Inside HFMA: It’s time for healthcare providers to standardize denials performance measurement

Along with business partners Revecore, Revint and TruBridge, and leading health systems BJC Healthcare, CommonSpirit Health, Jefferson Health, Legacy Health, OhioHealth, Mass General Brigham, Spectrum Health and University of Wisconsin Health, HFMA’s Claim Integrity Task Force set out to scope and define metrics that could be adopted industrywide for benchmarking.

For decades, every provider has fought the constant battle to avoid denials and other claim integrity issues. Yet today somehow there remains a lack of standardized denials metrics and definitions to help put their own performance into context.

That’s the same problem HFMA was trying to solve earlier this year when we assembled the Claim Integrity Task Force — pre-pandemic. With revenue cycle operations under greater pressure than ever before, developing these metrics is the right project at the right time.

Boosting guidance and best practices

HFMA’s Claim Integrity Task Force set out to scope and define metrics that could be adopted industrywide for benchmarking. But we couldn’t do it without our business partners Revecore, Revint and TruBridge, or leading health systems BJC Healthcare, CommonSpirit Health, Jefferson Health, Legacy Health, OhioHealth, Mass General Brigham, Spectrum Health and University of Wisconsin Health.

While HFMA has been creating and sharing best practices for denials management and prevention for years, we hoped this effort would lead to even more robust guidance and best practices.

In short, we would be bringing clarity to terms and what to measure, and ultimately collect data and create benchmarks to help you better collaborate with payers.

Evolving set of key performance indicators

To begin working toward a common goal of producing tools for the industry to use, our discussions led to seven key performance indicators (KPIs) for denials management. These metrics are the first phase in what will be an evolving set of KPIs for industrywide adoption, and in January, we’ll be releasing a white paper that covers this phase.  In a fast-evolving healthcare landscape, this is just a first step toward the development of tools and solutions for denials management. In the future, you can expect more metrics, more KPIs and more guidance.

Creating discussion opportunities

Additionally, we will be creating discussion threads in the Revenue Cycle forum within HFMA’s online Community where we will be talking about issues, best practices and case studies.

And you can expect a steady stream of content in 2021, including education, peer-to-peer networking and solution-focused activities.