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CASE 30 MILWAUKEE REGIONAL HEALTH SYSTEM
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Revenue Cycle Management
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Student Version
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This case focuses on various aspects of revenue cycle management and differences between chargemaster
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prices and the amounts actually collected from different payers. Unlike most models, this model does not have
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separate input data, key output, and model-generated data sections. Rather, the model is divided into two
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templates that each focus on one important aspect of the case: the top template focuses on benchmarking metrics
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while the bottom template focuses on chargemaster prices versus reimbursement rates.
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This model consists of a complete case analysis--no changes need to be made. However, in the top template
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students must chose which of the metrics are best suited for the case and justify then justify their choices.
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In the bottom template, some of the cells are colored red. In the student model, these cells contain a zero or hyphen.
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Students must enter the appropriate value needed to complete the calculation. When this is done, any error cells
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will be corrected and the solution will appear.
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BENCHMARKING METRICS TEMPLATE
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National Benchmarks
MRHS Values
Variance
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Overall Metrics:
 HospitalClinicHospitalClinicHospitalClinic
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 A/R Days48.328.545.426.3-2.9-2.2↓
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% of A/R greater than 90 days
29.6%19.0%21.5%20.1%-8.1%1.1%↓
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Cost to collect
3.5%4.2%2.9%4.5%-0.6%0.3%↓
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Defect Metrics:
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 Scheduling:
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Preregistration rate
84.8%99.1%80.8%99.9%-4.0%0.8%↑
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Insurance verification rate
90.0%98.7%85.3%100.0%-4.7%1.3%↑
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Registration:
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Point of service collection rate
13.4%36.2%8.7%48.5%-4.7%12.3%↑
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Registration quality score
98.7%99.4%91.6%99.9%-7.1%0.5%↑
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Case Management:
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Preauthorization denial rate
1.8%0.7%2.4%0.3%0.6%-0.4%↓
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% of medical necessity write-offs
0.4%0.6%0.7%0.2%0.3%-0.4%↓
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Clinical-Charge Processing:
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Charge lag days
3.65.13.26.8-0.41.7↓
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Late charge %
8.4%78.6%2.1%86.9%-6.3%8.3%↓
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Medical Records:
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Days in total discharged not final billed
7.40.14.50.1-2.90.0↓
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Coding quality score
96.5%93.2%98.7%90.2%2.2%-3.0%↑
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 Billing:
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Initial denial rate
4.9%8.2%5.6%7.8%0.7%-0.4%↓
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Clean claim rate
76.8%81.2%72.4%85.2%-4.4%4.0%↑
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Payment Posting:
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% of payments posted electronically
86.7%83.1%90.1%78.9%3.4%-4.2%↑
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Net days revenue in credit balance
1.93.22.52.30.6-0.9↓
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CHARGEMASTER PRICES VERSUS REIMBURSEMENTS TEMPLATE
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MRI of the Knee
Major Joint Replacement
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Chargemaster price =
$0$0
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Medicare payment rate =
$0.00 $0.00
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Medicare
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Base payment rate
$0.00 $0.00
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No payment denial rate @ 3 percent
 0.00 0.00
No payment denial rate =
0.0%
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Part A deductible of $1,184 @ 65% collections rate
(1184.00)
JR collections rate =
0.0%
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Part B deductible of $140 @ 78% collections rate
(140.00)
MRI collections rate =
0.0%
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Total reimbursement
($140.00)($1,184.00)
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Percent of charges
#DIV/0!#DIV/0!
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Medicaid
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Rate of $284/procedure or $2,044/day
$0.00 $0.00
MRI per procedure rate =
$0.00
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No payment denial rate of 0.5%
 0.00 0.00
JR length of stay (LOS) =
0
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Total reimbursement
$0.00 $0.00
JR per diem rate
$0.00
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Percent of charges
#DIV/0!#DIV/0!
No payment denial rate =
0.0%
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Commercial/Managed Care
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58% of charge
$0.00 $0.00
Payment rate =
0.0%
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No payment denial rate of 12%
 0.00 0.00
No payment denial rate =
0.0%
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20% patient coinsurance @ 40% collection rate
 0.00 0.00
Coinsurance rate =
0.0%
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Total reimbursement
$0.00 $0.00
Coins collection rate =
0.0%
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Percent of charges
#DIV/0!#DIV/0!
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Self Pay/No Insurance
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30% discount
$0.00 $0.00
Discount rate =
0.0%
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5% self pay collection rate
 0.00 0.00
Self pay collection rate =
0.0%
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Total reimbursement
$0.00 $0.00
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Percent of charges
#DIV/0!#DIV/0!
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Average Reimbursement and Percent of Charges
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MRI of the Knee
Major Joint Replacement
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Average Collection Amount
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 Payer Mix:
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Medicare =
0.0%$0.00$0.00
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Medicaid =
0.0%
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Comm/MC =
0.0%
Average Percent of Charges
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Self-pay/No ins =
0.0%
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0.0%#DIV/0!#DIV/0!
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END
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