“Whether your billing operations are in-house or outsourced, the oversight of revenue cycle has evolved, and the key to managing it effectively is understanding data and transforming it into actionable tasks to maximize your return."
If you heard corks popping, that was the Strategic Radiology (SR) revenue cycle and data analytics team cheering completion of Phase 2 of the reconfigured revenue cycle database. The team celebrated the transition from charge data to transactional data with a webinar to show members around the enhanced reporting capabilities of SR’s new RadIQ™ business intelligence (BI) tools.
According to Sharon Fremer, SR’s VP, revenue cycle optimization, the use of transactional data will significantly enhance the value of the database to members. “Greater granularity in our data warehouse improves our ability to provide comparative key performance metrics across our member practices, and improves our ability to identify opportunity for improvement and sharing of best practices among coalition members.”
The SR accounts receivables database was created in 2017, providing practices that contributed data with the ability to compare financial and operational metrics against five benchmarks and three practice-specific key performance indicators (KPIs). The AR database has evolved to include more than twenty benchmarks, fifteen practice-specific KPIs, and 120 million detailed transactions, one of several benchmarking offerings through SR’s business intelligence service RadIQ™. Fourteen of SR’s 27 members are currently housed in RadIQ, with seven more practices in the queue.
The Nitty Gritty
Dave Polmanteer, analytics and BI director, says the move to transactional data provides further insight into collection activity on each charge or encounter. This opens the door to do denial trending, future payment forecasting, and underpayment reporting based on contracted reimbursements.
“We were working with high-level charge data that was aggregated to the extent that it was hard to understand what had happened to a charge over its lifetime,” he explained. “We just knew how it ended up. We wanted to change that by moving to transactional data so that we had a better view into the charge’s life cycle.”
A newly formed RCO subcommittee that includes representation from Quantum Radiology, Huron Valley Radiology, and The Hill Medical Corporation provided guidance that defined the new KPIs from the practice level, identifying what could be drawn from the data on hand and where the practices need to move to get new KPIs tomorrow.
“We can crunch data all day long,” noted Polmanteer, “but we want the data to be transformed into information that is useful to the practice. Bringing in the insight from practice leaders who use this information to manage their practice really helped.”
Roadmap for 2019
With the help of the RCO sub-committee, the SR revenue cycle team has developed a roadmap that will roll out the enhanced benchmark reports and practice-specific KPIs through the end of 2019.
The Q1 data deliverables included % of claims resolved in 60 days, average days to post charges, average AR days by location type and primary payer, and percentage credit balances, all information that could be gleaned from high-level data.
The Q2 deliverables begin to include some transactional data, enabling the identification of bad debt and write-offs. Participating practices will receive further insights into their revenue cycle, including gross and net collection percentage; net collections per CPT by procedure type (professional versus global), and average days from bill date to 1st payment date.
In Q3, deliverables will reflect the AR database’s transition into full transactional mode, providing the ability to achieve deeper insights by all affected payers, not just the primary, including patient and contracted charges.
Data Validation, Normalizing Unique Data
With 14 of Strategic Radiology’s 27 members set up in the warehouse or in progress, and 7 others awaiting implementation, data normalization among practices with disparate billing solutions is not a painless process, Polmanteer acknowledges, but it is a necessary step in engaging with the AR warehouse and participating in benchmarking.
After receiving the initial data, Polmanteer and Lopez do their best to understand the anomalies—refunds, contract bills, other income, reversals, voids, and “special rules.” “All of these things make the situation wiggly in the data warehouse if we don’t understand them,” he says.
Reports are generated in Power BI, and the team looks for out-of-range values. The next step is a meeting with the practice to walk through the data and validate the mapping accuracy and results.
“Once we are satisfied that we’ve categorized everything correctly so that they can be compared to other groups, we will get your sign-off that we have met our goal,” said Polmanteer. That goal is to aggregate the data for the purpose of tracking variances, establishing threshholds for productivity and benchmarking, and forecasting trends and the impact of contract changes, such as proposed Medicare Physician Fee Schedules.
Participation in the AR database is free to SR member groups, but the groups must provide their data. Individual practice data is visible only to that practice but aggregated for the purpose of benchmarking.
Views of the data are divided into three sections: practice specific, physician or subspecialty productivity and utilization, and benchmarks, where the data is aggregated. Various data slicers allow the information to be sorted by service date, location, modality, payer, physician, and enable visibility to individual practices all the way down to the raw data.
Some of the dashboards currently available are generic, including top 10 locations by volume; top 10 primary insurance by volume; top 10 referring physicians; volume by date of service; volume by gender; and volume by modality.
Others benchmarks have grown out of internal interests and projects undertaken by individual physicians, finance operatives, and individual groups, such as average days between date of service and posting of first payment, % of credit balances; gross collections by group; % of subspecialty volume read by subspecialists; and % of volume in subspecialty.
All reports from RadIQ—including Patient Satisfaction Survey results, Culture of Safety Surveys, and the soon-to-be-released Clinical Dashboards—are delivered in Microsoft® Power BI, which can be provisioned via SR, in which case support for the application will be provided by Dave Polmanteer and Pam Lopez, senior program analyst.
In November, the revenue cycle teams from various SR member practices will gather for Strategic Radiology’s first Revenue Cycle Summit.
“Managing revenue cycle is no longer just ‘billing and collections’,” noted Fremer. Today, she said, radiology practices engage in producing clean data, implement multiple interfaces and technologies, comply with complex payer submission rules, and must adapt to frequent regulatory changes. High-deductible plans require ever more technical and revenue cycle expertise to ensure practices are optimizing collections. All of this requires increased attention to accuracy of payment from payers.
“Whether your billing operations are in-house or outsourced, the oversight of revenue cycle has evolved, and the key to managing it effectively is understanding data and transforming it into actionable tasks to maximize your return,” Fremer says. “The SR-RCO Education Summit will equip you with tools and insight to elevate your understanding of the full revenue cycle and provide the opportunity to collaborate with your peers who face similar challenges in maneuvering the complexities off revenue cycle.”
Hub is the monthly newsletter published for the membership of Strategic Radiology practices. It includes coalition and practice news as well as news and commentary of interest to radiology professionals.
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