test.com - approval bad card credit credit online

Are your revenue cycle processes "state of the dark" or "state of the art"? Stanford University Medical Center fosters a culture of accountability. Its revenue cycle is metric-driven for performance and sustainability. Its report cards and dashboards provide the controls, focus, and acknowledgment for doing things right. Peter Drucker's classic definition of management as "achieving results through others" still rings true.

A successful and sustainable revenue cycle reflects a team of accountable, talented, committed individuals who know how to execute well and are constantly learning and retooling, continually trying to make what is good better. We all work with challenging situations and less than optimal tools as our organizations make difficult choices around discrete resources. With consistent and straightforward use of and adherence to performance-based report cards, an infrastructure and culture can be created and sustained that go beyond any one individual or revenue cycle leader.

Think of the revenue cycle in terms of a team sport, such as basketball. All National Basketball Association teams play well. What separates one team from another besides individual skill mix is how well they execute the fundamentals. All players at this level have great field goal shooting percentages. If, however, they can improve by 1 percent (getting clean bills that pass all edits and "score" a payment the first time), it will make a difference over time. If the team can reduce the number of turnovers (denials) by just 1 percent, over time it can make a difference between a successful franchise (organization) and one that is just in the league. Continually and perhaps routinely executing well on fundamentals and constantly improving marginally differentiates top performers.

Five Guiding Principles

Although Stanford University Medical Center's transplant services, cutting-edge medical advances, and international patients add to the organization's prestige, these features bring significant corresponding revenue cycle challenges. Revenue cycle management is about collecting cash timely and to the organization's fullest entitlement while not running afoul of the three third rails of the revenue cycle: collecting too little cash (financial stability), failing to achieve regulatory compliance (reputation), and undermining guest relations (image). The following guiding principles are not an epiphany but an homage to performing the fundamentals meticulously well.

Guiding Principle #1: Have appropriate job functions and work flow design in place. Make sure work is stratified, with the most experienced people working the highest dollar accounts and compensated accordingly for their demonstrated knowledge and skill sets. At Stanford, the account categories are $1,000-$20,000 and >$20,000, with the most experienced staff working account balances > $20,000. Patient representatives at Stanford have four levels, with those attaining level four being the candidates to work balances >$20,000. Backlogs should be outsourced. Do not overlook any part of your business. Outsource firms should be treated as vendor-partners. They need their own metrics and report card. If you know your staff cannot get to a book of business, outsource the work early enough so that the outsourcer can help contribute to your goals. (This step assumes outsourced receivables remain on the books in active accounts receivable.) Look at outsourcing partners as a relief valve that can be opened or closed as the business situation demands.

Establish situation response guidelines for staff so they will always have on hand specific scripts of actions and know when they are to act upon them. Staff should be held accountable to following scripts that allow them to escalate actions proactively and appropriately. Ensure that work flow design reflects the responsibility and accountability of the performing unit (e.g., admitting, medical records, case management, patient financial services) throughout the revenue cycle core process.

Guiding Principle #2: Elevate staff performance through quality and productivity goals. Goals should be adjusted periodically. Make sure quality reviews are timed to drive desired performance. Reviews should ensure that situation response guidelines are being followed. Scoring should be weighted more heavily upon the appropriateness and timeliness of actions. Reviews should expand and occur more frequently based on desired outcome and less when goals are achieved. Ensure that quality and productivity goals are documented in the responsible employee's evaluation. When quality reviews and individual discussions take place regularly, no surprises should occur at yearly evaluations. You are hardwiring accountability into the culture.

For example, Stanford's quality scores are based on 3.0. Follow-up representatives are expected to score at least 2-75 or higher. Those scoring 2.9 to 3.0 are reviewed monthly. Those who score between 2.75 and 2.9 are reviewed biweekly. Those scoring below 2.75 are reviewed weekly, and a developmental corrective action plan is put in place. There are productivity scores as well. A follow-up representative is expected to touch and complete follow-up on 185 accounts per week. Both quality and productivity scores are reflected in the employee's evaluation.

Guiding Principle #3: Ensure that effective technology infrastructure is in place. Revenue cycles crave stability. Two events that can undo a revenue cycle are key management turnover and a computer conversion. During a conversion, it is important to minimize system downtime, maximize response time, and prioritize cash-flow-related system requests through regular meetings between IT and finance. One example of working with IT at Stanford is reducing month-end close from five days to an overnight process, which was essential to enable review of month-end results and establish work priorities for the following month. A second example is reviewing the prioritization of reports, ensuring that reports and computer jobs that generated both bills and follow-up work lists receive top priority and are available when staff arrive in the morning.

Guiding Principle #4: Deploy at all levels a comprehensive management tool set and report card metric (dashboard). A report card needs to:

* Measure each department's key performance indicators against goals

* Be published regularly

* Be distributed widely (including executive level)

* Incorporate KPI goals into management performance evaluations extending up the chain of command

Examples of KPIs are A/R days, cash versus 13-week average, adjustments versus 13-week average, revenue versus 13-week average, credit days, work in progress or being held by departments after discharge/registration by key revenue cycle stakeholder departments by reason category, aging > 90 days by dollar stratification, stratified billing productivity versus unbilled inventory, stratified follow-up productivity versus unworked follow-up, late charges, bad debt, cost to collect, and denials.

[GRAPHIC OMITTED]

The two most challenging aspects in introducing report cards are ensuring service-line executive support and buy-in and ensuring agreement and confidence around the sources of the data. Once these aspects are achieved, dialogue can focus on support, goal attainment, corrective action plans, removal of barriers, and acknowledgment of a job well done.

Stanford University Medical Center produces and distributes report cards every Monday. The complete report package is 58 pages, with the first three pages containing the executive summary:

* Page 1, a snapshot of selective KPIs, for the week ending Friday

* Page 2, written narrative highlights

* Page 3, 11-week trend of key KPIs plus prior fiscal year-end baseline

Guiding Principle #5: Sustain a culture of accountability. Create a venue where key executives and revenue cycle stakeholders come together to review the report card or dashboard. Stakeholder departments include patient financial services, health information management systems, contracting, IT, case management, admitting, and finance. The meetings should be chaired by the organization's revenue cycle leader. Continued executive involvement is crucial. The meetings should occur as often as necessary to obtain desired performance.

The organization's revenue cycle task force should meet monthly to ensure sustained revenue cycle success and achieved goals. This meeting should be the main meeting event of the revenue cycle. All other meetings should be preparatory meetings in anticipation of the main revenue cycle meeting. Preparatory meetings should be held daily, weekly, or biweekly as appropriate within, between, and among key stakeholder departments. At these meetings, key stakeholders should review their own respective dashboard reports and billing work in progress that is delayed and in inventory. The focus of these meetings should be to be proactive and to prepare the key stakeholder department leader for his or her report at the main revenue cycle task force before the executives. Examples of these preparatory meetings are:

* PFS biweekly meeting to review KPIs, work in progress (by dollar amount and number of projects), aging accounts, and accounts with balances greater than $200k > 45 days billed

* PFS and admitting biweekly meeting to provide billing feedback on authorizations, eligibility, and sponsorship

* PFS, admitting, and case management weekly meeting on all in-house accounts whose sponsorship has not been secured

* Admitting biweekly meeting to review KPIs and goal attainment around sponsorship

* PFS and finance biweekly meetings to review write- off trends, bad debt reserves, A/R portion of financial close, trends of actual payer collections versus revenue model, and transaction code mapping integrity to general ledger

Key stakeholders should be expected to come to revenue cycle task force meetings prepared to discuss their respective department performances. If any area is not meeting its goals, that area's stakeholder should be expected to bring specific corrective action plans and time frames to the meeting. Key stakeholders should be allowed to attend with a service-line executive if particular barriers are being confronted and organizational support is needed. In this venue, a culture of accountability is reinforced. The revenue cycle leader has the prerogative to call the necessary leadership and decision makers to attend to achieve appropriate attention, corrective actions, and organization goal congruence. Also in this venue, valued and sustained contribution is acknowledged and made visible to the executives.

Revenue Cycle Success

Stanford Hospital & Clinics achieved sustained progress over the past five years with a reduction of gross days in A/R of 40. About five of these days are due to write-offs, which occurred as the result of a demerger in 2000. Over the past five years, revenue cycle improvements have brought in an additional $162 million, 80 percent of which is related to balance sheet improvement and 20 percent of which is related to ongoing income statement improvement.

Lucile Packard Children's Hospital achieved sustained progress over the past four years with a reduction of gross days in A/R of 66. About 10 of these days are due to write-offs, which occurred as the result of a demerger in 2000. Over the past five years, revenue cycle improvements have brought in an additional $114 million, 87 percent of which is related to balance sheet improvement and 13 percent of which is related to ongoing income statement improvement.

The revenue cycle contributes to key ratios that are important in terms of how an organization is viewed by the capital market. The capital market establishes an organization's credit rating. The credit rating determines in large measure the cost of going to market to raise capital. Examples of key ratios affected by the revenue cycle are:

* Days of cash on hand

* A/R days

* Bad debt expense

* Bad debt as a percentage of total operating revenue

The sustained revenue cycle success that is predicated on metric-driven dashboards has continued to find value even with executive change at Stanford Hospital & Clinics. The revenue cycle success has borne itself out at two different medical centers with two different executive groups, two different cultures continuously for five years. The results have been acknowledged by internal university audit and external audit. Finally, the results have been acknowledged and commended by both hospitals' boards of directors.

Create the Future

A metric-driven organization that has hardwired into it a culture of accountability has the greatest potential of sustaining and creating permanence in its revenue cycle successes. The ROI is both financial and an important culture shift. To paraphrase Philip Pizzo, MD, dean of Stanford University School of Medicine, when he was addressing the future of academic medicine:

"This is our purpose: We don't mean to predict the future, we mean to create the future...."

CASH ON HAND IMPROVEMENT

Days Cash on Hand

Moody's A Median = 155.2

2001    93.0
2002    95.0
2003   158.9
2004   184.4

Note: Table made from bar graph.

HFMA'S CONTRIBUTION TO STANFORD'S REVENUE CYCLE SUCCESS

HFMA has played a very important role in Stanford University Medical Center's revenue cycle successes. HFMA, at both the National and local levels, serves as an invaluable resource of ideas and tools. HFMA has benefited Stanford in several ways.

First, HFMA e-learning has helped Stanford create a meaningful career path at the patient financial services representative level. Stanford was an early adopter of HFMA e-learning. All PFS staff go through the various modules. HFMA's e-learning allows us to provide consistent, up-to-date, and repetitive learning as well as free up supervisors' time. PFS representatives at Stanford have the opportunity to advance through four levels. The ability to get to the next highest level depends in part upon completing certain e-learning modules. Fourth-level representatives (the highest level) have the opportunity to take the next big step into supervision. Individuals who have successfully completed e-learning modules are recognized at monthly town hall meetings.

Second, Stanford has benefited from HFMA's PATIENT FRIENDLY BILLING[R] initiative. We have found vendor partners through HFMA and have deployed a same look and feel patient-friendly billing statement enterprisewide, which means at both hospitals, at the clinics, and by the faculty. Doing so has had a positive impact on our guest relations and has reduced the number of phone calls and call times. We will soon be deploying online access to patient statements and itemizations.

Third, we avail ourselves of HFMA's educational sessions. The revenue cycle is only as good as the last retooling, and we are always making sure to test and validate what we believe to be our best practices against industry best practices we learn through HFMA. Further, a number of our vendor partners came to our attention when we visited Exhibitor and Idea Exchange venues at HFMA conferences.

Fourth, we avail ourselves of HFMA's networking resources because recruitment and certification are always a desirable part of our job descriptions for leadership positions.

Fifth, many of the HFMA chapters have been enlisted to play key roles in our revenue cycle. As an academic medical center, Stanford, particularly Lucile Packard Children s Hospital, receives patients from all over the United States. Many of the payers we deal with are located in the states patients come from or are state Medicaid fiscal intermediaries or Medicaid health maintenance organizations. Negotiating the myriad claim edits has been daunting at times. Whenever we have significant dollars pended with a particular out-of-state payer, we immediately look up the HFMA chapter leadership (www.hfma.org--best Rolodex around) for that state and look for a revenue cycle expert among the chapter leaders or contact the chapter president to find a hospital that has significant receivables with that payer and therefore established contacts. This networking and sharing of contacts has been invaluable to our revenue cycle.

ABOUT STANFORD UNIVERSITY MEDICAL CENTER

Stanford University Medical Center is composed of two medical facilities: Stanford Hospital & Clinics (613 licensed beds) and Lucile Packard Children's Hospital (264 licensed beds). The faculty is a part of Stanford University's School of Medicine. The facilities see approximately 33,000 admissions, 400,000 ancillary/ outpatient visits, 38,000 emergency department visits, and gross revenues approaching $4 billion annually.

David Haray, FHFMA, is vice president, Patient Financial Services, Stanford University Medical Center, Palo Alto, Calif., and a member of HFMA's Northern California Chapter. Questions or comments about this article may be sent to him at dharay@stanfordmed.org.

Copyright (c) 2006
credit card, apply online for credit card, apply for a credit card, 0 apr credit card, business credit card, credit card debt, credit card application, online credit card approval, chase credit card, credit card processing, low apr credit card, credit card debt consolidation, travel reward credit card, bad credit credit card, credit card offer, student credit card
test.com Site Map

test.com - approval bad card credit credit online

Menu