Apache Health founder and CEO Sean McSweeney will be speaking on the subject of laboratory RCM analytics at the upcoming G2 Laboratory Summit in Las Vegas, Nevada on December 6, 2018:

How to Gauge Reimbursement Success, Part 1

    • By Sean McSweeney, Founder/President, Apache Health

What is “reimbursement success?” Success is making as much money as possible as fast as possible. Then why is it so difficult to benchmark performance when it comes to revenue cycle management (RCM)?

Revenue cycle management (a.k.a. billing) is often viewed as a black box with no simple way to determine success. Since there are so many opportunities for error and loss while payers are trying to take advantage of labs, there is a lot of money lost in billing. How do you even know whether you’re doing great or are a poor outlier?

Key questions include:

      • How much revenue is being lost? How can we even measure this?
      • What is reasonable or even acceptable? What or whom are we comparing ourselves to?
      • What can be done about it?

There are many variables and metrics/KPIs. But which actually matter? Which help your business? This presentation will help you to weed through what consultants or RCM vendors tell you and focus on what drives RCM success in your lab.

At the end of this session you will be able to:

    • Ask the right questions to determine where money is being lost
    • Identify key RCM processes to measure in your lab
    • Develop a plan for capturing data and quantifying loss


How to Gauge Reimbursement Success, Part 2

    • By Sean McSweeney, Founder/President, Apache Health

You have some tools and are now asking the right questions. You can even quantify some of the performance of key RCM processes. Now what? How do you measure the quality of your performance? The answer is benchmarking.

Which “typical” benchmarks are misleading or completely useless? For example, “AR days” is not the benchmark you should be looking at. It can be very deceptive and, in reality, does not matter as much as other KPIs. Which KPIs are truly valuable and actionable? Distinguishing between poor performance that isn’t controllable and what can be improved is critical.

Another important component is where to get data. A data point, without comparison, is not much better than having no data at all. Without comparison data, you have no idea where to set objectives or how urgent the need for improvement is. In this session we will also look at avoiding apples-to-oranges issues when comparing benchmarks.

At the end of this session you will be able to:

    • Identify key metrics / KPIs to benchmark
    • Find and analyze comparison benchmark data
    • Determine if your RCM is not high-performing


Lab Reimbursement Summit 2019: Agenda


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