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

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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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