Pre-Service

  • Scheduled patients not pre-registered

  • Pre-Certification not performed/late

  • Medical Necessity determined after service

  • Insurance verification not completed

Registration​

  • Errors

  • Point of service - inconsistencies

Financial Clearance​

  • Self pay vetting not conducted

  • Financing options limited

  • Eligibility - no follow through

  • Back end emphasis vs. front end

Patient Experience​

  • ​Patient complaints

  • Redundant interaction with patients/families

Charge Capture

  • CDM not updated/maintained

  • Lack of ownership

Clinical Documentation

  • Limited physician engagement

  • Incomplete/missing documentation

Medical Necessity​

  • Limited Utilization Review interaction

  • LOS issues

  • High number of clinical denials

Health Information Management

  • Coding backlogs/issues

  • High level of unbilled (DNFB) accounts

Other Major Experience Areas

  • Benchmarking/Metrics - not produced/tracked

  • Dashboard - not available for leadership

  • Report infrastructure limited/fragmented

  • Physician engagement -limited/no feedback

  • Silo effect with other departments

  • Information technology - issues/challenges

  • Clinical/Ancillary leadership - no communication

Billing/Followup

  • Clean bill rate improvement

  • High$/Aging A/R

  • High level of account write offs

  • Denial Management

Self Pay Collections

  • High volume of bad debt

  • Limited collection strategy/resources

 

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