Introduction

In a blog posted a few years ago, we introduced how providers can discover the hidden treasures of data mining. In it we wrote, “Refined data transformed into information becomes knowledge and knowledge – the power to act. Data mining, therefore, helps executives discover what is happening now, track trends, anticipate with some accuracy what may happen in the future, and explore the strengths of possible actions.” The data treasure trove becomes meaningful when viewed through dashboards.  

This concept has direct application to your QAPI[1] initiatives.

What is a dashboard?

A dashboard helps deliver information which is easy to retrieve, interpret, and act on. It may include tables, charts, and graphs indicating progress toward your QA goals and can deliver alerts to Key Performance Indicators (KPIs)[2] which may be significantly below or above targeted benchmarks. Because a dashboard offers information refreshed throughout the day, clinicians should monitor it routinely. Beyond regular viewing of the dashboard, making it and its displayed results an integral part of everyday conversation among clinicians is extremely important.

How to leverage your dashboard

You have worked hard to create a culture of quality and the dashboard can serve as a tremendous tool for acknowledging and rewarding progress and for working with your team to take opportune corrective action when performance falls short. Because the KPIs are timely and relevant, dashboards invite involvement among all the organization’s key QAPI players.

Through its KPI roll-up and drill-down capabilities, a dashboard enables clinicians at all levels within the organization to view KPIs germane to their responsibilities. A corporate clinical executive can view rolled up KPIs summarizing information at a corporate level. They can also drill down to a region, facility, and department level as desired or direct region and/or facility managers to focus on outliers. Because they do not have to create or wait for reports created and submitted by others, clinical managers can focus on what needs to be done now.

Dashboards can help clinicians to:

• Facilitate communication within a team and among teams across the organization
• Organize and render KPIs accessible at all levels
• Track progress and opportunities for improvement

Some dashboards, like PCT’s primeVIEW, offer a hybrid of clinically-oriented KPI views for clinicians taken directly from the clinical applications each provider uses, such as PointClickCare, and partnered predictive analytics, such as PointRight, and resident and family satisfaction trends from Pinnacle Quality Insight. For example, clinicians can track such KPIs as:A Monthly Clinical Summary

• Year-to-Date Clinical Trending
• Re-hospitalization rates
• 5 Star Rating, including facility ratings, deficiencies and fines, quality measures, comparison to local facilities, staff PPD ratings and trending
• Resident and family satisfaction trends
• Staffing KPIs including actual to census-adjusted labor hour PPDs
• And more.

Dashboards can help clinicians to meaningfully:

• Identity gaps and opportunities
• Take action to redirect and support

Data converted to information delivers the knowledge to take positive steps to achieve an organization’s goals. Business intelligence enables purposeful data mining to extract the relevant data and display it in meaningful ways through dashboards. If you have not already seized the opportunity to harness the power of dashboards, we highly encourage you to do so.

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[1] From the AHCA/NCAL website we read that ”​QAPI is defined by CMS as ‘an initiative that goes beyond the current Quality Assessment and Assurance (QAA) provision, and aims to significantly expand the intensity and scope of current activities in order to not only correct quality deficiencies (quality assurance), but also to put practices in place to monitor all nursing home care and services to continuously improve performance.’

• “Quality Assurance (QA) = the process of meeting quality standards and assuring that care reaches an acceptable level.
• “Performance Improvement (PI) = continuously analyzing your performance and developing systematic efforts to improve it; also known as Quality Improvement.”

[2] KPIs are quantifiable benchmarks used to measure actual performance compared to, in this case, Quality Assurance and Performance Improvement goals.

 

 

Jim Hoey, Prime Care Technologies, Inc.’s President and CEO, once responded to a question about why his company offers what it offers – cloud-based managed hosting services, business intelligence solutions, automated procurement services, talent management automation, and an LTPAC-focused claims clearinghouse. He proffered the following insight, “We listen to our customers’ concerns and needs and respond with user-friendly and cost-effective cloud-based solutions.” Universally, the needs are the same – to save money, increase productivity, improve the bottom line, and ensure compliance. Among the concerns expressed by billing and AR managers is the need to hit collection targets and to save time.

If you and your team are still processing claims manually, just think of the time, money, and resources wasted – not to mention the frustrations felt. Let’s just take a look at the secondary co-insurance claims process for a minute. Let me quote from a recently-posted blog written for CFO’s about Medicare crossover claims.   

“Secondary claims, if not properly handled can slow up cash flow. ‘A claim is a claim, isn’t it?’ Nope. ‘Well, I’ve got the staff and I am certainly paying enough for them to process the claims. They know what they’re doing.’ Yes, but because of the intricacies of submitting the secondary claim after receiving payment from the primary payer, providers can and often do see a delay in payment or no payment at all. ‘But why?’ you may ask.

“Once Medicare pays the claim, the MAC may through a coordination of benefits agreement automatically forward the secondary claim to the secondary payer. But not in all cases. Only if the secondary payer pays a fee for such services….

“In those cases where the secondary payer does not pay the fee for Medicare to automatically forward the secondary claim, the provider’s Central Billing Office or AR staff or Billers will have to identify, process, submit, monitor, and intervene as needed to collect the…payment. They can do this manually or electronically.

“Paper-based secondary claims – This process is as old as dirt. Because there are many nuances to the process and opportunities for omissions, errors, and procrastination, it creates delays. The billing department receives notices of payment from the primary payer. Then billers have to print the UB04, attach the claim level (and) related remittance advice, and mail or fax these papers to the secondary payer. The manual method usually requires a tickler file, likely an accordion file…to place copies of the submitted documents for follow-up. On the follow-up day, the biller places a call to the payer. Unfortunately, it’s not unusual for the payer to not have a record of the submission. So the biller will have to resubmit the claim again and move the claim documentation further back in the accordion file.

“Oh, and here is another possible ‘… grant me the serenity to accept the things I cannot change…’ moment. Some secondary payers require a 15-30-day waiting period before a provider can resubmit the claim…

“Because preparing, filing, and following up on secondary payer claims can engender procrastination, it's easy to lose track of (these) claims. This can result in further payment delays or no payment at all, if the submission takes place outside the allowable filing window (sometimes up to a year).”

Save time and effort, where possible, with claims automation

Where possible, “Automate. Automate. Automate.” Some claims clearinghouses scrub your claims before submission (according to each payer’s requirements), submits the claims, monitors the claims throughout the process, notifies you of each claim’s status in real time, alerts you (when necessary) to the need for additional information, and informs you of the claims outcome (payment or denial). No more tickler files, no more lost documentation or misplaced claims, no more fruitless and frustrating follow-up phone calls, and you get timely feedback.  

Think of the possibilities

The time you and your team would otherwise normally spend processing and following up with secondary co-insurance claims, you can devote to researching and collecting delinquent accounts, preparing for and appealing denied claims, and, if you are like some billers I know who wear multiple hats, you can focus on your other responsibilities. Whether you process claims at the facility or in a central billing office, automating claims processing makes “cents” for you and your company.

 

“I believe people are like boats.” With that I’ve started many a seminar and webcast. After a brief pause, I relieve the tension by saying, “They toot the loudest when they’re in a fog.” Ambiguity, tardy information, and just plain situational ignorance can keep many a decision-maker in a fog. However, because of the critical need to know how much and when cash will be flowing into and out of the bank, CFOs need crystal clear visibility. And business Intelligence dispels the haze and sharpens the perception of what is happening. From cash collections and revenue projections to labor and non-labor spend management, operations and finance executives alike can know almost up to the minute how much cash is flowing in and how much is flowing out.

Business Intelligence makes it happen

As we have discussed in previous blogs, Business Intelligence (BI) has become the go-to tool to help managers keep their fingers on their business’s multiple pulses all in one convenient easy-to-view location. For LTPAC providers, this amounts to such Key Performance Indicators (KPIs) as census, cash, accounts receivable, labor and non-labor spend, clinical, and other information. Roll up. Drill down. It doesn’t matter. CFOs can glimpse a consolidated view of KPIs important to them and then drill down as deep as they need to track, trend, and act. It’s real time and it’s highly effective. How? BI makes information visible at all levels within the organization simultaneously. And visibility drives accountability

But let’s limit this conversation to cash flow

Turning revenue into cash in the bank

Let’s explore a day-in-the-life-of one of a CFO who uses BI to monitor and hold accountable those responsible for keeping the cash flow steady and predictable. It’s mid-month and after logging into the BI tool (in our customers’ case, primeVIEW), the CFO, we’ll call him, “Craig”, reviews the tiles he’s configured for his home page displaying what to him are the critical KPIs. From there he clicks on the Cash/AR tab to view such information as:

• The current month collections-to-goals performance with 12-month trending
• What’s been collected and deposited each day by payer type for the current month, recent quarter, and year-to-date (Remember. He can view a corporate summary or drill down to a region or facility level.)
• How each facility or region ranks compared to their company peers by payer type
• The status of each facilities aging with payer type drilldown capabilities
• The Days Sales Outstanding (DSO) over a specified period of time
• How revenue is trending by payer typ

Craig notices that the South region is falling short of its MTD collections through the 15^th of the month. He calls Melissa, one of his veteran regional managers, and invites her to open up primeVIEW to discuss these outliers and what her staff can do today to right the regional ship and get it back on course by the next collection benchmark which is the 20^th. Melissa reports that she and her staff have been working with Facilities A and D since noticing the slowdown in collections on the 10^th. She assures Craig that her team is confident that these facilities will reach the month-end harbor very close to their goals

Financial performance

After concluding the call, Craig clicks on the financial tab to check on current revenues generated compared to budgeted projections by region as well as by facility by payer type. He further reviews revenue by occupancy by day, by payer, and by service. Convinced that the company is on track to meet goals and, in a couple of facilities, to exceed goals, Craig then turns his attention to the bad debt allowance status by facility as well as month-to-month trending. He makes a note to himself to address this issue in the next meeting with his corporate AR manager

Conclusion – Visibility is more than just clarity of sight

Because of BI, cash flow visibility is current, communication is specific, and required action is timely. Visibility encourages accountability and fosters real results.

For CFOs, the bottom line matters, whether it’s the P&L or identifying what’s in the bank. Occasionally, though, it does help to know within the context of “what’s in the bank,” how the money gets there. Since Medicare Part A is a significant revenue source, being aware that just submitting a claim for Part A-covered days-of-service may not be enough can be helpful to supporting the organization’s efforts to create an impediment-free flow of cash to the bank.

Let’s take a closer look at the obvious. Assuming the resident meets all the Part A eligibility requirements and that he or she receives Medicare-coverable services, the Medicare MAC will pay the entire amount of the RUG-determined per diem for the first 20 days of the spell of illness. The “rub” is who pays for the coinsurance for the remaining days of qualified services from the 21^st day onward? This is where the secondary payer comes in and, potentially, the headaches.

Introduction

Secondary claims, if not properly handled (and I mean filed electronically, not manually – more about that in a moment) can slow up cash flow. “A claim is a claim, isn’t it?” Nope. "Well, I’ve got the staff and I am certainly paying enough for them to process the claims. They know what they’re doing.” Yes, but because of the intricacies of submitting the secondary claim after receiving payment from the primary payer, providers can and often do see a delay in payment or no payment at all. “But why?” you may ask.

A little background

Once Medicare pays the claim, the MAC may through a coordination of benefits agreement automatically forward the secondary claim to the secondary payer. But not in all cases. Only if the secondary payer pays a fee for such services. The secondary payer can be a commercial insurance (Medi-Gap) or Medicaid. In some states, Medicaid secondary payer claims will cross over automatically. However, even if the state automatically processes the secondary claim, some states do not pay the entire coinsurance amount.

In those cases where the secondary payer does not pay the fee for Medicare to automatically forward the secondary claim, the provider’s Central Billing Office or AR staff or Billers will have to identify, process, submit, monitor, and intervene as needed to collect the secondary payer payment. They can do this manually (Really?) or electronically (Get with the program, folks.).

Manual or electronic processing – showing our bias

Let’s look at the two alternatives.

Paper-based secondary claims – This process is as old as dirt. Because there are many nuances to the process and opportunities for omissions, errors, and procrastination, it creates delays. The billing department receives notices of payment from the primary payer. Then billers have to print the UB04, attach the claim level, related remittance advice, and mail or fax these papers to the secondary payer. The manual method usually requires a tickler file, likely an accordion file with 30 slots in which to place copies of the submitted documents for follow-up. On the follow-up day, the biller places a call to the payer. Unfortunately, it’s not unusual for the payer to not have a record of the submission. So the biller will have to resubmit the claim again and move the claim documentation further back in the accordion file.

Oh, and here is another possible “...grant me the serenity to accept the things I cannot change…” moment. Some secondary payers require a 15-30-day waiting period before a provider can resubmit the claim. How’s that for taking the starch out of your shirt?

Because preparing, filing, and following up on secondary payer claims can engender procrastination, it's easy to lose track of the secondary payer claims. This can result in further payment delays or no payment at all, if the submission takes place outside the allowable filing window (sometimes 90 days to a year).

Electronic claims – the aspirin of secondary claims processing

Processing secondary payer claims electronically through a clearinghouse is as fast and easy to follow as this paragraph. Because the process of claims preparation to submission to follow-up to payments is automated, it gets the job done faster. It also helps to reduce the staff hours consumed when processing claims manually. Word to the wise, “Use the technology at hand.” 

What can a CFO do?

The bottom line looks much healthier, because the provider electronically processes not only primary payer claims, but secondary claims as well. It’s certainly one less headache.

And that makes cents.

 

Likely you’ve heard the old Biblical reference about the fruitless outcome of trying to put new wine in an old bottle. Sometimes you just have to discard the old bottle and start afresh with a new one. From an organizational standpoint, that means scrapping the old ways and introducing the new. Business Intelligence with its Key Performance Indicators and dashboard views are the new wine of data-driven decisions. But as intoxicating as that may sound, if you try to introduce it into the old bottle of your organization’s old ways of reporting and communications, you may have an informational hangover. So what can the new bottle look like? I suggest the following may help, based on some of our BI customers’ successful practices:

• Make BI part of your organizational culture - your mission and objectives
• Tie BI to performance incentives
• Use BI daily – communications and support
• Include BI in your monthly financial and operational performance reviews

Make BI part of your organizational culture – your mission and objectives

In our recent blog, I introduced the following:

“I like the concept of each organization focusing its decision making on its mission and objectives. BI helps significantly to do just that, because executives and management can identify and align Key Performance Indicators (KPIs) to the broader organization’s mission, goals, strategies, and culture as well as to each of its business units’ objectives. The magic of BI is that the information displayed can be rolled up or drilled down to specific levels of interest and responsibility within the organization. Let’s say that the COO, who likely would never log into his or her organization’s clinical application, can view a consolidated corporate view or an expanded view of all regions’ or facilities’ clinical KPIs. Likewise, a department head can view his or her specific KPIs benchmarked against department-specific goals.”

Doing so, makes the next step easier.

Tie BI to performance incentives

One of our customers, operating over 40 buildings across five states, has tied administrator and other executive incentive plans to the KPIs specific to their responsibilities. Doing so keeps the entire organization focused on tightly-defined outcomes tied to the company’s overall mission and objectives as mentioned above. This makes accountability measurable and immediate. And because BI is “real time”, it is a useful tool for coaching, facilitating, supporting, and redirecting. This unique level of transparency is motivational. It helps leaders to review their performance trends and, where appropriate, even within the context of how they are doing compared to their peers.

Use BI daily – communication and support

Many of our customers use BI in their daily morning stand-up meetings. Because of the dashboard’s flexibility, the dashboard administrator can determine who sees what information based on predetermined roll-based permissions. Department heads can view their relevant KPIs, while their administrators/executive directors can view all department and facility-specific KPIs. Regional managers and consultants view consolidated regional information as well as specific facility and department performance. CEOs, COOs, and CFOs can view consolidated information at a corporate level or drill down to region and facility information as desired.

This helps also to simplify communication up and down the organizational structure. Facility, regional and corporate staff no longer have to ask, “What?” They can dwell on the “why” and what to do about the opportunities or challenges that the “what” reveals.

Include BI in your monthly financial and operational performance reviews

One COO of a multi-facility chain, reports that he uses the dashboard during the monthly financial and operational reviews. “Today with primeVIEW (PCT’s BI dashboard) conspicuously displayed on a large monitor in his office for group discussion, (Ray Tyler, COO of Health Services Management Group) and (his) team can observe and examine such Key Performance Indicators (KPIs) as census, labor, RUG levels, and accounts receivable throughout the day. His use of primeVIEW goes beyond daily operations; Tyler also refers to it during his monthly financial reviews with facility administrators who simultaneously view performance in areas of focus. ‘By the time our P&Ls are ready, they are a month or more in arrears,’ commented Tyler. ‘But with primeVIEW, we can discuss what happened last month and examine current KPIs which directly impact financial performance and help us predict month-end outcomes.’”

Summary

Business Intelligence can become an integral part of your organization’s communication, management, leadership, and accountability structure. Inculcating in how you lead and oversee your business can yield significant dividends.