Milwaukee Regional Health System [Case 30, P.193].
1. Using the template in exhibit 30.1, add one additional benchmark and one defect benchmark for each revenue cycle function listed.
b. Describe each metric in the completed template, and justify choosing these benchmarks over the alternatives listed in exhibit 30.2.
2. Compare the benchmark values in your completed template with the actual MRHS metric values given in exhibit 30.3. Discuss your results. Most important, suggest what actions might be implemented to improve revenue cycle performance.
3. Complete the reimbursement amount template provided in the case for CPT 73722 (MRI of the knee) and MS-DRG 470 (major joint replacement). Discuss the fairness and efficiency of the current fragmented reimbursement system to providers, insurers, patients, and society (the ultimate bearers of healthcare costs).
b. Assume that MRHS’s payer mix is 46 percent Medicare, 34 percent commercial/managed care, 16 percent Medicaid, and 4 percent self-pay/no insurance. Calculate the average expected payment for each of the two procedures
There are also questions in this google docs excel sheet. I have done the first page.
Expert Solution Preview
Introduction:
In this assignment, we will be analyzing the revenue cycle functions and their benchmarks of Milwaukee Regional Health System (MRHS), discussing the comparison of benchmark values with actual metric values and suggesting actions to improve revenue cycle performance. We will also analyze the reimbursement amount template for CPT 73722 and MS-DRG 470 and discuss the current fragmented reimbursement system’s fairness and efficiency to providers, insurers, patients, and society.
1. Using the template in exhibit 30.1, add one additional benchmark and one defect benchmark for each revenue cycle function listed. Describe each metric in the completed template, and justify choosing these benchmarks over the alternatives listed in exhibit 30.2.
Revenue cycle functions play a vital role in the healthcare industry, and it is essential to set benchmarks to measure and improve performance. The exhibit 30.1 template provides various benchmarks for each revenue cycle function, and we will add one additional benchmark and one defect benchmark for each function listed.
a. Patient Registration:
Additional benchmark: Percentage of registrations completed within 10 minutes of the patient’s arrival
Defect benchmark: Percentage of incorrect information entered in the system during registration
The additional benchmark is essential to measure the registration process’s efficiency as it ensures that patients are registered promptly. The defect benchmark is crucial to measure the quality of data entered in the system, which is crucial for accurate billing and revenue cycle management.
b. Eligibility and Benefits Verification:
Additional benchmark: Percentage of insurance coverage verified within one hour of patient arrival
Defect benchmark: Percentage of ineligible patients provided with services
The additional benchmark measures the efficiency of the verification process, ensuring timely revenue cycle management. The defect benchmark helps to measure compliance and the revenue loss due to ineligible patients receiving services.
c. Charge Capture:
Additional benchmark: Percentage of charges captured within 24 hours of service delivery
Defect benchmark: Percentage of charges missed during charge capture
The additional benchmark measures the efficiency of capturing charges, impacting revenue cycle management. The defect benchmark measures compliance and ensures that all charges are captured to prevent revenue loss.
d. Coding:
Additional benchmark: Percentage of coding completed within 48 hours of charge capture
Defect benchmark: Percentage of coding errors leading to claim denials
The additional benchmark measures the efficiency of completing coding, which impacts timely billing and revenue cycle management. The defect benchmark measures the quality of coding done, which is crucial in reducing claim denials and ensuring revenue is not lost.
e. Claim Submission:
Additional benchmark: Percentage of claims submitted within two days of coding completion
Defect benchmark: Percentage of claims rejected due to technical errors
The additional benchmark measures the timely submission of claims, which is essential for faster revenue cycle management. The defect benchmark measures how many claims are denied or rejected due to technical errors, affecting the revenue cycle’s efficiency and revenue loss.
f. Accounts Receivable (AR) Management:
Additional benchmark: Percentage of AR over 120 days old cleared within 30 days
Defect benchmark: Percentage of AR write-offs due to incorrect billing
The additional benchmark measures the efficiency of clearing AR, impacting cash flow and revenue cycle management. The defect benchmark measures the quality of billing, leading to revenue loss due to incorrect billing.
2. Compare the benchmark values in your completed template with the actual MRHS metric values given in exhibit 30.3. Discuss your results. Most importantly, suggest what actions might be implemented to improve revenue cycle performance.
Comparing the benchmark values with actual metrics, we found that MRHS has an efficiency gap in patient registration, charge capture, and AR management.
To improve the patient registration process’s efficiency, MRHS can implement a self-registration kiosk, enabling patients to enter their information directly into the system, reducing errors and wait times.
To improve charge capture, MRHS can use automated charge capture solutions, ensuring that all services provided are captured, reducing revenue loss.
To improve AR management, MRHS can implement automated follow-up and collections processes, reducing the number of claims over 120 days old and improving cash flow.
3. Complete the reimbursement amount template provided in the case for CPT 73722 (MRI of the knee) and MS-DRG 470 (major joint replacement). Discuss the fairness and efficiency of the current fragmented reimbursement system to providers, insurers, patients, and society (the ultimate bearers of healthcare costs).
The reimbursement amount template provides insight into the fragmented reimbursement system’s fairness and efficiency for MRHS procedures, CPT 73722 and MS-DRG 470.
The current reimbursement system is inefficient and unfair as it relies on negotiations between providers and insurers, leading to significant variations in reimbursement rates, affecting profitability and quality of care.
Patients and society bear the brunt of these costs, leading to high healthcare costs, and inefficient healthcare systems affect overall healthcare outcomes negatively.
To address this issue, healthcare policymakers should focus on creating a standardized reimbursement system that is fair and efficient for all stakeholders, ensuring quality care is provided without affecting healthcare costs.
