Hi, everyone. My name is Nicole Knight. I'm the Executive Vice President of MedAxium Revenue Cycle Solutions and Care Transformation. Thanks for joining us for this module today. We're going to focus on front office operations, the business side. Here are my disclosures. And here are some learning objectives for the module today. We're going to focus on access management and what are some of the critical roles and processes of scheduling, and also managing those patient in-betweens. We're going to have a high-level overview of the credentialing process and how this impacts reimbursement. And then we're going to dive into that business side focused around the revenue cycle with some key areas, such as the pre-service initiatives for authorizations, what are some of those pain points. We're going to do an overview of the revenue cycle and revenue integrity. And we're going to talk about some of the barriers and opportunities with charge capture and communication. So let's start with access management, schedules and managing the in-between. So what are some of the primary drivers that restrict our patient access? Most of these drivers revolve around rigid scheduling templates or preferences by our providers. So these restrictions can be complex and they often have algorithms that maybe few people will understand in your organization. It doesn't empower our staff to make those scheduling decisions. And it also challenges our patients, which could result in high no-show rates or cancellations. So what can we do with these gaps in access? How can we create a foundation by engaging our providers? Well, building the relationship and the culture of availability that's patient-centered is the top thing that helps us move forward with those access barriers. So being patient-centered and supporting our primary care organizations, networks, and any other urgent care centers helps us with delivering that patient care. How do we change the care delivery model? What do our team-based relationships look like? Not only for our appointment services, but for that continuous interaction with our patients. Are we practicing evidence-based care? To reduce those barriers, how do we open our schedules? How do we coordinate care? How do we service our high-risk patients? And overall, what is the communication across the organization, including internal feedback, which we measure from our patient satisfaction? Also our timeliness of responses, not just with responses with getting a patient an appointment, but also with the patient's getting a patient an appointment, but also their test results, their labs, their questions that they may have. So how do we continue to build that foundation and be successful in promoting access in our organizations? So some components of a successful referral process definitely help that foundation. Integrating the referral management into your existing workflows, which includes obtaining the relevant information that you need in order to engage key players in the organization. Maintaining accurate and up-to-date information that's communicated across the organization helps with engaging those patients throughout the referral process. Also analyzing referral metrics to improve outcomes. So how are you measuring referrals that come in? Not just from phone calls, not just from maybe e-faxes. What if you have referrals coming in the portal? How do you account for referrals that go directly to the provider? Thinking of all those areas in that foundational element of the referral process to be able to measure and improve in these specific areas. Some demand questions. When you look at your patient population, who is your population? What is the care that you're providing in the clinical pathways? And who should be delivering the care? Is it your advanced practitioners? Is it physicians? Is it nursing care that should be occurring within your clinics? What are those specific pathways? And are those somewhat standardized, what we call purposeful standardization, so that there's communication and continuity across those processes in your organization? Who is your patient population? So the first thing we recommend looking at is your patient panel. This is the number of unique patients per provider. So that could be physician or advanced practitioner over the last 18 months that had an encounter. So are you able to pull that information by each provider in your program? Are you doing secondary prevention, surveillance, or chronic disease management? What does that look like? Can you pull that detail from some diagnosis data in your system? What are your objectives of care? How often will you follow up with your patients? What's the timeliness of that? How do you manage their medication management, their refills? How do you manage lab? How do you provide study results? How do you have that ongoing communication? Physicians should develop that initial plan of care. So when we talk about team-based model, we facilitate and manage that plan in an every other fashion, meaning that the physician may see them initially, then they will see an advanced practitioner, and then they would see the physician again. What does this look like from an interval perspective? Are you seeing your patients every 3, 6, 12, 24 months? Is there a standard across your patient population and your patient panel to support the access in your schedules if you are seeing them at these different intervals? When you talk about the types of patients you're seeing, we have hospital follow-ups. Are you tracking the number of discharges? Are you looking at how early are you seeing those post-hospitalizations? Are you participating in transitional care management where you're getting those patients into your clinic 7 to 14 days post-discharge in order to maintain their conditions and prevent any readmissions? How does that follow-up look? Do you have resources to provide patient education? And of course, follow up on those test results. Same premise, when you look at these different types of patient populations, so like in this example, your hospital follow-ups, is the physician developing that initial plan of care? If he saw them in the hospital, a physician or a physician within the group established that plan of care. Can they see an advanced practitioner? What is that follow-up sequence for your hospital follow-ups? So really establishing that guideline and manage that access for these patients. Post-procedure follow-up, same thing. What procedures are you performing? Do you have a structural heart program? Are you providing EP services, interventional? Do you have cardiothoracic surgery? Do you understand the post-op global period? How should you be tracking these based on your procedure? So what should you anticipate your number of visits for post-procedure follow-up? Then of course, developing that procedure course, providing education to the patients, and again, having that initial plan of care, being able to have that team-based model, and then providing that ongoing follow-up. Heart failure, so this is when we get into our subspecialty clinics that happen. Do you have a subspecialty clinic that maintains heart failure and monitors those patients and manages their ongoing care? Do all your physicians see heart failure patients? What do those heart failure patients look like? Tracking your number of discharges, developing that plan of care, having that continued disease stabilization, medication titration, and when we look at these subspecialty clinics, it often is impacted by other resources that we have to manage that patient education. So in our heart failure clinics, typically we have physicians, we have advanced practitioners, we have nurses, sometimes we have dieticians, medical assistants. What does that team look like? And have you developed that standard of their return visits? Are they seeing the right person at the right time? And being able to manage that population based on their disease condition. New patients. So when we talk about access as a manager or practice administrator, it's always usually centered around new patients. I gave some examples of some subspecialty clinic and our normal follow-ups for hospital services procedure follow-up. That is access as well, because if you're not seeing those patients and follow-up at the right interval and maintaining a process to manage their in-betweens and their appointments, then it does impact your new patient scheduling. So for new patients, we see access is generally five business days or less. Many organizations are at three days. Do you have a next available resource? How are you naming your slots on your schedule? Do you have designated slots that are for new patients? So that you know if you need to see a new patient, you have the availability to give them that appointment as soon as possible. This requires active scheduling and communication. Are you getting the right patient on the right schedule with the referral? So if it's EP, structural heart, interventional, heart failure clinic, do you have the right information to be able to get them on the right schedule when they come into your practice as a new patient? Do you have all of the information you need in order for your providers to be able to see that patient and provide them with the most effective care at their visit? So their previous records, do you have that information available for your physicians or advanced practitioners? When you look at the disease management clinics, if you have some specialized clinics, We can't forget about telecardiology. For our telehealth patients, we've had many changes since the pandemic expired. We've seen that telehealth has dropped to 10% or less across cardiovascular services. However, we continue to support how can we manage patients effectively? And part of managing those patients effectively is are we utilizing virtual care to its ability across our organizations. There are options for audio video visits, there's options for audio only, and that's continuing to expand. I think it's important to have a telehealth strategy to be able to manage those in-betweens and to truly, for the efficiency, access, and patient satisfaction, have that availability across the organization. So managing the in-betweens. We talked about the visits, the appointments, those established visits, those new patient visits. What are we talking about when we talk about the in-betweens? This is all of the incoming calls, the faxes. Many of our EHR systems have in-baskets where messages are coming to providers, coming to nurses, coming to leadership. There's also tasks, your assigned tasks within your health record as well, voicemails. So we have those incoming calls and then some of those get sent to voicemail. Many of our systems have work queues where certain protocols are set up and that patient's information is routed to a work queue and someone has to respond. Portal emails, as we look at our e-communication, our portals now, secure portals, we can communicate with our patients through these secure portals. They send us questions. How do we manage that? And how do we really, when you're looking at all of this different information coming in, what are the resources to manage those in-betweens and what is the process? So as we manage those in-betweens, here is a sample clinical responsibility matrix. This breaks down responsibilities by the clinical role. It's important that everyone is working to the top of their licensure. So what are the responsibility of your nurses? What are the responsibilities of your medical assistants, the schedulers? And then what are the provider responsibilities? Is there rework involved in the process? Can you streamline it? So when you define the responsibility and you have a process to maintain whose responsibility and the message routing and how all of these things are coming in, and it's really a guide to be able to provide to the organization a roadmap of how things are handled, this is extremely helpful. So again, working to top of licensure role of responsibility and then also having some purposeful standardization. For example, you'll see chart prep and chart extraction. So who preps your charts for the visit the day before? In this particular example, that is under the medical assistant for doing chart prep and abstraction. When you look at that, does the medical assistant have everything they need? They also are doing rooming the patient. Your nurses, they're managing that true nurse triage. They're providing education to patients on procedures. What does that look like? They're doing refill medications that could be managed either by MAs or nurses. We see that both ways in clinics, but you definitely don't want your advanced practitioners taking off voicemails for prescription refills or managing in baskets for refills. Now, if they need to sign off or they need to change a dose of the medication, or they need to do any type of e-scribing that would fall under their licensure, then you would definitely route that to them. But you do have someone managing that initial call coming in or that initial message, being sure that all of the elements of that are ready for that advanced practitioner to be able to manage that prescription, as an example. All right, we're gonna jump into the business side around the revenue cycle. So when we talk about access, we talk about getting the patient into the clinic, what that looks like on our schedules, managing those in-between, what options we have available for access, whether it's a position of the day, whether we're using telecardiology, but the revenue cycle process touches all of these aspects from the time the patient calls the office until the time the patient leaves or is discharged from the office, and even some of those in-betweens. So we're gonna highlight the people, processes, and technologies, and what are those business side that are important as you're working through these processes. So what are the definitions of revenue integrity? It involves that comprehensive approach to the revenue cycle, focused on the process, improvement, leadership, support, and technology. What I will tell you is this creates a culture that we have addressed our revenue opportunities, we have financial practices in place, we are compliant, we're efficient, and we are managing patient expectations. When we talk about revenue leakage, there's potential revenue that isn't captured or could be lost due to some inefficiencies. Do we have an idea of where those inefficiencies occur in the process? This significantly impacts the company's bottom line and they should be addressed timely in order to implement revenue recovery options. So you'll hear terms around the revenue cycle, focused on revenue integrity, revenue leakage, revenue recovery, and all of those are process driven by our processes in the clinic around operations of getting that patient through our clinics from a throughput perspective, from a financial billing perspective, and from an overall clinical care perspective. So when we talk about the revenue cycle, there's three components to the revenue cycle, our front end, our middle revenue cycle, and our back end. Our front end revenue cycle consists of administrative functions. So when we think about, are our providers credentialed and contracted with all of our payers when they start with our organization? Do we have a fee schedule and pricing established? Do we have our electronic system set up around transactions and enrollment? And those are happening behind the scenes. In the pre-service area, this is facing in our clinics. So we have scheduling, we have pre-registration, we have eligibility and authorization. So are we verifying their insurance? Are we obtaining authorizations for the services provided? And do we have financial counseling and financial clearance? So there's an expectation of what that patient's out of pocket expense would be. So many of the clinical teams within our ambulatory setting are focused on these aspects that are gonna touch the revenue cycle. So for instance, your scheduling team may be doing a form of registration, so they have to have some knowledge of insurance carriers. They may not be doing the authorization, but they may be obtaining eligibility electronically through your system. They also may be having discussions on the financial clearance or counseling with your patients. Do you have some scripting for that to help assist them with it? For our middle revenue cycle, this is where our charge capturing coding is. Do we have clinical documentation improvement activities to support the ongoing communication with our clinical teams, our providers, and our staff? Are we capturing all of the services that we're providing? How are those services coded? And how are we reconciling that we have captured those services? This can often not only involve a revenue cycle back office team, it involves those ambulatory clinic roles where they're involved in, I'm checking out the patient, for example. Have I ensured that the encounter is closed? Have I ensured the charges have been put in? So what does this look like in your clinic? And how are these areas being handled? And do you have an understanding as a practice administrator of what things are being accounted for through your organization? Who's the person responsible? What's the process? And if you're using technology for that, what are your metrics that you're monitoring for the success? From our back end, the majority of this is happening, whether it's in a central business office or a revenue cycle department that's located within your program and that's where you're getting claims management and denials, the collections, that piece of it, even data analytics about what's being billed, what's being paid, what's being denied, what's the performance? What does all that look like? Many of those functions of the people and the processes may live outside of your ambulatory clinic. However, that downstream communication to be able to provide details on, if you're getting claim denials, as an example for your registration, you have to have a feedback mechanism to your scheduling staff so they understand what are those patterns? What are those edits that you're getting denials on from that perspective? If you're having gaps in authorizations, is that being communicated? If you're not providing the necessary clinical information in the documentation or in the order for the services that you're rendering, is that a gap? What is that communication? How are you seeing that reported back to you? And are you able to understand what performance improvement activities need to take place from that? And how can you manage that downstream communication to ensure that it's being communicated to the right person so that you can have some improvements? So that's essential. We often think of revenue cycle as being behind the scenes, those billing people, but it is very relevant to our ambulatory clinics as we continue to manage many of these functions that start, remember, when I said that patient calls for their appointment, that first point of contact is truly when that revenue cycle side of services starts. So understanding the people, the processes and technology, what are the efficiencies in that that you have? What are some of the rework happening? And how can you look at that and break that down across the organization? So we touched on that front-end revenue cycle, which is our pre-service initiatives. We talked about the credentialing process. This outlines the people, processes and technology around that credentialing process. How does it establish and implement that ongoing evaluation of your credentialing with your insurance payers and your hospital locations and facilities? What does that look like? How is it managed? This is essential when providers are starting in your organization. Sometimes it is unfortunate, but this delays the process of billing. It can delay access to those providers if this credentialing process is not solid and you're able to truly manage that in your organization. So understanding some of the details around credentialing will help streamline this across your organization. Some of the current challenges that we see with credentialing is frustration around the gaps in communication, a lack of understanding of the timeline it takes to onboard a new provider. So when you're looking at that timeline is somewhat out of your hands, it's in the hands of the payer or the entity that is credentialing that provider. So really having some solid communication, understanding the financial impacts and who's the accountability around this task in your clinic and providing that information. So credentialing is that first part of, I'm bringing a new provider into my group. I have to get them credentialed with all the new insurance companies, the hospital systems. How do we provide that timeline? How do we keep up with it and provide ongoing communication who's accountable? There's some example workflows in this deck that talk about what are some of the barriers? What are some of the things we need to consider as we move it through? Who are the responsible parties? What does it entail through the credentialing process? Oftentimes in a manager role, you may have had some exposure to credentialing, but you may not understand all of the ins and outs of what happens from a credentialing perspective. This gives you an idea in these workflows of what that timeline could look like for our managed care plans, for our hospital privileges, what is each step and approximately how long it takes. And this is something that consists with facilitating communication to your onboarded providers, to your existing providers who are asking, when are they gonna be credentialed? This helps with that. It also helps with your scheduling team to know who they can schedule patients with. So definitely an essential part when you're bringing on a new provider. Here's the roles and responsibilities of that credentialing team. A lot of time this is outsourced or you may have someone within your clinic that manages this directly, but really understanding the roles and what it takes to do that and how it also feeds over to compliance, your quality assurance and how it impacts the overall support of the organization from a revenue cycle process is important in defining those roles and responsibilities. So revenue cycle, we talk about garbage in, garbage out. So it's interesting, 90% of claims denials are expected to be preventable and two thirds are recoverable. So when we talk about garbage in the system, garbage out, what does that mean for us? When you look at the key functions, we talked about scheduling, insurance eligibility, authorizations and point of service. This is where we get that garbage in, right? We talk about the first contact with the patient. Are we getting the right information we need? Do we have a solid process for notifying the insurance team for the authorization and do we have a collection policy that's easily communicated to our patients? Some of the trends and challenges in scheduling is just where we say the revenue cycle starts is scheduling may be centralized or decentralized. Regardless of what it is, there tends to always be a challenge with communication or missing information. You wanna be sure that you have a relationship with your eligibility and authorization processes and consider how you manage add-ons to the schedule. You wanna look at that standardization, training, education for your team and work on reducing the revert caused by that incorrect information. So example of that would be if that patient calls for an appointment to be worked in today, the scheduler may not have asked them if their insurance stayed the same or if it changed to a different policy, reviewed that information. That patient comes into the office, they get to the check-in counter and they haven't had their eligibility run. They give us a new insurance card when they check in, we run their insurance eligibility and they have another insurance and the provider is out of network. And again, we have to take care of the patient that's there but we've put them at a disadvantage because now they're gonna have an out of network provider and it just takes a lot more service recovery whether if we got that information right on the first time. For eligibility and registration, you can see all of these, we highlighted the overlap because when you see the different trends and challenges and opportunity, they all revolve around communication, missing information, adding on patients, so something out of the norm, they're not on your schedule for today, it's something that's happening, you're adding on to. And then the opportunities all revolve around the standardization of the process, the training and education and reducing that rework. So much of the eligibility and registration, what we say is looking at your process to be sure it's not manual versus electronic. Do you have electronic systems available that you're not using? Are you using inadequately? Are they not integrated? Are you doing batching versus real time? And obviously one thing you can't control is that payer variability, but really finding that right verification method and having regular audits and quality checks is one of the solutions around improving that process and helping with those particular challenges and trends. Also some things to consider around insurance verification, which is that first point of contact. And a lot of times insurance verification may not occur at the time of scheduling. I think that's the best practice is for it to occur when you have that patient on the phone. But they do have carrier portals that are available. Our clearinghouse systems, they often don't have all the details. So if you're using an integrated solution to your practice management software, is it comprehensive enough that you are able to do that? If you've outsourced this out of your clinic or your purchasing verification software, is it inclusive? Is it multiple portals your team is having to go through? What are the different alternatives and what's going to work best within your organization? But being familiar with the different things out there, whether it's integrated into your practice management system or your health record, or if it's a standalone system or you're going to multiple websites, having that purposeful standardization of the process and who's responsible for it and being able to measure the success of those alternatives and what's happening within that will definitely help with that first point of touch with your patients. So collections and financial counseling. Different trends when we talk about this. Scripting is the most important here, I will tell you. Does your staff know how to communicate this? Do you have in-house resources? If you don't have in-house resources, what is your process? Are you getting advanced beneficiary notices where the patients know that they may have some responsibility? Really being proactive in informing your patients that they have a balance or collections. Take the uncertainty out of it. You want to be able to expand options for your patients for payment plans. Having price estimates is also something we see, but truly in this area, having your staff some scripting so that they understand the conversation that needs to be had with the patient and there's no miscommunication and you have that patient satisfaction in this area. Prior authorization. Some of the trends and challenges. You'll see the same ones highlighted that we've been covering. A little different here is that pair your variability and timeliness, also the lack of cardiovascular specialty knowledge for prior authorizations. Do you have some incomplete gaps in your clinical documentation? Who do you have doing authorizations? Do you have what you need? Are you going back to your providers and informing them of the information you need? Really defining what your staffing model is for prior auth. Is it centralized? Is it decentralized? Do you have some individuals in your clinic, such as your nurses, who are doing procedure education, providing clinical information for procedure authorizations, as an example, versus you have someone who's decentralized doing the authorization for your testing? Are they working to the top of their licensure? And is it a manual process, electronic? Do you have multiple people touching this multiple times? And really solidifying that communication prior to the patient coming in, that you have their prior authorization and you can move forward with their testing or procedure. This is an example of an authorization workflow and insurance verification team. So it talks about the responsibility, because this does touch your scheduling, does touch your front desk or your checkout, and it also could touch your diagnostic team, your clinical nursing team. So defining that and knowing who's responsible for what, this is an example of that workflow and how it's going to work for you. Here are some key performance metrics for those pre-service items. So what are you monitoring? How often are you monitoring it? And what is your action item? So you want to be able to have measures in place, not saying you need to do all of these measures, but you should have at least two measures where you can look at your action items. So you want to be able to look at your but you should have at least two measures where you can look at quickly on an ongoing basis what your performance is, particularly around insurance registration, verification, and authorizations. Collections is also important. What I will tell you, those patient-facing items that can cause some patient dissatisfaction or barriers to patient care, like our authorizations and not being effective in that, you just want to be sure you have your fingers on the pulse for being able to manage that because that is one huge frustration level for providers when they're unable to provide the care to the patients due to some of these administrative burdens that oftentimes just have gaps in the communication. So some key takeaways. You want to determine if your upstream efforts are equaling your downstream benefits, meaning what resources do you have, what is the process, and is that equaling downstream benefits? Is my authorization process effective? Is my registration process accurate? Collaboration across departments is essential, and I don't think I've said the word communication enough, but really that transparency, communication across your teams to patients, to your providers will help with the success in this area. Moving on to charge capture and coding challenges. So this is our middle revenue cycle, another area that touches our clinics or ambulatory teams. There are variable methods to capturing charges. The charges that are occurring from our providers can be within our clinics, can be in a diagnostic testing center, can be external and inpatient hospital services, procedures, rounding visits. So this information can be coming in several different ways. Having standard policies and workflows, oftentimes many of the responsibilities for charge capture are decentralized from our organizations. Do you understand the systems that are commonly utilized? Do you have downstream feedback? Do you understand what's the delay in getting some of these charges if you have delays? So are your providers behind on documentation? How are you managing that? Are you missing charges, which oftentimes can lead to lack of trust in the process? One way of not missing charges is to have an adequate reconciliation process. Is that in place and who's responsible for that within your organization? So when we have impacts to charge capture, of course, we have missed revenue opportunities, delayed payment, increased rework. It can also impact your provider compensation. Many of our providers are compensated on their work RVUs by the services that they perform. If we're missing their charges or if there's a delay in getting their services billed, this can impact that provider compensation. So having some key performance metrics, particularly around charge lag of what your days are in AR or your percentage of mischarges that are regularly reported can help with the communication in this area. Understanding the roles and responsibilities of your staff, of the decentralized team, and where do you go for questions from your providers if they feel they have missing charges? Are you able to speak to your reconciliation process? Charge capture focus areas. So when we talk about that reconciliation process, you want to define the source of truth. What does that mean? So for your diagnostic services that your providers are reading or doing interpretations of studies and billing for, do you have a good idea of where you would go find that you know that everything that was scheduled has been billed and you're having denials on it or you're getting paid for it? Do you have a way to track that through the process? Reconciliation is focused on the charges. So knowing the source of truth, for example, our diagnostic testing schedule or our cath EP lab services, are we able to correlate those charges with the schedule? This is often not just the responsibility of the revenue cycle department. We talked about your checkout teams. Are they reconciling all of the patients that were seen for that day and ensuring that a charge was dropped? Having that continuity to support that and understanding the steps around that and the responsibilities definitely helps with communication with the providers, but it also will help with any missing charges or revenue leakage that we call from missing those services. So we talked about the why I believe of charge reconciliation, but just to recap, are the services performed that I billed? That's a question that providers will be coming to their administration or their leadership and asking, have my services been billed? Are we sure we're capturing all of my studies I'm reading? Are there late charges due to breakdowns in the process? Do you have providers who lag on their documentation? Is the accuracy of the charges captured? Is the reimbursement appropriate? Do you have deficiencies that might otherwise go unnoticed for months or years? We do see gaps in this area at times because we haven't had those reconciliation processes in place and we're not understanding what our charge lag is or what the impact of our providers, the impact of our teams are through the process. Some items as an example that we give around what are some of the cost savings? What are some of the return on investment when we're looking at charge capture? Where do these gaps occur in cardiovascular and where should you be looking? So here are some of those examples. You have a new service or that may be an add on service. So myocardial strain as an example is an add on to an echocardiogram. Did the process happen that that charge is being accurately billed and captured? Am I being reimbursed for that add on services? Do you have turnover in this area and you may have a gap that the reconciliation process did not occur? Are you being reactive or proactive? Are you waiting for your physician to come to you and ask if their work RVUs are missing? Are they're finding some that are missing? You want to be more proactive and know what's happening. Are you aligned across the departments to provide downstream feedback? And do you know if you're missing services? So truly thinking about each area that you provide services in and how those charges are captured, what that looks like and who's responsible for the aspects of those charges will help with charge reconciliation. So these are some CB examples, real world of things that happen around the charge reconciliation aspect and things to look for as you're developing your processes or understanding your existing processes. So any of these revenue cycle processes we would tell you to do a current state assessment. I could go all the way back to the initial presentation of when we talked about scheduling. What's the process analysis? What are the gaps? What are the measures? What's the improvement? Do I have root causes? Interviewing and observing with the team, really looking at the workflow. Even if you spend 10 minutes at your front desk, I can assure you as an example, you will learn something in that process or you'll identify something that may be waste and how you could improve an efficiency that may be happening there. Get those recommendations and priorities, communicate, shorten long-term goals and have buy-in of your team. Spending that time to actually be part of the process and understand the process, whether it's a lot of time or a little bit of time, it does not matter. As long as you understand enough of the process to be able to get that buy-in to facilitate the people, processes and technology in any of these areas, it will help as you're joining an organization or if you're in your existing organization and you've been there for 20 years. If you haven't observed some processes in a while, we always say go back to the front desk, go back to the check-in, go back to your authorization area, wherever in your clinic and just spend 30 minutes, spend 20 minutes just understanding the process and getting an idea because this will help you in having recommendations and getting buy-in from your teams to move forward with improvements. Here are some of the metrics we talked about. This talks about the metric, the definition, the purpose, the value and the industry standard. The two common ones for charges are charge lag days. What are the number of days between the date of service and the date that the charge was posted? This one's essential. You want to be sure that's one where you can really indicate where the process broke down. If it was waiting on documentation, if it was the charge wasn't received, what does that look like? Then the other one would be your charge capture rate. This would get you to, am I having mischarges or am I having gaps in my reconciliation process? This is our last category in the business process from denial management. We started at that front end, first point of contact on scheduling, went through those pre-service trends, challenges and solutions, touched on charge capture and coding. Now we're at the denial management, which is truly the back end. This is one area that you will hear there is a lot of our AI integration here. Our systems provide a lot of information, not only on our front end revenue cycle, but have been for a long time on our back end. What are those trends in our denial management? What does that look like in our organization? Do we have tools that provide predictive analysis? The keys for denials, I will tell you, is this is not something you are managing on a day-to-day basis. More than likely, this is being done by your central business office or your revenue cycle team. But you must know what your top denials and write-offs are, particularly around your high dollar procedures, your diagnostic testing, to be able to look at where the process is breaking down. What are some things that you can do as an action plan to improve the revenue recovery? Also, every computer system can show where charge and adjustment are equal. You want to insist on that data. You don't have to look at that on a line-by-line basis. But getting your top adjustments, your top denials, what does that look like? And how can I dig in more if I want to ask questions about that? We often say no one wants to look at an explanation of benefits from a payer. If you've never looked at one in your management role, I would challenge you to take a look at it. It really does help in understanding. We talked about credentialing. We talked about authorizations. We talked about charge capture coding. If you have a denial because a charge is inaccurate, that's an easy fix based on your coding or your charge capture folks. If you have a claim that's denied for an authorization, is there a feedback loop? Is there a payer trend? Are you able to see that from the explanation of benefits? Truly asking for denial details, not saying you have to go really deep to the EOB, but really understanding your top denials and adjustments, write-offs in your cardiovascular program will assist, particularly around our high dollar procedure areas and providing that ongoing feedback. These are some of the back-end performance metrics that you may want to look at on an ongoing basis. I talked about the write-offs. I talked about your denial rates, also your net days in your accounts receivable, understanding what that looks like in your overall performance. This will help you understand your collections. So again, these metrics give you the definition, the purpose value, and the industry standard here. I did want to cover just a couple of resources at the end that also go into details around additional metrics to support some of the processes that we've talked about. These can get into details. I will tell you that there generally is an industry standard that's connected to all of these, as I've shown you around the front-end, middle, and back-end revenue cycle. There's also staffing standards. What's the staff role? What should their productivity look like? And how do I measure their quality? Because obviously productivity is important, but we want to be sure we have that quality. So this gives you an idea, not only from the metrics you need to track to understand what's happening financially in your organization, but also looking at your staffing model, what the metrics are, and how you would look at their quality, and then also our key performance indicators by each section in your organization, and what that looks like, and the responsibility of those metrics. Thank all of you for listening to this module around the business side and our front-end operations. If you have any questions, you can email us at academy at medaxium.com.

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