Admin & Finance - Section 5: Benchmarking Flashcards
A term used to describe a rule or guideline by which others can be measured or judged
Bechmarking
Used as a point of reference from which an evaluation can be made
Benchmarking
Comparing one’s processes and performance metrics to the best performance and practices in the industry
Benchmarking
How can benchmarks be evaluated in health care?
Set internally or obtained from clinical data registeries, payers (such as CMS MIPS quality benchmark) and accreditors
The purpose or benchmarking in healthcare is to improve what 4 things all except which of the following:
Efficiency Quality of care Volume of patients Patient safety Patient satisfaction Reimbursement from payers
Volume of patients and reimbursement from payers
What is important when new practices are implemented to ensure their success?
Finding a way to measure progress to determine if the benchmark is being achieved
What 3 things make a good benchmarking measure?
Importance, measurability, feasibility (achievability)
What benchmarking measure is described below?
The extent to which the measure is evidence based, has substantial potential for improvement through intervention, is prevalent and significant enough in the population to justify efforts, and has a substantial impact on patient and/or community health or value
Importance
Which benchmarking measure is described below?
The extent to which the measure produces consistent (reliable) and credible (valid) results. The measure should be precisely defined and specified, easily interpreted, and risk-adjusted as appropraite
Measurability
Which benchmarking measure is described below?
The extent to which data required is readily available or could be captured without undue burden and at a reasonable cost, and the measure implemented for improvement in the setting at which it is being applied
Feasibility
What type of benchmarking is described below?
A measure that assesses infrastructure, characteristics, or capacity to provide health care, such as equipment, personnel, or policies
Structure
What examples of benchmarking types are provided below?
Staff-to-patient ratio
Percent of diabetic patients tracked in a registry
Structure
What type of benchmarking is described below?
A measure that focuses on steps that should be followed to provide good care. There should be a scientific basis for believing the process, when executed well, will increase the probability of a desired outcome
Process
What examples of benchmarking types are provided below?
Colorectal cancer screening
Medication reconciliation
Process
What type of benchmarking is described below?
A measure that assesses the results of health care, such as clinical events, recovery, and health status
Outcome
What examples of benchmarking types are provided below?
Diabetes long-term complications admission rate
Controlling high blood pressure
Outcome
What type of benchmarking is described below?
Takes place between departments, divisions, or offices within the same hospital or clinic.
Internal benchmarking
What examples of benchmarking types are provided below?
Patient satisfaction per location
No shows
Internal benchmarking
What type of benchmarking is described below?
Occurs when an organization analyzes another organization process or similar service and compares that organization’s goals or outcomes against their own.
Competitive
Centers for Medicare and Medicaid Services, National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), National Association of RHCs, Medical Group Management Association, American Academy of Family Physicians, educational institutions, and non-profit organizations are ____ measure sources
Performance
What are 5 common financial benchmarks?
Gross collection percentage Adjusted collection percentage Financial summary dashboard Days in accounts receivable Aged accounts receivable
What does the gross collection percentage measure?
The ratio of payments to charges, without consideration of contractual adjustments
The gross collection percentage measures the ratio of payments to charges, with consideration of ____ ____.
Contractural adjustments
Calculate the gross collection percentage using the following information:
Total monthly payments: $60,000
Total monthly charges:
$100,000
Divide $60,000 (payments) by $100,000 (charges) = .60
Multiply by 100 to get a gross collection percentage of 60%
True or False:
The fee schedule, payer contracts, and payer mix do not affect the gross collection percentage
False; The fee schedule, payer contracts, and payer mix directly affect the percentage.
If the clinic fee schedule is based on 200% of the Medicare Allowable, you can automatically expect the gross collection percentage to approximate ____%
20%
True or False:
The gross collection percentage takes contractual adjustments into account
False; the gross collection percentage does not take contractual adjustments into account
This metric shows how much revenue is lost due to factors in the revenue cycle such as uncollectible bad debt, untimely filing, and other noncontractual adjustments
Adjusted collection percentage
The adjusted collection rate should be ____% at minimum
95%
The average collection rate is ____% -____%.
95%-99%
The highest performers achieve a minimum adjusted collection rate of ____%
99%
The adjusted collection percentage should be used to quantify if inappropriate or excessive ____ are being applied.
Write-offs
Adjusted collection percentage measures ____ revenue
Collectible
Why does adjusted collection percentage subtract write-offs from charges?
To calculate a more accurate collection percentage than gross collection percentage
True or False:
Payments, charges, and adjustment figures used in the adjusted collection percentage don’t need to be from the same period
False; payments, charges, and adjustment figures used in the calculation should all be from the same period
True or False:
Given RHC reimbursement mechanisms, it is not uncommon for RHCs to have an adjusted collection percentage above 100%
True
High performing RHCs may have an adjusted collection percentage of ____% or greater
105%
Calculate the adjusted collection percentage using the information provided below:
Monthy payments: $60,000
Monthly adjustments: $35,000
Monthly charges: $100,000
$60,000 (payments) + $35,000 (adjustments) = $95,000
$95,000 / $100,000 (charges) = .95 x 100 = 95%
This indicator calculates how many days of charges are represented in total AR
Days in AR or AR Days
What does days in accounts receivable measure?
How long it takes a practice to collect payments due
Calculate the days in AR using the information provided below:
Total receivables: $70,000
Credit balance: $5,000
Average daily gross charge amount/365: $600,000
$70,000 (total receivables) - $5,000 (credit balance) = $65,000
$600,000 (charges) / 365 = $1,643.83
$65,000 / $1,643.83 = 39.54
Fill in the blank:
AR days less than 30 = \_\_\_\_ performance AR days less than 40 = \_\_\_\_ performers AR Days 40-60 = \_\_\_\_ performers AR Days 60-90 = \_\_\_\_ performers AR Days more than 90 = indicates \_\_\_\_
Wow Best Moderate Poor Problems
Represents the percentage of claims denied by payers during a given period relative to total charges
Denial rate
How do you calculate denial rate?
Add the total dollar amount of claims denied by payers within a given period and divide by the total dollar amount (total charges) of claims submitted within the same period
Denial rates should not exceed ____%
5%
Calculate the denial rate using the below information:
Total claims denied - $20,000
Total claims submitted - $300,000
Time frame: 90 days
$20,000 (total claims denied) / $300,000 (total claims submitted) = 0.666
0.666 x 100 = 6.6%
Fill in the blank:
Denial rate less than 2% = ____ performers
Denial rate 2-5% = ____ performers
Denial rate 5-10% = ____ performers
Denial rate more than 10% = ____
Highest
Better
Moderate
Poor
Fill in the blank:
AR Days less than ____ = Wow!
AR Days less than ____ = Best performers
AR Days ____ - ____ = Moderate performers
AR Days ____ - ____ = Poor performers
AR Days more than ____ = Indicates problems
30 40 40-60 60-90 90
Fill in the blank:
Denial rate less than ____% = Highest performers
Denial rate ____-____% = Better performers
Denial rate ____ - ____% = Moderate performers
Denial rate more than ____% = Poor performers
2
2-5
5-10
10
All aging accounts receivable buckets should be monitored at what frequency?
Monthly
True or False:
All aging accounts receivable buckets should be monitored quarterly
False; monthly
The 0-30 category should have ____% or greater of AR
50%
120+ days of AR should represent less than ____%
12%
Significant AR over 120 days indiciates significant problems such as:
Large ____ balances
____ submission issues
____ contracting problems
Patient, claim, payer
Fill in the blank:
Less than 12% of total AR is over 120 days old = ____ performers
12%-25% of total AR is over 120 days old = ____ / ____ performers
More than 25% of total AR is over 120 days old = indicates ____
High
Best/moderate
Problems
Fill in the blank:
Less than ____% of total AR is over 120 days old = High performers
____-____% of total AR is over 120 days old = Best/moderate performers
More than ____% of total AR is over 120 days old = Indicates problems
12%
12-25%
25%
What is the most critical decision in benchmarking?
Selecting the performance measures to track
Performance measures must be ____ to the practice and must have ____ readily available.
Relevant, data
Why is it essential that reports are compared with prior periods?
To determine trends
How should management communicate practice benchmarks?
To assigned teams
What do benchmarks identify?
Problems
For monthly reporting, develop a clinic dashboard of relevant performance measures and include monthly ____, ____, and ____.
Charges, payments, and adjustments
What is the benchmark for the adjusted collections metric (%)?
98% or greater
What is the benchmark for AR Days?
Less than 45 days
What is the benchmark for denial rates?
Less than 2%
What is the benchmark for AR greater than 120 days?
Less than 12%
