Regularly discussing KPIs allows revenue cycle staff to review progress and spot potential problems and solutions.
Well organized revenue cycle department meetings that cover topics that affect staff members’ everyday work are key factors in revenue cycle improvement and staff engagement. A recent HFMA Forum listserv discussion focused on what should be on the agenda for a revenue cycle department meeting. Several members responded to that question and added information about who should attend these meetings and how they are run.
Start with the KPIs
A revenue cycle meeting covers a lot of ground, even at a small hospital. The agenda items mentioned by Forum participants ranged from a discussion of new billing and payment services being offered to mentions of employee anniversaries and other milestones. But several participants said that a review of key performance indicators (KPIs) should be part of every meeting and most commonly at the beginning.
One Forum participant said that when she worked in hospital operations, her revenue cycle meetings included a review of the following KPIs.
- Cash
- Accounts receivable (A/R) days
- Denials
- Aging
- Customer service statistics
- Staff vacancy/turnover rates
Another participant, David Catoe, FHFMA, assistant vice president at Carolinas Healthcare System, added several other KPIs to the list.
- Discharged not final billed (DNFB” accounts
- Coding backlogs
- Registration errors
- Medical record turnaround times
- Up-front collections prior to service
“Generally, you want to discuss performance in certain key areas to ensure staff are performing as expected and to spot potential problems early on so they don’t become larger problems,” Catoe said.
In a follow-up interview, Catoe said that he asks the appropriate individuals to report on their KPIs briefly using visuals, such as a short PowerPoint presentation, and then opens the floor to discussion if needed.
“For example, we may go over the A/R days, and they’ve shot up five days in the past three months. We need to dig into this and figure out why,” Catoe said. “That starts the discussion with ‘Here’s what we found, here are some concerns.’ Anybody and everybody can jump in and offer any information or assistance they can regardless of the department they work in. You want that lively debate. You need that to solve problems.”
Those debates last anywhere from 10 minutes to half an hour, Catoe said. If they stretch beyond that, he often recommends a separate meeting to deal with that issue, because he keeps his revenue cycle meetings to a two-hour maximum time limit.
Another Forum member, Ryan Larson, executive director/revenue cycle at Children’s Hospital Colorado in Aurora, said that his meetings are limited to just one hour per month, and that the discussion of the key A/R metrics is kept broad. He added that the committee digs deeper into one new topic each month. For example, the topic in January may be a recap of last year’s denial performance; the February meeting may include an update on clinical documentation improvement (CDI), coding, and release of information; and the March meeting may cover late charge analysis and contract updates.
See related tool: Revenue Cycle Committee: Annual Meeting Plan
Other Agenda Items
Discussing KPIs, and the issues the KPIs measure, is an essential part of many hospitals’ revenue cycle meetings. But there are other important topics that make an effective agenda, according to Forum members.
For example, one respondent wrote that all new contracts are reviewed, new services and codes are discussed, and issues related to charges or chargemasters are considered.
Another Forum member noted that pertinent topics gleaned from the media are discussed, such as issues related to the Affordable Care Act, population management trends, and other topics. This member also noted that patient complaints and challenges are noted as well as kudos to staff members for jobs well done are also discussed at the meeting. To lighten up the meetings, employee anniversaries and birthdays are celebrated.
Who Attends?
Some Forum members also noted who attends revenue cycle meetings. One contributor provided this list of attendees.
- Billing staff
- Coders
- Denial management staff
- The compliance officer
- The CFO
- The revenue cycle manager
- The health information management (HIM) manager
She noted that the last two on the list co-host the meetings and managers from other departments are invited depending on the issues being discussed.
Larson said that his committee consists of leaders from the following areas.
- Billing
- Insurance
- Financial counseling
- Admissions
- Charge/pricing
- HIM
- Contracting
- Service lines
In a follow-up interview he said that it is difficult getting involvement from people who are not directly involved in revenue, but who still play a role.
“I’d say our biggest challenge is getting engagement from non-revenue cycle leaders,” Larson said. “We invite a handful of service line or ambulatory leaders. … I’d say two or three consistently join.”
Catoe noted that attendance in his revenue cycle meetings is mandatory for those invited; if they can’t make it, he expects someone else from the department to attend and be ready to report and answer questions. This ensures that issues affecting each department can be fully addressed.
It’s often useful for senior managers to occasionally attend the meetings, Catoe added. “I think the higher level involvement, such as from the CFO or vice president of revenue management, shows support for the purpose of the meeting,” he said.
Face-to-Face Pays Off
In today’s high-tech world, do some revenue cycle meetings happen via Skype or conference call? Catoe said that his organization does use Skype for certain meetings because employees are spread all across the Carolinas, but he prefers face-to-face meetings for revenue cycle topics.
“I want to see their faces, and I want them to stand up and verbalize their results and have them available for questions,” he says, adding that attendees often bring in examples of problematic forms or other documents that they share with the group. “Having them present to talk with the group is far superior to any discussion that we could have over the phone.”
Not Too Formal
Catoe and Larson said that their revenue cycle meetings are fairly informal, though an agenda is always provided and someone takes minutes.
“I don’t like the rigid, formal structure where you have to raise your hand to speak,” Catoe said. “But you do need structure. The meetings have to be action-oriented, purposeful, engaged, and as short as possible but still cover all the required angles.”
Interviewed for this article: David Catoe, FHFMA, is assistant vice president at Carolinas Healthcare System, Charlotte, N.C., and is a member of HFMA’s North Carolina Chapter.
Ryan Larson is executive director/revenue cycle at Children’s Hospital Colorado, Aurora, Col., and a member of HFMA’s Colorado Chapter.
