Using Quality Analysis to Improve Medical Office Finances

One of the fastest growing trends in health care is the use of a quality analysis to improve finances. Medical office managers are facing many difficulties due to the constant changes in billing and coding standards and IT requirements. It can be quite a challenge for the manager to keep up with so many changes especially in a small office with limited staff. You don't have to go it alone. One option is to hire a quality analyst on a full-time or contract basis to recommend goals, process improvements, and how to measure them.

Quality Analyst Responsibilities

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A quality analyst is an experienced medical biller and/or coder who conducts performance audits in the medical office specifically related to billing and accounts receivables. The quality analyst has many responsibilities, but the main objective is to enhance processes and shorten revenue cycle times.

According to the HFMA (Healthcare Financial Management Association), the nationwide average days of accounts receivable (A/R) is 44.5. If your A/R days are greater than 60, your medical office could significantly benefit from hiring a quality analyst.

You could employ a quality analyst full time or on a contract as-needed basis. 

Recommend Performance Improvement Goals

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What should your goals be to improve the financial performance of your medical office? The quality analyst can look at your processes and performances and make recommendations.

  • Increase total cash collections on a consistent basis by improving processes in financial counseling, registration, admitting, billing and collections.
  • Increase employee satisfaction and reduce turnover by providing incentives and increasing salaries.
  • Increase upfront collections by providing extensive training to registration staff, implement 100 percent insurance verifications and provide payment estimates for every patient at every access point from scheduling thru discharge until payments or payment arrangements are made.
  • Reduce total discharge days, not final billed, aging of accounts receivable days, late charges, bad debt write-offs, and denial rates.

Identify Opportunities for Training and Developement

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What further education and training do your staff need to stay current with new regulations, guidelines, and processes? Billers and coders may also find it challenging to find time to read up on all the new updates. You have options for how you can provide this for your staff.

  • Provide job aids or other performance support tools for increasing staff performance including collections scripts, payer specific billing manuals, templates for determining patient estimates, and others.​
  • Develop or revamp new-hire training processes
  • Schedule training sessions or days for staff who do not meet expectations in particular areas by using a team of dedicated trainers.
  • Encourage and plan cross-training among different job duties to avoid lapses or delays that affect cash collections.
  • Schedule revenue cycle team meetings every two weeks until performance improvement goals are met.
  • Encourage employees to attend conferences, webinars, and online education sessions to improve revenue cycle knowledge base.

Suggest Process Improvement Activities

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How can you improve your processes once you find weaknesses and sources of error and missed opportunities? The quality analyst can make recommendations.

  • Establish continuous quality improvement processes to identify errors and inaccurate billing practices including researching rejected claims, denied claims and underpaid claims.
  • Create a corrective action plan once errors have been identified.
  • Prioritize areas that show the greatest need for improvement.
  • Stay ahead of industry changes by staying informed.
  • Use the IT staff effectively to transition toward more automated processes, improve workflow, and enhance operational efficiency.
  • Outsource hard to collect accounts such as self pay and liability claims to relieve staff to focus on insurance accounts.
  • Develop a standard to measure performance based on quality and production.

Measure Performance

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If you don't measure, you won't know whether your improvement efforts have been effective. Your goals need to be measurable and you need to set measurement processes.

  • Efficiency: Refers to how well time and effort are used to perform job tasks
  • Effectiveness: Refers to how accurately or completely tasks are performed
  • Timeliness: Refers to whether the work is being performed within the desired time frame.
  • Productivity: Refers to the value of the output of the work performed or income that results from the work performed.Quality: Refers to the degree the work performed meets the standards, requirements, and expectations.
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