You have been hired as the new Director of Revenue Cycle for a large integrated health delivery organization. The company president feels the revenue cycle process has been running on autopilot for some time and that revenue is probably being “left on the table” or being lost.

 

Your goal is to review the revenue cycle process and develop key performance indicator metrics that will be used to measure and identify areas needing improvement or change to ensure that revenue is completely captured in an efficient and effective manner.

 

You have decided to concentrate on 4 core process areas of ICD-10 coding, clinical documentation, billing, and collection of payments.

 

Select company data:

Net Accounts Receivable = $270,000

Total Number of Claims Denied = 1,500

Average Daily Net Patient Service Revenue= $4,700

Number of Correct Coding Data Elements = 5,100

Total Data Elements Required at Coding =6,000

Total Number of Claims Remitted = 45,000

Days between Service Date and Posting of Charge = 5

 

Assignment:

1.         Using the above select company data elements, calculate and or provide the following performance metrics below (a – d) and identify which of the 4 process areas each one is used for to measure and monitor revenue management. Show all calculations.

a) Claims Denial Rate =

b) Coding Quality Score =

c)  Net Days in Receivables =

d)  Charge Lag Days =

 

Based on your results from the above 4 performance metrics (a – d) above, provide an assessment of the organization’s revenue cycle core processes including any areas you feel have an opportunity for improvement and why?