By: Joe Mack, Director of Revenue Cycle
Every system and EHR has some form of reporting – some more robust than others. There are weekly standups, canned reports, and uber metrics like cash, DNFB, and AR Days. The list goes on and on…
Regardless of how they are looked at, any use of data is better than none. The real challenge is focusing on what you really need without being overwhelmed by what you don’t.
One thing I have found to be helpful is the use of scorecards to both supplement and simplify all the data that is out there. There is so much data at our fingertips that it’s easy to get lost in the noise.
For me, scorecards help solve that problem.
The benefits of having relativity and key data at a glance make revenue leadership decisions easier.
Don’t know which payer to target for your next rate negotiation? Use scorecards.
Don’t know which clinic is having the lowest overall revenue cycle performance? Scorecards √
So now that I’ve generically mentioned ‘scorecards’ several times, let’s go deeper with an example. In this case, we can continue the payer scorecard approach. Most systems know who their top payers are, both in volume and rates. They can also name their perceived poor performers, though sometimes that perception can be anecdotal.
Scorecards provide more than that, and should be developed to take key information from various departments to create a simple and actionable view to drive negotiations with payers going forward. The key is to always be grading.
Scorecards can be used for departments and clinics, IT projects, and even staff. They can be the driver for monthly revenue cycle meetings, and they can be applied to vendors to gauge where the best (or worst) usage of your vendor dollars is. I use them for all of my clients because they help me identify a problem, and move budget and resources to tackle it quickly.
Some of the best components to include in payer scorecards are
- Volume / % of Payer Mix – how big are they for our business
- Rates vs CDM/CMS – how well they are paying relative to a universal benchmark
- Speed to Credential – relative to other payers how smooth is the credentialing process
- Willingness to Collaborate and Meet – how willing is your provider rep to come to the table when needed?
- Denials as % of Clean Claims – are they denying/info requesting disproportionately to your other payers?
- Adjudication Speed – how fast are they processing claims?
Feel free to use the metrics listed above, but don’t just settle there. Come up with your own! Create a set of metrics that will drive impact throughout your organization.
Here is a step-by-step approach to developing your own scorecards:
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- Create your criteria – there’s a ton of data out there, what’s most important for your organization?
- Add a scale/Likert score to get relativity across the population being measured.
- Add weights – not all metrics are going to be as important as others, so make sure you increase or decrease a certain % (Pro tip: gross things up or down in increments of 20% or 25% – it will keep your data smoother)
- Create grades based on scores – Letter grades have worked for years so no need to complicate your grades!
- Socialize – both internally and externally and elicit feedback. In my payer scorecard example, sharing that relativity with payers during quarterly on-site meetings or rate reviews shows them that you know what is going on with their peers and helps you call them out for things they are doing well/not well.
- Update and maintain – these are best utilized on a continuous basis so you don’t want them to be stale. Look at them regularly, make changes, and keep them ready.
Customizing your scorecards to meet your specific needs is critical. It will save you time, align all stakeholders, and make it easier for you to make the necessary changes to drive results.
So, what are you going to grade today?