7-1 Activity: Analyzing KPIs

IHP 630 Module Seven Activity Dashboard

The following is a dashboard for a hypothetical hospital. It includes key performance indicators for the front end, middle, and back end of the revenue cycle. Use the data in this dashboard to support your work on the Module Seven Activity.

Area of the

Cycle

Key Performance Indicator (KPI) Target: 100%

January - March Actual

April - June Actual

July - September Actual

October - December

Actual

Front End

Accurate patient demographics (correct spelling of name, middle initial, address, phone number, date of birth) are collected at registration.

89% (Color: Yellow)

87% (Color: Yellow)

92% (Color: Yellow)

92% (Color: Yellow)

Insurance is verified and insurance card is scanned or copied upon initial visit or admission.

71% (Color: Red)

68% (Color: Red)

92% (Color: Yellow)

75% (Color: Red)

Required prior authorizations are obtained before procedures are scheduled.

98% (Color: Green)

99% (Color: Green)

89% (Color: Yellow)

85% (Color: Yellow)

Patients without insurance or potential high out-of-pocket costs will be provided information about the organization’s financial assistance program at the time of registration.

48% (Color: Red)

32% (Color: Red)

30% (Color: Red)

51% (Color: Red)

Middle

Charges are captured for services provided. 91%

(Color: Yellow) 92%

(Color: Yellow) 85%

(Color: Yellow) 86%

(Color: Yellow)

Clinical documentation is completed within 5 days of patient visit/discharge.

93% (Color: Green)

96% (Color: Green)

81% (Color: Yellow)

81% (Color: Yellow)

Area of the

Cycle

Key Performance Indicator (KPI) Target: 100%

January - March Actual

April - June Actual

July - September Actual

October - December

Actual

Members of the medical staff are notified within 2 days of any delinquent (greater than 5 days) clinical documentation in patient charts.

100% (Color: Green)

98% (Color: Green)

99% (Color: Green)

100% (Color: Green)

Coding is completed within 5 days of clinical documentation completion in the medical record.

100% (Color: Green)

70% (Color: Red)

78% (Color: Red)

76% (Color: Red)

Back End

Claims will be “scrubbed” for errors using electronic scrubbing software prior to submission to a third-party payer.

100% (Color: Green)

98% (Color: Green)

100% (Color: Green)

100% (Color: Green)

Denied claims are reviewed/accepted/appealed within 21 days of claims denial.

62% (Color: Red)

53% (Color: Red)

59% (Color: Red)

59% (Color: Red)

Patients will be billed for any account balance within 14 days of insurance reimbursement.

88% (Color: Yellow)

95% (Color: Green)

96% (Color: Green)

95% (Color: Green)

Days in accounts receivable will be less than 47 days at the end of any quarter.

56 days (Color: Red)

48 days (Color: Red)

55 days (Color: Red)

53 days (Color: Red)

The following table explains the color-coding system in the dashboard above:

Meeting Requirements 95% or Greater Green

Meeting Requirements 80% to 94% Yellow

Meeting Requirements Less Than 80% Red