Volume VIII Number 3

September 2002

The Newsletter of

D E K A Y E  Consulting, Inc.

231 Oakview Avenue
Oceanside, New York 11572
Phone / Fax: (516) 678-2754
E-Mail: Adkcmpa@aol.com
E-Mail: DKConsult1@aol.com
URL: http://www.dekaye.com

Vital Signs

sm at  www.pfspowerank.com

DEKAYE Consulting, Inc., a Long Island, New York, based consulting firm specializing in healthcare financial consulting announced the debut of PFS POWER RANKINGSsm. The scoring system is designed to help hospital financial managers measure and track the performance of their Patient Financial Services (PFS) departments. These areas are responsible for most hospitalís billing and collection of insurances (such as Medicare, Medicaid, Commercial and HMOs) and patient balances.

According to DEKAYE Consulting, Inc.ís President and CEO, Allan P. DeKaye, MBA, FHFMA, "This will be the first time hospital CFOs will be able to really answer the question: ĎSo howís my PFS department doing compared to others?í" Mr. DeKaye was quick to add, "By simplifying the monthly survey process to answering 14 YES or NO questions, hospital subscribers will be able to have their individual score and PFS POWER RANKINGSsm automatically calculated and displayed in real-time."

"There is a large benefit to hospital financial management because theyíll see how they measure up over time on key performance indicators, as well as how they rank against others," Mr. DeKaye noted. While the system will display rankings on a national and regional level, as well as by bed size, hospital anonymity will be preserved through the use of a coding system. The 14 questions will measure the following: Strength, Quality, Consistency, Production and Detractors as they relate to the hospitalís PFS department.

Mr. DeKaye, whose national consulting practice focuses on hospitals, physicians, other healthcare providers and corporations, expects the benefits to extend to non-hospital subscribers, too. Those industry leaders who examine financial trends and watch hospital performance such as consulting firms, billing and collection companies, accounting firms, and associations will also want to subscribe so that they can view this information.

As author of The Patient Accounts Management Handbook (Aspen), Mr. DeKaye is viewed as an expert in the field. He speaks regularly at national and regional conferences, and contributes to the industry literature. For more information about the company, or subscribing to PFS POWER RANKINGSsm contact our office at (516) 678-2754, or visit: www.dekaye.com, and www.pfspowerrank.com.

Perspectives and Commentary

Intensity and Consistency

By Allan P. DeKaye, MBA, FHFMA, President and CEO, DEKAYE Consulting, Inc.

All too often, Iím asked "what caused our A/R to go up, and why canít it come down?" There are two factors that are usually missing that likely contributed to the rise in A/RĖand preclude the recovery effort from reaching fruition: Intensity and Consistency! In this issue, both of these elements will be examined.


Intensity. What is it? I define it as "hearing the sound of work!" You can walk-through a PFS office, and hear the "buzz." Itís the keystrokes posting payments and taking allowances; itís billing electronically and following up on targeted payersí open accounts. But more importantly, itís the ability of staff and supervisory personnel being able to articulate exactly what theyíre doing, and how effective they expect to be.

Intensity isnít only a state of mind that is projected or felt, but also one that is demonstrable. Meeting and exceeding objectives is more the rule, not the exception. Merely having the staff, whether billers, collectors, representatives, etc., know their role, responsibility and goals are very positive steps missing in many PFS organizations.

Intensity is built and developed. In order to have a good foundation on which to build, front-line supervisors need to understand the production environment that exists in todayís PFS environment. However, front-line supervisors are not always in abundance, and so management must often take a direct leadership role to set expectations, distribute work, and review production, if they are going to achieve success. But it doesnít end there. If all of these steps (and more) are taken, then synthesizing the results of production, collections, denials (if any) still needs to occur. Merely having the data isnít enough. One client once described their situation as "Data Rich...Information Poor." Using what you have to further improve your situation is an important and critical aspect of effective accounts receivable management.


Iím reminded of the "one-hit" wonders that are immortalized on "oldieís radio stations." Where are they now? Whatís happened to them? This should not become the characteristic of present day business office operations.

One CEO once proclaimed his pleasure when the staff met their cash goal for the first time during his then short tenure. But as an aside mentioned to me that theyíll need to do this "three months in a row" in order to build his confidence in them." And build it they did. But it wasnít easy.

Consistent performance is an important characteristic in the quest for goal attainment. Performance can be measured in the aggregate (i.e., at the highest level: Did A/R go down?), or in its component parts (i.e., Did all the bills go out timely and correctly? Did cash collections exceed targets? Were the targets made across patient types, and all payer lines? etc.). Performance can be up, and goals still not met. Hereís where the right mix of resources and resolve need to be brought to bear to find the winning combination.

It may take some time for a "team" to get it together. The adage, "clicking on all 8-cylinders" is still applicable, as would professional sports teams ability to play both offense and defense well. Championship teams are rarely one dimensional, and neither are successful PFS operations.

Making the Grade

It may not take rocket science to know that "intensity" and "consistency" are necessary ingredients in a PFS success formula. However, achieving it may require years of study and practice in finding what works and what doesnít, and applying it successfully in day-to-day operations.

Interestingly, when you begin reaching your goals and milestones on a regular basis, you should be able to point to the intensity and consistency of individuals, and the department as a whole as a critical successful factor in your achievement. Once attained, the achievement stands as a motivator to maintain performance at the higher level. It will become clear to everyone involved that losing the focus of "intensity and consistency" can be more painful than achieving it in the first place.


: Ask The Expert

by Allan P. DeKaye, MBA, FHFMA

Q:  We are in need of a new set of manuals for our PFS department.  Should we borrow one from another hospital and use it as a boilerplate?

A: It is important to keep in mind that no two PFS offices will process work in exactly the same way. Therefore borrowing someone else's will, in all likelihood, not be a good match. Boilerplates (templates) can be used as a guide, but not be used as a substitute for creating your own document.

It is suggested that you examine your own department's workflow, and begin by outlining the major functional workflows that exist. A good working outline will help you organize the movement of work from one area to another, keeping in mind that procedure manuals need to draw a balance between how patient, paper, staff and system interact to form a process. If you are able to see others' manuals, use their outline (table of contents) to see if you've missed any subject areas.

In the industry, we tend to call these compendiums, "policy and procedure" manuals. Rarely do these manuals ever state "policies." For example:

Policy: The hospital will make every effort to collect patient responsible amounts at the time of service, except in the Emergency Room, where EMTALA regulations will require special procedures.


1. The admitting and registration staff will ask for payment at the time of registration for all known insurance deductibles and co-payments (applicable for all outpatient service areas and for all elective, non-emergent admissions, except the Emergency Room).

2. In the Emergency Room, any known deductibles and co-payments will be asked for during the patient's discharge processing, to ensure compliance with EMTALA regulations.

There will be fewer policy statements, and more procedural steps. [Note: You can then detail as many steps as you fee warrant the level of specificity you desire.]

These manuals are usually not high on the PFS department's priority list, unless an upcoming JCAHO survey preparation shows that your area is deficient. While we've assisted many clients create flowcharts, procedure and resource manuals, and have trained staff on how to use the manuals and its contents, everyone should assess whether what they have is adequate, and to what level of detail you (and senior management) feel you need to maintain and enhance operations. Manuals often lay dormant on shelves, and are not updated. Today, they could also be placed on a provider's Intranet, for more ready access. They can help improve operations, if designed correctly and updated on a regular basis. If you want to discuss your individual needs, please contact us.

Q: We're having trouble collecting at the time of service.  What should we incorporate into a plan to address this problem?

A While many providers say they "collect at time of service," in reality, they may have omitted several key elements. The following are "key elements" of any program:

1. Create patient expectation that payment is required (e.g., signage, literature, brochures and pamphlets, etc.). Establish a written policy, have it approved by the Board, and promote it through staff training and patient communication)

2. Be able to generate a demand bill (patients won't pay if you can't give them the price and a bill)

3. Provide convenient places to pay (cashiering stations nearby service areas)

4. Accept alternatives to cash (e.g., check, credit and debit cards, electronic payments, etc.)

5. Enforce payment of managed care deductibles and co-payments

6. Where appropriate, have a "deferral of service" protocol.

For more information on this topic, go to our web site to see the following references:

The Patient Accounts Management Handbook (Aspen) by Allan P. DeKaye, MBA, FHFMA has a several chapters on this topic, including "The Impact of the Admitting Process on the 'Cash Flow Cycle,' " and "The Self-Paying Patient." Our OnTarget newsletter also discusses this issue of Collection at the Time of Service in the October 1998 issue.

Q: In reference to our self-pay patients, we are having difficulty with our patient statements and we think they need of audit relative timeliness of delivery, errors, etc.  What can you suggest?

A: 1. Be sure that the system masterfiles are correctly set regarding timing, and changes in message with each subsequent letter/statement. [Some masterfiles are set to "trigger" statements based on the occurrence of certain events. If that event never occurs, the statement will not be sent.]

2. Use a control report to determine how many letters/statements should have been sent; verify this number by counting the pieces, or viewing the postage meter report. If an outside service is sending your patient statements, have them issue a log or control totals.

3. Include a test patient(s) where the mailing address is your office. This will help you confirm the mailing sequence and deliver time.

4. Use address correction requested services available from the U.S. Post Office. Coordinate that internally with eligibility verification or other data integrity services. Work "return mail" to determine where internal data vulnerabilities exist.

5. Monitor phone calls and written inquiries for complaints and specific problems.

6. If working "self-pay" trial balances, monitor collector progress and catalogue problems.

7. Use collection agency findings to gauge areas of internal operational weakness.

8. Review the bills for clarity and ease of understanding (ask those in other departments to provide input).

Self-Pay is a growing, and often under-worked portion of the trial balance. Most who say they are working this portion of the trial balance, really mean they have staff devoted to answering incoming inquiries (mostly complaints). Consider the type of outsourcing or internal resource allocation where dedicated staff will make the "follow-up call" to reinforce the "dunning" process.

For more information on this topic, see "The Patient Accounts Management Handbook" (Aspen), or contact us.

Q: What should our collection goal be?  75%? 85%?

A: There is only one goal: 100% complete and accurate data collection. While this may prove to be an illusive target for some, on any given day, any one (or members) of your staff can achieve perfection. But would you know it? Monitoring and reinforcement are necessary to improve your score.

If you can focus in on those areas where problems are rampant, your goal has to be to train (and re-train) the staff until they get it right. Preventable errors can be avoided, if you work at it.

To learn more about quality measuring and monitoring techniques, see "The Patient Accounts Management Handbook," (Aspen) for more information, or contact us.


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D E K A Y E Consulting, Inc.
231 Oakview Avenue, Oceanside, NY 11572  Phone/Fax: (516) 678-2754
URL: http://www.dekaye.com E-Mail: Adkcmpa@aol.com or DKConsult1@aol.com

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