Using Metrics to Motivate and Reward Reimbursement Staff Jim Knight, Partner Operations ACUServe Corporation, Cuyahoga Falls, OH
CE Credit in Five Easy Steps! 1. Scan your badge as you enter each session. 2. Carry your Evaluation Packet to every session so you can add session evaluation forms to it. 3. Track your hours on the Statement of Session Attendance Form as you go. 4. At your last session, total the hours and sign both pages of your Statement of Session Attendance Form. Keep the PINK copy for your records. Put the YELLOW and WHITE copies in your Evaluation Packet. Make sure a completed Session Evaluation Form is in your Evaluation Packet for each session you attended. Missing one? Extras are in a file near Registration. 5. Complete the General Attendance Evaluation Form located in your Evaluation Packet and place it back in your envelope. Write your name on the outside of your Evaluation Packet envelope, seal it, and drop it in the box near Registration. Applying for Pharmacy CPE? If you have not yet registered for an NABP e Profile ID, please visit www.mycpemonitor.net to do so before submitting your packet. You must enter your NABP e Profile ID in order to receive CE credit this year! 3/24/2014 2
Disclosure Slide The speaker declares no conflicts of interest or financial interest in any service or product mentioned in this program. Clinical trials and off label/investigational uses will not be discussed during this presentation. 3/24/2014 3
Learning Objectives 1. Define metrics to measure A/R departmental and employee productivity and efficiency. 2. Describe techniques for monitoring employee performance and communicating expectations with a focus on continuous quality improvement. 3. Discuss the motives of various reimbursement professionals and identify individualized goals that will keep employees engaged. 4. Examine recognition, incentives and compensation options for rewarding employees and teams. 3/24/2014 4
Intentionally Blank for Printable Slides 3/24/2014 5
Presentation Rules Audience Participation is REQUIRED! Please interrupt me! This is an interactive presentation - any and all questions are welcome. (We will make fun of your questions later.) I will be asking you questions so be ready! A copy of this presentation is available to you so don t worry about writing everything down. 3/24/2014 6
Learning Objective #1 Define what metrics you should be tracking 3/24/2014 7
Why Track the Data? You can ONLY manage what is measured! Tracking key elements at the Employee level and at the Company level provides you the foundation needed to create reward-based programs that are RESULTS based. These metrics will allow you to tie goals from an organizational standpoint, and down to the employee level, creating a team of people working towards a COMMON GOAL! 3/24/2014 8
What Metrics to Track Employee? Activity How many invoices are worked per day, week, month Is activity the best way to manage? NO! Action Taken and WHY Use custom or unused fields to track what happened to an invoice and why Examples of actions: Rebilled, Appealed, Write Off, Paid, Processing, Tasked Examples of why: NCOF (No claim on File, Missing modifier, etc.) 3/24/2014 9
What Metrics to Track Employee? Billing Output Activity that could result in future payment. Rebill, Appeal and Balance Transfer are examples of billing output. Formula: Billing Output / Activity Effectiveness How many invoices that were worked resulted in payment Create report that ties payments back to the person who worked the invoice. Formula: Invoices Paid / Activity. Payments will not tie directly back to specific invoices worked but that is OK. 3/24/2014 10
What Metrics to Track Company? Clean Claim Rate (CCR) % of Claims Paid in a period with No Touch Goal: 90% or higher Formula: Invoices Paid (No Activity)/ Invoices Paid 3/24/2014 11
What Metrics to Track Company? Collection Rate % of Payments collected against allowable Goal: 90% or higher Formula: Payments / Allowable Created Current and Over 90 A/R % % of A/R in the 0 30 Bucket and Over 90 Bucket Goal: Current A/R % > 50% &Over 90 A/R % < 20% Formula: A/R Bucket / Total A/R 3/24/2014 12
Learning Objective #2 Understand how to tie metrics to expectations with a focus on continuous improvement 3/24/2014 13
Benefits of Monitoring Higher productivity Recognize the strong performers Identify and improve the weaker ones Higher employee engagement! Give them a purpose to their workday. 3/24/2014 14
How to Use the Data Use your tracking fields to provide valuable feedback for continuous improvement Determine how much $$ and how many invoices are affected Quantified Data! Learn easily where your money is and WHY! Payor Issues NCOF, Paid Incorrectly, Delayed Payments Front end Issues Modifier Missing, Order Confirmation, Creation issues Preventable! 3/24/2014 15
How to Use the Data Breakdown the touched invoices by Invoice Note Codes to fix processes/people Increase Clean Claim Rate! 3/24/2014 16
How to Use the Data Drill down to see Subcode and WHY rebilled: Payer Issue 3/24/2014 17
Trend the Data Examples of employee trending 3/24/2014 18
Trend the Data Examples of employee trending Which on is Peforming better? 3/24/2014 19
Trend the Data Examples of employee trending Which on is Peforming better? 3/24/2014 20
Trend the Data Examples of company trending Trending your metrics allows you to see when your goals are being reached! 3/24/2014 21
Trend the Data Examples of company trending Trending and using %s allows you to see that NOT All A/R increases are BAD! 3/24/2014 22
Learning Objective #3 Learn to create goals both individually and organizationally 3/24/2014 23
Tying Metrics to Goals Now that metrics have been identified, tie them back to company and individual goals Start with the end in mind Example: If the company goal is to increase cash by 5% for the year relate that back to increasing the collection rate by 5%. Break the goal down into Quarters & Months. i.e. Q1 Q3 Goals by 1%, Monthly Goals by.33% Q4 Goal by 2%, Monthly Goals by.66% 3/24/2014 24
Tying Company Goal to Staff Company Goal: Increase Collection Rate by 5% Relating back to staff: Example: Each individual from intake to collector needs a goal. Intake: Increase Accuracy by 5%. Decrease Touch Rate of invoices created by CSR. Note: Tie back denials and touched invoices to CSR and Order Confirmation Collector: Increase Activity and Effectiveness by 5%. Example: A/R worker touches average of 60 invoices per day at an effective rate of 40%. We are asking for 3 more worked invoices per day and 2 more invoices to be paid. Does that seem reasonable? 3/24/2014 25
Motivation Through Goals The most effective goals are SIMPLE along with being Measured AND Reported weekly or monthly. Employees must receive feedback consistently 3/24/2014 26
Example of Monetary Reward Create a Bonus Pool for the Monetary Reward Example: If 5% increase is goal: Set aside a % percent to share i.e. 5% or 10% of cash Increase Bonus is paid IF company goal is met AND personal goals are achieved Share a portion Monthly or Quarterly to keep Focus! Highest contributors get Higher bonus but ALL get something if company goal is reached! 3/24/2014 27
Proceed with Caution Potential Pitfalls of Reward Programs Corners being cut to get payments Individual achievement vs. teamwork Silos are created Unwillingness to help coworkers Only rewards top achiever s and everyone else is discouraged 3/24/2014 28
Learning Objective #4 Examples of Recognition Strategies 3/24/2014 29
Recognition and Reward Strategies Measure activities that lead to accomplishment of company goals Focus on specific metrics and report consistently Reward Results NOT Behaviors Concentrate on positive reinforcement and a culture of recognition Recognize periodic, ongoing performance for ALL employees (continuous improvement is the goal!) Improve employee morale, satisfaction and retention 3/24/2014 30
Is this your office? 2 out of 3 people received NO workplace recognition in given year 99 out of 100 people WANT a more positive environment at work 9 out of 10 people say that THEY are more productive around positive people 3/24/2014 31
This could be your office! Employees receiving recognition and praise within previous seven days Show increased productivity! Improved communications with co workers and customers! Results: These employees are engaged! 3/24/2014 32
What you are up against A major study of employees worldwide reported disturbing news: Only 14% of people are fully engaged on the job and willing to go the extra mile for their company. Conducted by Towers Perrin s HR Services business Surveyed 85,000 people 3/24/2014 33
What you are up against? U.S. Department of Labor # 1 Reason people leave their jobs is that they do NOT feel appreciated 3/24/2014 34
The Top 10 Reasons that Supervisors Don t Recognize: 1. I don t know how. 2. I don t have time. 3. People don t really care about it all that much. 4. It s not MY job. 5. I don t believe in rewarding people for just doing their job. 3/24/2014 35
The Top 10 Reasons that Supervisors Don t Recognize, continued: 6. It becomes meaningless if done too much. 7. I m very limited in what I can do. 8. People will think they have made it and stop working hard. 9. I don t get it. Why should I give it? 10. Sometimes it s awkward and uncomfortable. Top 10 List Source: 180 Ways to Walk the Recognition Talk by Eric Harvey 3/24/2014 36
Recognition Examples Wall of Fame Peer s nominate each other for going above and beyond Name gets put into a monthly drawing for gift Extra PTO time Jean s day 3/24/2014 37
Recognition Examples Attendance rewards STAR of the day/week A/R worker got a difficult claim paid ANY employee that found a problem that when corrected increases clean claim rates for the future! 3/24/2014 38
Let Them Do It! Spirit Committee Nominated individuals from ALL departments Company provides minimal funding Responsible for fundraiser, fun, promoting the company vision! 3/24/2014 39
Time to Share! What has worked for YOU? 3/24/2014 40
Q & A 3/24/2014 41
Thank You! 3/24/2014 42