Share key metrics with clinical areas

Leaders misunderstand revenue cycle

Hundreds of revenue cycle metrics were shared with the Cleveland (OH) Clinic's 22 clinical institutes each month, but much of the information wasn't relevant to them, according to Susan M. Milheim, senior director of revenue cycle management.

"We overwhelmed them with too much data," she says. "We said, 'Instead of sending you 1,000 different metrics, let's whittle it down to the 15 most important."

Clinical leaders had no idea how their processes affected the revenue cycle, says Milheim, but revenue cycle leadership now meets twice monthly with administrators on the clinical side to discuss revenue cycle opportunities. "There is a longstanding gap between the clinical side and the financial side," says Milheim. "I think we wanted to keep out of each others' backyards. But it really comes down to financial viability, and the patient experience, for the organization."

A revenue cycle steering committee created a scorecard with metrics relevant to clinical areas, and education was performed about their role in the revenue cycle. "As we look at performance across these metrics, we might see one area performing very well and another performing poorly" on such metrics as authorization-related denials, says Milheim. "This provides us the opportunity to look for opportunities and best practices."

Accuracy is priority

In some cases, registrars' priority was to move patients quickly through the scheduling or check-in process, often without obtaining all the necessary information, she says.

"They didn't understand the implications, both for the patient experience or the cash they were leaving on the table," she says. "If we get the registration wrong, the likelihood of missing the authorization opportunity strongly exists. We may have no opportunity to correct it."

Consistency within each of the 22 clinical institutes is an important goal, says Milheim. "We don't want patients to go to cardiovascular and have one experience, and have a different experience at gastroenterology," she says. Milheim notes that copay collection rates vary from 75% to 95%.

Patient access is implementing a registration quality assurance tool that might slow down the scheduling and registration process, Milheim notes, but will result in fewer claims denials. "Registrars want to get the patient on and off the phone with as little disruption as possible, asking very few questions," she says. "We are putting these edits in place because we need to get it correct for the benefit of the patient and the organization."

Registrars were informed that if the patient isn't asked the right questions at the point of scheduling or registration, or if information isn't entered correctly into the system, the claim will be denied, says Milheim. She asks her staff to imagine how much happier the patient would be if the registration was done correctly and how much less rework would have to be done.

"When the patient receives a denial, he or she has to call their payer to resolve it, and if necessary, call customer service to discuss the denial and possibly wait for us to investigate and respond back," says Milheim. "This is frustrating for the patient, and labor-intensive for all parties involved."

Sources

For more information on collaborating with clinical areas, contact:

• Susan M. Milheim, Senior Director, Revenue Cycle Management, Cleveland Clinic, Independence, OH. Phone: (216) 636-7210. Fax: (216) 636-8088. E-mail: milheis@ccf.org.

• Stacy Calvaruso, CHAM, Assistant Vice President, Patient Management, Ochsner Health System, New Orleans. Phone: (504) 842-6092. Fax: (504) 842-9108. E-mail: scalvaruso@ochsner.org.