This article was updated in September 2019.

Tribal health is always a top concern for tribal governments because many tribal members can suffer extraordinarily from chronic conditions such as diabetes that require significant resources to manage. Many tribes have taken over health care services from the Indian Health Service (IHS) and ventured into this complex industry with mixed results.

While revenue cycle optimization can help tribal health care organizations identify billing problems, increase reimbursements, and maximize cash flow, it’s one of the most critical and complicated aspects of health care administration.

Navigating the Lack of Information

Tribal health care providers often struggle to benchmark their performance in this area because there’s limited relevant, publicly available information. While indicators are available for nontribal hospitals, federally qualified health centers, and other types of providers, it’s often difficult for tribal organizations to derive meaningful comparisons from these data points because the organizations are often funded differently through both grant and patient service revenue.

Tribal health care providers, however, can still ensure that third-party revenue processes are performing to, or better than, industry standards. Success in this area can help tribal organizations more effectively ensure they’re maximizing their often limited funds, which can help them improve health care services to their members. This can maximize the opportunity to have tribal organizations caring for tribal members.

Key Metrics

Comparing certain information to benchmarks is a good way grasp the significance of the opportunity. Some particularly relevant metrics include:

• Discharges that haven’t been billed or coded
• Visits per day compared to billed visits per day by service type
• Coding accuracy and completeness
• Charging accuracy and timeliness
• Percentage of visits with verified insurance eligibility
• Percentage of claims billed electronically
• Days in accounts receivable

Addressing Challenges

Tribal health care providers using the Resource and Patient Management System may face an added layer of difficulty accessing and measuring information because it’s often unavailable. For example, revenue often isn’t recorded until it’s been billed. This makes measuring discharged-not billed cases—a measure of how quickly you get bills out the door—difficult. Providers should develop workarounds and build custom analyses when canned reports aren’t available for important metrics.

Despite the difficulty, revenue cycle benchmarking is valuable and often the only approach for tribal organizations to gain insight into how to improve performance and access cash to further the mission of caring for tribal members.

We’re Here to Help

If you’d like assistance assessing opportunity and optimizing your tribal health care revenue cycle, contact your Moss Adams professional.