At Wheaton Franciscan Healthcare in Glendale, WI, patient access managers use productivity data, accuracy, and cash collection goals as key metrics to ensure they’re staffing patient access areas appropriately.
"Knowing these metrics and our volume, we can know our staffing limits. When new volume hits our department, we try to adjust accordingly," says Kim Gehl, manager of patient access in central scheduling and central precertification.
These categories are used: "role model," "exceeds standard," "meets standard," "partially meets standard," and "does not meet standard." "We always want to be at meets standard’ at a minimum. We strive for role model,’" says Gehl. Staff in central scheduling are given these criteria:
Accuracy.
-
Role model: 100%.
-
Exceeds standard: 99.7%-99.9%.
-
Meets standard: 99.1%-99.6%.
Partially meets standard: 98.1%-99%.
-
Does not meet standard: 98% or less.
Percentage of worked hours logged in the automated call distributor queue.
-
Role model: 100% logged-in time.
-
Exceeds standard: 90% to 99.9% logged-in time.
Meets standard: 80% to 89.9% logged-in time.
-
Partially meets standard: 70% to 79.9% logged-in time.
Does not meet standard: Less than 70% logged-in time.
Incoming call volume.
Role model: 8.1 or more calls per logged-in hour.
-
Exceeds standard: 7.1-8 calls per logged-in hour.
-
Meets standard: 6.1-7 calls per logged-in hour.
-
Partially meets standard: 5.1-6 calls per logged-in hour.
-
Does not meet standard: Five calls or less per logged-in hour.
Outgoing call volume.
Role model: 13 or more outgoing calls per worked hour.
Exceeds standard: 11.5-12.9 outgoing calls per worked hour.
Meets standard: 9-11.4 outgoing calls per worked hour.
Partially meets standard: 6-8.9 outgoing calls per worked hour.
-
Does not meet standard: Less than six outgoing calls per worked hour.
Central authorization
Staff members in central authorization are required to meet these criteria:
Verify insurance eligibility and authorization requirements.
-
Role model: Continuously goes above and beyond in follow up and investigation of eligibility, benefits, and authorizations. Independently works to identify and resolve process issues affecting reimbursement. Looks at services outside the design for incorporation to process, thus improving reimbursements and patient satisfaction. Recognized as an expert on processes. Completes 8.1 or more accounts per hour with no authorizations denied due to associate error.
Exceeds standard: Obtains eligibility and authorization to services inside and outside the department design when appropriate, documenting findings appropriately. Routinely offers improvement suggestions to processes. Completes 6.6-8 accounts per hour, with one account in which authorizations were denied due to associate error.
Meets standard: Obtains eligibility and all required authorization completing all required documentation in the referral/authorization screen for all appropriate accounts. Completes 4.0-6.5 accounts per hour, with 2-3 accounts in which authorizations were denied due to associate error.
-
Partially meets standard: Routinely needs assistance in determining follow up and next steps. Assignments require management follow up. Completes 2-3.9 approval screens per hour, with 4-5 accounts in which authorizations were denied due to associate error.
-
Does not meet standard: RA screens not completed where information and/or documentation were not obtained on required accounts. Completes less than two accounts per hour, with greater than five accounts in which authorizations were denied due to associate error.
Precertification denials.
-
Role model: No authorization denials due to associate error.
-
Exceeds Standard: One account where authorization denied due to associate error.
Meets standard: 2-3 accounts where authorizations denied due to associate error.
Partially meets standard: 4-5 accounts where authorization denied due to associate error.
-
Does not meet standard: Greater than five accounts where authorization denied due to associate error.
Accuracy.
-
Role model: 99% or above.
Exceeds standard: 98%.
Meets standard: 97%.
Partially meets standard: 96%.
Does not meet standard: 95% or less.
