Workforce Performance Solutions_Diagnostic Value Presentation
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Hospital & Health System CFO's aren't alone wondering whether their Patient Financial Services Team is an Asset or a Liability ... and this is AFTER completion of whatever Learning Management System (web-based, CD-ROM, Instructor-Led Training, or ... !!! This Presentation was created over ten years ago as a proprietary proposal for a national association of financial professionals. Ten Years After ... how does your Health System match up? If you're TEAM isn't tracking along these metrics, how much is it costing YOU?
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Workforce Performance Solutions_Diagnostic Value Presentation
- 1. Workforce Performance Solutions Optimizing Business Performance
- 2. Workforce Performance Solutions ♦ Helping Organizations understand how to re-align and position resources in today's cost sensitive, highly demanding efficient workplace. ♦ Supporting company leadership with an un-biased, “non-secular” approach to Project Management.
- 3. Human Capital Capability: The Reality Research points to a significant payoff to organizations that invest in exceptional human capital development, but few do a good job of it.
- 4. The Advantage of Superior HCC Practices ♦ A Leading Indicator of Financial Performance ♦ Provide Returns to Shareholders 3 Times Greater than Companies with Weak Practices ♦ Research Points to Certain Specific Practices improving Shareholder Value while Others Diminish It
- 5. Evolution of HCC Interventions and ROI Factors FROMFROM ♦ Backward looking ROI ♦ Discrete learning events ♦ Reactive ♦ Lacks credibility ♦ Tactical ♦ Necessary but not sufficient ♦ Used for self-justification TOTO ♦ Predictive, diagnostic value ♦ Total integrated development ♦ Proactive ♦ Drives accountability ♦ Strategic ♦ Necessary and sufficient ♦ Directs Continuous Improvement
- 6. Practices linking Human Capital and Shareholder Value ♦ Total Rewards and Accountability ♦ Collegial, flexible workplaces ♦ Recruiting and Retention ♦ Communications Integrity ♦ Focused HR Service Technologies
- 7. Diagnostic Value Practice Optimizing Business Performance
- 8. Diagnostic Value Practice ♦ To establish a front-end to Phase I that creates a well defined and client supported approach, timeline, commitment and set of expectations. ♦ To link a clients strategic and financial objectives, business processes and performance metrics.
- 9. Practice Approach ♦ Diagnostic Value Practice is an approach used to define and analyze a unique set of ROI metrics used to measure the impact “selected” Business Processes have on Revenue Cycle. ♦ This approach uses strategy, a structured methodology, a set of tools, templates & processes for capturing and intersecting “selected” Business Processes with Revenue Cycles, to deliver a unique and usable set of ROI metrics.
- 10. Method ♦ Identify Business Processes ♦ Identify Revenue Cycle Metrics ♦ Review all impacts ♦ Create baseline ♦ Review Outcomes ♦ Make Recommendations ♦ Support Recommendation Implementation ♦ Monitor Impacted Metrics
- 11. DVP Process Interview Scheduling PRE-Kick- Off Preparation Kick- Off Meeting Step 1. Clearly Define Need Work Shop Tools Assessment Business Objective Review Metrics Review Member Input Marketing & Distribution Plan Work Force Resources Operations Review Step 2. Gather Input (Capture, Collect and Scope) Step 3. Analysis & Assessment of Information Prototype Project Plan Resource Plan Solution “Other” Recommendation s Summary Step 4. Translate Analysis into Requirements Definition
- 12. Compelling “Diagnostic Value Practice” Benefits Diagnostic ValueDiagnostic ValueDiagnostic ValueDiagnostic Value Benefits Benefits Benefits Benefits BusinessBusiness ProcessesProcesses Workflow Human CapitalHuman Capital Competent Staff Profile & Performance Review Integrated Process Workflow Continuous Improvement Human Capital Development Optimum Performance Strategic VisionStrategic Vision FinancialFinancial MetricsMetrics Key Performance Indicators Financial Performance Metrics Profitable ROI
- 13. Learning Cycle to Revenue Cycle Pain Compliance Determinat ion Of Medical Necessity Pain Compliance Determination Of Medical Necessity Interventio ns Coding Curriculum Interventions Coding Curriculum Advanced Beneficiary Notification of Services Not Covered Targeted Questions Billing Errors, Type, %, # Collections Metrics:% Billings Denied, Appealed & Paid Metrics Industry Standards;% Paid, Denied, Appealed Industry Standards; % to Total Dashboard Coding Errors +/- % Increase in Billings Paid, Increase in Customer Satisfaction
- 14. Applying theApplying the Diagnostic Value PracticeDiagnostic Value Practice to Revenue Cycle Managementto Revenue Cycle Management in Healthcarein Healthcare Optimizing Business PerformanceOptimizing Business Performance
- 15. Healthcare Financial ManagementHealthcare Financial Management LandscapeLandscape Human Capital DevelopmentHuman Capital Development HealthcareHealthcare DeliveryDelivery SystemSystem PatientsPatients PayersPayers ProvidersProviders HospitalHospital • Healthcare Benefits • Patient Demographics • Membership Eligibility • Benefit Eligibility • Pre-Certification • Patient Privacy • Customer Service • Patient Satisfaction • Patient Education • Benefit Plans/Premiums • Fiduciary Accountability • Membership Eligibility • Benefit Eligibility • Medical UM/CM • Claims Adjudication • Negotiated Contracts/Fees • Claims Payment • EOBs to Patients • Quality Outcomes • Credentialed • Staff Privileges • Business Associate • Negotiated Fees • Malpractice Coverage • Medical Mgt. Compliance • Quality Management • Education/Treatment • JCAHO/HIPAA Certified • Pre-Registration • Scheduling/Admissions • Contract/Fee Management • Patient/Benefit Eligibility • Patient Financial Services • Patient Care Services • Quality Performance • Revenue Cycle Management Business Admin.Business Admin. • Competent, Certified Staff • Interfaced Business Processes • Administrative Efficiencies • Risk/Financial Management • Financial/Performance Metrics • Quality Outcomes • Billing and Collections • Effective A/R and A/P • Organizational Performance • Business Process Alignment • Learning Interventions
- 16. Major Cost & Productivity ExposuresMajor Cost & Productivity Exposures in HC Revenue Cycle Managementin HC Revenue Cycle Management ♦ Highly Fragmented Business ProcessesHighly Fragmented Business Processes ♦ High Staff Turnover/Lack of ContinuityHigh Staff Turnover/Lack of Continuity ♦ Lack of Standards for Staff Training/PerformanceLack of Standards for Staff Training/Performance ♦ Untimely and Costly Process BottlenecksUntimely and Costly Process Bottlenecks ♦ Lack of Accountability and CommunicationLack of Accountability and Communication ♦ Costly Visibility Downstream in Financial OutcomesCostly Visibility Downstream in Financial Outcomes ♦ Disparate Legacy System TechnologyDisparate Legacy System Technology
- 17. Evolution of the Managed HCEvolution of the Managed HC Revenue Cycle ProcessRevenue Cycle Process Revenue Cycle Management ProcessesRevenue Cycle Management Processes Revenue Cycle Success FactorsRevenue Cycle Success Factors ProcessManagement Revenue Cycle Process ImprovementRevenue Cycle Process Improvement CompetentCompetent QualifiedQualified StaffStaff Revenues Rewards &Rewards & Incentives =Incentives = ImprovementImprovement ProcessProcess WorkflowWorkflow ManagementManagement Business &Business & FinancialFinancial MetricsMetrics RegistrationRegistration & Admissions& Admissions RevenueRevenue Collections/Collections/ ReconciliationReconciliation Patient CarePatient Care Services &Services & ChargesCharges ServiceService CodingCoding & Billing& Billing
- 18. Key Performance IndicatorsKey Performance Indicators ♦ # Hrs. to Register/Verify Eligibility/Admit Patients# Hrs. to Register/Verify Eligibility/Admit Patients ♦ # Minutes to Complete UB92 Billing# Minutes to Complete UB92 Billing ♦ Number of UB92 Bills Submitted DailyNumber of UB92 Bills Submitted Daily ♦ % of Bills Reworked and Resubmitted% of Bills Reworked and Resubmitted ♦ # Days Claims Paid in 30 Days# Days Claims Paid in 30 Days ♦ # Days A/R Outstanding# Days A/R Outstanding ♦ # Days A/P Outstanding# Days A/P Outstanding ♦ % Reduction in Expenses -Revenue Cycle% Reduction in Expenses -Revenue Cycle ManagementManagement ♦ % Improvement if RCM Staff Performance/Production% Improvement if RCM Staff Performance/Production ♦ % Reduction in Staff Turnover% Reduction in Staff Turnover ♦ % Improvement from Staff Training Programs% Improvement from Staff Training Programs ♦ % Compliance Increase with Performance Indicators% Compliance Increase with Performance Indicators
- 19. Improvements in ROI PerformanceImprovements in ROI Performance ♦ Improved Revenue Cycle EfficienciesImproved Revenue Cycle Efficiencies ♦ Improved Employee Performance/ProductivityImproved Employee Performance/Productivity ♦ Improved Employee Retention & SatisfactionImproved Employee Retention & Satisfaction ♦ Reductions in Billing and Payment CycleReductions in Billing and Payment Cycle ♦ Improved Compliance with PKIsImproved Compliance with PKIs ♦ Measurable Improvement in ROIMeasurable Improvement in ROI
- 20. Evolution of Learning:Evolution of Learning: Revenue Cycle RelationshipRevenue Cycle Relationship ChargesCharges & Codes& Codes RegistrationRegistration PatientPatient BillingBilling CollectionsCollections AccountAccount ReconcileReconcile LMSLMS FinancialFinancial ManagementManagement ROIROI StrategicStrategic ContributionsContributions Human CapitalHuman Capital DevelopmentDevelopment Performance IndicatorsPerformance Indicators Revenue GoalsRevenue Goals
- 21. Value-Added Benefits fromValue-Added Benefits from Workforce Performance SolutionsWorkforce Performance Solutions ♦ In-Depth Experience and Knowledge Base of Healthcare Providers and Payers ♦ Hands On Healthcare Provider/Payment and Billing and Collection Expertise ♦ Experience in Strategy Development ♦ Define and Link HCC factors to Improvements in Revenue Cycle Enhancements and ROI ♦ Proven Methodology & Project Approach to Improve Internal Processes or Outsource Solutions ♦ Project-Based Success Metrics
- 22. Workforce Performance Solutions ♦ Experts in defining & linking HCC factors and ROI metrics ♦ Cumulative 45+ years of Business Process Experience – Healthcare - Provider/Payment – Pharma, Insurance, Manufacturing – Distribution, Operations , Customer Service – Strategy Development ♦ Proven Methodology and Project Approach – Implementation of relevant LMS/TMS tools & technologies – Workforce performance management – Project management ♦ Delivering Projects Based on Success Metrics
- 23. Workforce Performance Solutions Thank You Optimizing Business Performance
Editor's Notes
- Optimizing Business Performance
- Practices linking Human Capital and Shareholder Value
- Optimizing Business Performance
- is utilized to provide quality and thorough set of requirements, recommendations and solutions. This is done through a set of processes, tools and templates to clarify the project goal. Data is gathered through a set of targeted questions, interviews, surveys and analysis of various operations measurements.
- Identify Business Processes Identify Revenue Cycle Metrics Review all impacts Create baseline Review Outcomes Make Recommendations Support Recommendation Implementation Monitor Impacted Metrics
- Optimizing Business Performance
- Optimizing Business Performance