1. Today’s Business Office Model: Streamlined Staffing & Productivity
Lori Zindl, President OS inc.

2. Learning Objectives Business Office Model ICD-10 Considerations
Cost to Collect – Staffing Levels
Productivity Standards
Technology
Questions –
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3. Doug Brown, Managing Partner, Black Book Rankings LLC
The frank reality is that a currently failing RCM strategy could quickly close a marginally performing hospital for good.
Doug Brown, Managing Partner, Black Book Rankings LLC
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4. Components for Success
Solid Leadership
Healthy Company Culture
High Performing Teams
Strategic Vision
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5. Business Office – What is your culture?
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6. Cost to Collect Cost to Collect – Open Accounts on A/R
Higher A/R requires more staff –
thus higher costs
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7. Cost to Collect goes down
Cost to A/R
Less A/R to work
Less resources needed
Cost to Collect goes down
GDRO down
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8. Higher Costs When A/R Increases
More A/R to work
GDRO high
Cost to Collect goes up
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9. Staffing Issues for Business Office
Risk with payer specific splits
Cross training critical to reduce risk
Coverage and backup
Customer service
Performance comparisons
Training and finding qualified personnel
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10. Calculating Staffing Levels - Biller
Number claims billed per month
Less than 15%
Billing system should edit and provide clean claims not requiring review
# Claims needing intervention
# Claims Needing Intervention 80
Productivity standard of 80 claims per hour
Monthly hours needed for billing activity
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11. Calculating Staffing Levels – Biller Example
10,000 claims per month
15% of claims should require review
1,500 Claims needing intervention
1,500 Claims needing intervention 80
Productivity standard of 80 claims per hour
18.75 hours per month for billing (0.1 FTE)
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12. Calculating Staffing Levels – How Many Per Hour?
10,000 claims per month
Number of hours spent on claims processing
Claims per hour (Goal 60-80)
10,000 claims per month
Number needing to be touched
Error rate
(Goal 15%)
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13. Calculating Staffing Levels – Insurance Follow Up
Number claims billed per month
Less than 20% of accounts should require follow up
# of accounts to follow up on per month
# of accounts to follow up on per month 15
Productivity standard of 15 transactions per hour
Monthly hours needed for insurance follow up activities
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14. Calculating Staffing Levels – How Many Per Hour?
Claims per month
Number of hours on Denials & Follow Up
Claims per hour (Goal 10-15)
Claims per month
Number of denials/follow up claims to be worked
Denial/Follow Up rate (Goal 20%)
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15. Calculating Staffing Levels – Cash Posting
Number claims billed per month 3
Average number of transactions posted per claim (includes credit balances)
# of transactions to post per month
# of transactions to post per month 65
Productivity standard of 65 transactions per hour
Monthly hours needed for posting activity
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16. Calculating Staffing Levels – Self Pay Collections
Number of Self Pay accounts on ATB over 60 days
# of accounts to follow up on per month
# of accounts to follow up on per month 60
Productivity standard of 60 transactions per hour
Monthly hours needed for Self Pay Collections
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17. Staffing Needs – 10,000 Claims per Month
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18. Why FTE Creeps Up Technology deficiencies
Inadequate claim scrubber
Denial reporting tools not available or not analyzed and integrated into claim scrubber
Document imaging systems
Outside /internet blocking
Performance standards not met (or used at all)
No peer comparisons
Multi-tasking often leads to “selective-tasking”
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19. Staffing, Productivity, Auditing & Monitoring
19-Jun
26-Jun
3-Jul
# Worked
Hours %
371
19.05
121.7%
393
18.75
131.0%
297
19.48
95.3%
292
18.52
98.5%
348
23.27
93.5%
210
12.34
106.4%
501
39.30
79.7%
396
38.62
64.1%
339
31.53
67.2%
Beginning 75 50 57
Assigned
181
222
161
Backlog 54
Worked
206
215
164 93 82 51
146
171
121 48
157
202
124 97 61 67
192
194 65
228
188
173
165
178
133
135 86
273
208
166
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20. Performance Matrix
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21. Performance Expectations
The following essential functions will be monitored and reported regularly. All functions will be reviewed for timeliness and appropriateness of activity. Performance expectations are in the chart below.
Productivity
Quality audits – Follow up activities
Attendance
Tardy/schedule deviations
Continuing education
In addition the following performance measures will be monitored and reported regularly. The performance target is indicated.
Percentage of accounts aged over 90 days – Less than 20%
Rejections percentage – Less than 3%
Collections for payer(s) – Charted on Team Goal sheet each month
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22. Denial Analysis
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23. Where to Focus Resources
Coding
Medical Necessity write offs
Costs of rework on denials and edits
Billing/Denials Software
Costs of rework
Costs of unnecessary follow up
Increased A/R, # of accounts and aging issues
Slow payment turnaround
Untimely filing write offs
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24. Where to Focus Resources (continued)
Pre-registration/insurance verification
Costs of rework
Untimely filing and bad debt write offs
Authorization write offs
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