offers. “There is a lot to every revenue cycle role.”

At Rockledge, FL-based Health First, patient access leaders are committed to transparency. “It fosters an environment of clear expectations and staff accountability. Transparency allows staff to see exactly where they stand,” says Michelle Fox, DBA, MHA, CHAM, director of revenue operations and patient access.

Leaders do not speak in generalities; they offer specific feedback on exactly what registrars are doing incorrectly so the mistake will not happen again. This eliminates much rework because errors are fixed before claims are sent. “It helps with decreasing revenue loss, timely billing, improving the clean claim rate, and decreasing the cost to collect,” Fox says.

Health First’s revenue cycle department has made transparency an important focus in several ways:

  • Leaders email daily reports of results for individuals, teams, and the organization.
  • Registration areas publicly display daily, weekly, or monthly progress.
  • Staff receive timely feedback in a huddle at the beginning of each shift.
  • The department comes up with fun challenges to hit certain metrics. “We have multiple ways to recognize and reward for optimal performance,” Fox says.

Of all the revenue cycle metrics, accuracy rate is by far the most important.

“It affects numerous downstream processes,” Fox explains. If information is not obtained at the time of registration, or is incorrect, it delays billing. “In turn, that negatively impacts cash collection,” Fox adds.

Registrations per hour also are of great importance. “It allows us to evaluate proper staffing and identify any barriers preventing an efficient workflow,” Fox says. If anyone is not meeting standards, it is discussed openly. The department relies strongly on one-on-one coaching. “We deliver real-time feedback and address any performance issues with the staff,” Fox says.