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Cultivate One Touch Claim Resolution with a Robust Quality and Training Program
The document discusses the importance of a robust quality and training program in improving claim resolution efficiency. Key statistics include an average rework cost of $25 per claim and the need for ongoing coaching and measure of success through regular reporting. It outlines steps for effective implementation and maintaining momentum in quality improvements.
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Cultivate One Touch Claim Resolution with a Robust Quality and Training Program
- 1. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Cultivate One Touch Claim Resolution with a Robust Quality & Training Program By Megan Smith HRG Executive Director, Quality and Training July 15th, 2020
- 2. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Impact of Rework Average Cost to Rework a Claim is $25 Change Healthcare Study from 2017 • Denial rework cost $118 per claim • Average % of billed charges denied = 7.5% • Missing or Invalid claim data 14.6% Average claim processing 14 – 60 days Rework/resubmissions starts the clock over
- 3. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Impact of Quality Talking Budget: What’s the Benefit of Additional FTEs? • Detect breakdowns in workflow automation • Incorrect adjustment trends on reimbursable charges • Identify training opportunities on a larger scale • Non-authoritative support for billing staff
- 4. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com By the Numbers Comparing April to June • Overall scores increased by 4% • Markdown volume decreased 15% • Overall reduction in re-touched claims 3% • Coaching hours increased month over month; providing 34 additional coaching hours
- 5. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Getting Started What does/doesn’t work? Which elements bring the most value? What amount is best to review? How will you measure success?
- 6. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Data Gathering Held 4 Two-Hour Sessions 10-12 attendees per session Existing QA team and billers Structured Agenda Assumptions Emotional experience What brings them value GOAL: REBRAND THE QUALITY PROGRAM
- 7. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Fortify the Foundation Two Day Kaizen Event Timed observations with quality staff Average biller production Daily Productivity VOLUME Department survey results Current claim review data Previous score trending Feedback from mini sessions CRITERIA GOAL: DETERMINE ACCOUNT VOLUME AND FINALIZE REVIEW CRITERIA
- 8. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Gear Up for Go-Live • Update Existing Materials or Create New Ones • Procedures • Infographics, training documents/presentations • Over-Communicate the Changes • Multiple virtual presentations • Join team/leadership meetings • Laminated At a Glance document for all staff • Maintain the Course • Follow rollout timeline • Monitor scores closely
- 9. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Measure Success Bi-Weekly and Month End Reporting • Weekly trending (by Director/Supervisor) • Six month trending by biller • Volume of markdowns by criteria trending • Total # of quality dept. coaching hours and team productivity - PETER DRUCKER
- 10. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Keeping the Momentum • Daily team huddle/calibration • Attend weekly Director meetings • Weekly organization-wide knowledge sessions • Quality and Training SharePoint site • Medicare Boot Camp
- 11. © 2020 HealthcareResource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com
Editor's Notes
- #3 2017 Change Healthcare study published in Becker’s Hospital CFO Report Looked at analysis from 724 hospitals | IP/OP claims totaling >3.3B hospital transactions
- #5 Reduction of re-touched accounts: based April discharges that resolved by June ME with 3 or less touches
- #7 Ensure buy-in through collaboration and involving the folks from the shop floor Talked about assumptions people had about the existing quality program Word association to start the conversation of emotional experience during feedback meetings We had fun! Walked in each other’s shoes by doing a hands-on warm up activity focused on performing quality reviews
- #8 VOLUME: Ran simulations using different account volumes Based on calculated takt time, determined ideal volume of accounts and billers for each member of the team Must also consider time for meetings CRITERIA: Talked about items “coached” in the past Determined focus areas include : Account Documentation, Including Supporting Attachments, Internal workflow, Resolution of Entire Balance
- #9 Remember, if you’re increasing the volume scored some top performers may slip due to casting a wider net
- #10 Number of staff available to review Total number of staff reviewed each month