Admin & Finance - Section 5: Benchmarking

Question 1

A term used to describe a rule or guideline by which others can be measured or judged

Answer 1

Bechmarking

Question 2

Used as a point of reference from which an evaluation can be made

Answer 2

Benchmarking

Question 3

Comparing one’s processes and performance metrics to the best performance and practices in the industry

Answer 3

Benchmarking

Question 4

How can benchmarks be evaluated in health care?

Answer 4

Set internally or obtained from clinical data registeries, payers (such as CMS MIPS quality benchmark) and accreditors

Question 5

The purpose or benchmarking in healthcare is to improve what 4 things all except which of the following:

Efficiency
Quality of care
Volume of patients
Patient safety
Patient satisfaction
Reimbursement from payers

Answer 5

Volume of patients and reimbursement from payers

Question 6

What is important when new practices are implemented to ensure their success?

Answer 6

Finding a way to measure progress to determine if the benchmark is being achieved

Question 7

What 3 things make a good benchmarking measure?

Answer 7

Importance, measurability, feasibility (achievability)

Question 8

What benchmarking measure is described below?

The extent to which the measure is evidence based, has substantial potential for improvement through intervention, is prevalent and significant enough in the population to justify efforts, and has a substantial impact on patient and/or community health or value

Answer 8

Importance

Question 9

Which benchmarking measure is described below?

The extent to which the measure produces consistent (reliable) and credible (valid) results. The measure should be precisely defined and specified, easily interpreted, and risk-adjusted as appropraite

Answer 9

Measurability

Question 10

Which benchmarking measure is described below?

The extent to which data required is readily available or could be captured without undue burden and at a reasonable cost, and the measure implemented for improvement in the setting at which it is being applied

Answer 10

Feasibility

Question 11

What type of benchmarking is described below?

A measure that assesses infrastructure, characteristics, or capacity to provide health care, such as equipment, personnel, or policies

Answer 11

Structure

Question 12

What examples of benchmarking types are provided below?

Staff-to-patient ratio
Percent of diabetic patients tracked in a registry

Answer 12

Structure

Question 13

What type of benchmarking is described below?

A measure that focuses on steps that should be followed to provide good care. There should be a scientific basis for believing the process, when executed well, will increase the probability of a desired outcome

Answer 13

Process

Question 14

What examples of benchmarking types are provided below?

Colorectal cancer screening
Medication reconciliation

Answer 14

Process

Question 15

What type of benchmarking is described below?

A measure that assesses the results of health care, such as clinical events, recovery, and health status

Answer 15

Outcome

Question 16

What examples of benchmarking types are provided below?

Diabetes long-term complications admission rate
Controlling high blood pressure

Answer 16

Outcome

Question 17

What type of benchmarking is described below?

Takes place between departments, divisions, or offices within the same hospital or clinic.

Answer 17

Internal benchmarking

Question 18

What examples of benchmarking types are provided below?

Patient satisfaction per location
No shows

Answer 18

Internal benchmarking

Question 19

What type of benchmarking is described below?

Occurs when an organization analyzes another organization process or similar service and compares that organization’s goals or outcomes against their own.

Answer 19

Competitive

Question 20

Centers for Medicare and Medicaid Services, National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), National Association of RHCs, Medical Group Management Association, American Academy of Family Physicians, educational institutions, and non-profit organizations are ____ measure sources

Answer 20

Performance

Question 21

What are 5 common financial benchmarks?

Answer 21

Gross collection percentage
Adjusted collection percentage
Financial summary dashboard
Days in accounts receivable
Aged accounts receivable

Question 22

What does the gross collection percentage measure?

Answer 22

The ratio of payments to charges, without consideration of contractual adjustments

Question 23

The gross collection percentage measures the ratio of payments to charges, with consideration of ____ ____.

Answer 23

Contractural adjustments

Question 24

Calculate the gross collection percentage using the following information:

Total monthly payments: $60,000

Total monthly charges:
$100,000

Answer 24

Divide $60,000 (payments) by $100,000 (charges) = .60

Multiply by 100 to get a gross collection percentage of 60%

Question 25

True or False: The fee schedule, payer contracts, and payer mix do not affect the gross collection percentage

Answer 25

False; The fee schedule, payer contracts, and payer mix directly affect the percentage.

Question 26

If the clinic fee schedule is based on 200% of the Medicare Allowable, you can automatically expect the gross collection percentage to approximate ____%

Answer 26

20%

Question 27

True or False: The gross collection percentage takes contractual adjustments into account

Answer 27

False; the gross collection percentage does not take contractual adjustments into account

Question 28

This metric shows how much revenue is lost due to factors in the revenue cycle such as uncollectible bad debt, untimely filing, and other noncontractual adjustments

Answer 28

Adjusted collection percentage

Question 29

The adjusted collection rate should be ____% at minimum

Answer 29

95%

Question 30

The average collection rate is ____% -____%.

Answer 30

95%-99%

Question 31

The highest performers achieve a minimum adjusted collection rate of ____%

Answer 31

99%

Question 32

The adjusted collection percentage should be used to quantify if inappropriate or excessive ____ are being applied.

Answer 32

Write-offs

Question 33

Adjusted collection percentage measures ____ revenue

Answer 33

Collectible

Question 34

Why does adjusted collection percentage subtract write-offs from charges?

Answer 34

To calculate a more accurate collection percentage than gross collection percentage

Question 35

True or False: Payments, charges, and adjustment figures used in the adjusted collection percentage don't need to be from the same period

Answer 35

False; payments, charges, and adjustment figures used in the calculation should all be from the same period

Question 36

True or False: Given RHC reimbursement mechanisms, it is not uncommon for RHCs to have an adjusted collection percentage above 100%

Answer 36

True

Question 37

High performing RHCs may have an adjusted collection percentage of ____% or greater

Answer 37

105%

Question 38

Calculate the adjusted collection percentage using the information provided below: Monthy payments: $60,000 Monthly adjustments: $35,000 Monthly charges: $100,000

Answer 38

$60,000 (payments) + $35,000 (adjustments) = $95,000 $95,000 / $100,000 (charges) = .95 x 100 = 95%

Question 39

This indicator calculates how many days of charges are represented in total AR

Answer 39

Days in AR or AR Days

Question 40

What does days in accounts receivable measure?

Answer 40

How long it takes a practice to collect payments due

Question 41

Calculate the days in AR using the information provided below: Total receivables: $70,000 Credit balance: $5,000 Average daily gross charge amount/365: $600,000

Answer 41

$70,000 (total receivables) - $5,000 (credit balance) = $65,000 $600,000 (charges) / 365 = $1,643.83 $65,000 / $1,643.83 = 39.54

Question 42

# Fill in the blank: ``` AR days less than 30 = ____ performance AR days less than 40 = ____ performers AR Days 40-60 = ____ performers AR Days 60-90 = ____ performers AR Days more than 90 = indicates ____ ```

Answer 42

``` Wow Best Moderate Poor Problems ```

Question 43

Represents the percentage of claims denied by payers during a given period relative to total charges

Answer 43

Denial rate

Question 44

How do you calculate denial rate?

Answer 44

Add the total dollar amount of claims denied by payers within a given period and divide by the total dollar amount (total charges) of claims submitted within the same period

Question 45

Denial rates should not exceed ____%

Answer 45

5%

Question 46

Calculate the denial rate using the below information: Total claims denied - $20,000 Total claims submitted - $300,000 Time frame: 90 days

Answer 46

$20,000 (total claims denied) / $300,000 (total claims submitted) = 0.666 0.666 x 100 = 6.6%

Question 47

# Fill in the blank: Denial rate less than 2% = ____ performers Denial rate 2-5% = ____ performers Denial rate 5-10% = ____ performers Denial rate more than 10% = ____

Answer 47

Highest Better Moderate Poor

Question 48

# Fill in the blank: AR Days less than ____ = Wow! AR Days less than ____ = Best performers AR Days ____ - ____ = Moderate performers AR Days ____ - ____ = Poor performers AR Days more than ____ = Indicates problems

Answer 48

``` 30 40 40-60 60-90 90 ```

Question 49

# Fill in the blank: Denial rate less than ____% = Highest performers Denial rate ____-____% = Better performers Denial rate ____ - ____% = Moderate performers Denial rate more than ____% = Poor performers

Answer 49

2 2-5 5-10 10

Question 50

All aging accounts receivable buckets should be monitored at what frequency?

Answer 50

Monthly

Question 51

True or False: All aging accounts receivable buckets should be monitored quarterly

Answer 51

False; monthly

Question 52

The 0-30 category should have ____% or greater of AR

Answer 52

50%

Question 53

120+ days of AR should represent less than ____%

Answer 53

12%

Question 54

Significant AR over 120 days indiciates significant problems such as: Large ____ balances ____ submission issues ____ contracting problems

Answer 54

Patient, claim, payer

Question 55

# Fill in the blank: Less than 12% of total AR is over 120 days old = ____ performers 12%-25% of total AR is over 120 days old = ____ / ____ performers More than 25% of total AR is over 120 days old = indicates ____

Answer 55

High Best/moderate Problems

Question 56

# Fill in the blank: Less than ____% of total AR is over 120 days old = High performers ____-____% of total AR is over 120 days old = Best/moderate performers More than ____% of total AR is over 120 days old = Indicates problems

Answer 56

12% 12-25% 25%

Question 57

What is the most critical decision in benchmarking?

Answer 57

Selecting the performance measures to track

Question 58

Performance measures must be ____ to the practice and must have ____ readily available.

Answer 58

Relevant, data

Question 59

Why is it essential that reports are compared with prior periods?

Answer 59

To determine trends

Question 60

How should management communicate practice benchmarks?

Answer 60

To assigned teams

Question 61

What do benchmarks identify?

Answer 61

Problems

Question 62

For monthly reporting, develop a clinic dashboard of relevant performance measures and include monthly ____, ____, and ____.

Answer 62

Charges, payments, and adjustments

Question 63

What is the benchmark for the adjusted collections metric (%)?

Answer 63

98% or greater

Question 64

What is the benchmark for AR Days?

Answer 64

Less than 45 days

Question 65

What is the benchmark for denial rates?

Answer 65

Less than 2%

Question 66

What is the benchmark for AR greater than 120 days?

Answer 66

Less than 12%