Five Steps to Capture Lost Revenue for Hospital Outreach and Outpatient Services

This blog post is part three of a five part series. View Part One, View Part Two, View Part Four, View Part Five.

In this series, we’ve explored the substantive topline and bottom-line impacts of front-end revenue cycle automation and enhanced claim denial management capabilities. Next, we look at capturing and exploiting the right data, to help regain lost outpatient revenue. 

Faced with the pronounced fiscal impacts of Covid-19, health care financial and administrative professionals are clamoring for improved analytics and reporting to facilitate better decision-making. In a December 2020 survey of Healthcare Financial Management Association (HFMA) members, 81% prioritized the need for “enhanced management reporting”, while 71% wanted “more comprehensive performance insights across enterprise”.¹ The ability to identify, track, and manage essential KPIs associated with outpatient and outreach service claims is fundamental to achieving these goals.

Elevate Your Performance as a Strategic Business Partner

Armed with the right information, RCM leaders and department heads can engage with finance executives and payor relations leaders as a strategic business partner. To this end, providing valuable insights into real profitability, claim processing effectiveness, team and individual productivity, and client and payor behaviors, is pivotal. A selection of relevant metrics may include:

• Percentage of unbilled/unclean claims
• Client error rates
• Payor denial rates
• Time it takes from requisition to payment (days in AR)
• Average and median price per encounter
• Average and median cash per encounter
• Net revenue vs. cash collected
• Actuals vs expected pricing
• Month-over-month revenue and profitability by client, sales rep, procedure, and payor
• Percentage of bad debt

To ensure greater utility, critical metrics, calculated using real data – not assumed or allocated data – are consolidated into helpful dashboards that pinpoint problem areas, track progress toward issue mitigation, and ultimately demonstrate successful performance.

Beyond gaining a tactical understanding of internal performance, the right data can be proactively applied to support more strategic initiatives, such as making more informed pricing decisions based on the relationship between service costs and reimbursements for all payors (not just Medicare); identifying and supporting specific payor contract negotiation needs; supporting client management decisions, based on a holistic view of account profitability.

Interested in reading the rest of this series? Subscribe to our blog and get alerted when we cover Part 4, “Complete a Compliance Review.”

Source:
1. https://www.hfma.org/topics/hfm/2021/april/financial-analytics-leadership-council-members-share-5-challenges-responses-to-pandemics-financial-long-haul.html 

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