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Using Quality Analysis to Improve Finances

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One of the fastest growing trends in health care is the use of a quality analysis to improve finances. Medical office managers are facing many difficulties due to the constant changes in billing and coding standards and IT requirements. It can be quite a challenge for the manager to keep up with so many changes especially in a small office with limited staff. Billers and coders may also find it challenging to find time to read up on all the new updates. It seems as though Medicare changes something every other day.

A quality analyst is an experienced medical biller and/or coder that conducts performance audits in the medical office specifically related to billing and accounts receivables. The quality analyst has many responsibilities, but the main objective is to enhance processes and shorten revenue cycle times. According to the HFMA (Healthcare Financial Management Association), the nationwide average days of accounts receivable (A/R) is 44.5. If your A/R days are greater than 60, your medical office could significantly benefit from hiring a quality analyst.

1. Recommend Performance Improvement Goals

  • Increase total cash collections on a consistent basis by improving processes in financial counseling, registration, admitting, billing and collections.
  • Increase employee satisfation and reduce turnover by providing incentives and increasing salaries.
  • Increase upfront collections by providing extensive training to registration staff, implement 100% insurance verifications and provide payment estimates for every patient at every access point from scheduling thru discharge until payments or payment arrangements are made.
  • Reduce total discharge days not final billed, aging of accounts receivable days, late charges, bad debt write offs and denial rates.

2. Identify Opportunities for Training and Developement

  • Provide job aids or other performance support tools for increasing staff performance including collections scripts, payer specific billing manuals, templates for determining patient estimates, and others.
  • Develop or revamp new hire training processes
  • Schedule training sessions or days for staff that do not meet expectations in particular areas by using a team of dedicated trainers.
  • Encourage and plan crosstraining among different job duties to avoid lapses or delays that effect cash collections.
  • Schedule revenue cycle team meetings every two weeks until performance improvement goals are met.
  • Encourage employees to attend conferences, webinars and online education sessions to improve revenue cycle knowledge base.

3. Suggest Process Improvement Activities

  • Establish continuous quality improvement processes to identify errors and inaccurate billing practices including researching rejected claims, denied claims and underpaid claims.
  • Create a corrective action plan once errors have been identified.
  • Prioritize areas that show the greatest need for improvement.
  • Stay ahead of industry changes by staying informed.
  • Use the IT staff effectively to transition toward more automated processes, improve workflow, and enhance operational efficiency.
  • Outsource hard to collect accounts such as self pay and liability claims to relieve staff to focus on insurance accounts.
  • Develop a standard to measure performance based on quality and production.

4. Measure Performance

  • Efficiency: Refers to how well time and effort is used to perform job tasks
  • Effectiveness: Refers to how accurately or completely tasks are performed
  • Timeliness: Refers to whether the work is being performed within the desired time frame.
  • Productivity: Refers to the value of the output of the work performed or income that results from the work performed.Quality: Refers to the degree the work performed meets the standards, requirements and expectations.

FOR MORE INFORMATION

You could employ a quality analyst full time or on a contract as-needed basis. If you would like more information about hiring a quality analyst on a contract as-needed basis email me at medicaloffice@aboutguide.com or call 919-896-9479 for details.

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