Key Performance Indicators to Strengthen Eligibility and Enrollment Services – and Your Bottom Line

Learn how Centra Health was able to boost revenue by implementing an effective eligibility & enrollment program.

So you have an eligibility and enrollment program at your hospital. But how are you tracking its success? Do you evaluate and monitor Key Performance Indicators (KPIs) to determine how successful your eligibility & enrollment program is? How often? If you rely on an in-house program to screen self-pay patients and enroll them in Medicaid or other assistance programs, how do you know when it might be time to consider bringing in a third-party vendor? If you’re already outsourcing your eligibility program, how do you know whether your hospital and your patients are getting the maximum benefit?

Emdeon recently hosted a webinar, “Ten Key Performance Indicators to Strengthen Eligibility and Enrollment Services – and Your Bottom Line,” which takes a closer look at these issues. Hosted by Joe Koons, managing director of revenue cycle for Centra Health and Matt Russel, vice president of business development for Chamberlin Edmonds, an Emdeon company, this webinar provides best practices for choosing an eligibility and enrollment vendor, implementing the services and tracking the results using quantitative measures.

Faced with the challenge of screening not only its inpatient population, but also outpatients and visitors to the emergency department, Centra needed a partner willing to take a holistic approach to the eligibility and enrollment process. Chamberlin Edmonds was a perfect fit for the health system. Eligibility specialists tailored their processes to adhere to Centra’s specific needs and the positive results of Chamberlin Edmonds’ efforts were evident from the beginning of the engagement.

In order to maintain the effectiveness of Chamberlin Edmonds’ work at Centra Health, leaders at both organizations are constantly monitoring a set of KPIs that provide a snapshot of the eligibility program’s performance. One of the most important metrics Centra uses to gauge overall success is bad debt as a percent of gross revenue, which has decreased from nearly four percent at the time Chamberlin Edmonds was implemented in 2003 to less than two percent in 2011. Centra also monitors the amount of charity care it provides as a percent of gross revenue, as well as the shift from bad debt to the system’s charity program. As a non-profit, mission-driven organization, screening patients for its internal charity program is an important component of Centra’s service to its patients.

In order to maximize returns of the eligibility process, it is vital to screen as many self-pay patients that come through the system as possible. With this in mind, Chamberlin Edmonds maintains an overall contact rate between 98 and 100 percent. Other KPIs used by Centra and Chamberlin Edmonds to evaluate the success of the eligibility and enrollment program currently in place include:

• Acceptance rate
• Approval rate
• Yield: Referral to remittance
• Cycle time: Referral to approval
• Cycle time: Approval to pre-certification authorization
• Conversion rate

Listen to Emdeon’s webinar, “Ten Key Performance Indicators to Strengthen Eligibility and Enrollment Services – and Your Bottom Line” and learn more about measuring the effectiveness of your eligibility program.

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