How Delta Memorial Hospital identified operational gaps and built a path toward KPI-driven performance
Challenge: Limited Visibility and Inconsistent Accountability Across the Revenue Cycle
Delta Memorial Hospital (DMH) engaged Stroudwater’s team to conduct a focused revenue cycle assessment across both front-end and back-end functions.
While core processes were in place, performance was not consistently measured or managed. Reporting was taking place, but it was not used to guide decisions, track trends, or hold teams and vendors accountable.
In addition, responsibility across internal teams and external partners was not clearly defined. This created gaps in ownership, particularly in areas like denials management, KPI tracking, and follow-up workflows.
Approach: End-to-End Assessment of Revenue Cycle Functions
The engagement focused on a full review of revenue cycle activities, including:
- Scheduling, registration, and prior authorization
- Charge capture, coding, and claim submission
- Payment posting and accounts receivable follow-up
- Denials management and appeals
- Patient billing and collections
- KPI reporting and analytics
The work combined on-site interviews with leadership and staff, detailed data analysis, and benchmarking against rural and industry standards.
Specific attention was given to denial trends, reporting structure, and the use of performance data across the organization.
Findings: Data Was Available, but Not Driving Action
KPI Reporting Was Not Driving Performance
DMH had access to KPI dashboards and reporting tools, but they were not being used as a management tool.
- Metrics were tracked but not consistently trended over time
- No formal cadence existed for KPI review at the leadership level
- Performance was not being measured against benchmarks
- Reporting did not clearly highlight areas of improvement or decline
As a result, KPIs were not influencing operational decisions or day-to-day priorities.
Denials Management Lacked Clear Structure
Denials were being actively worked, but the process lacked clarity and consistency.
- Weekly discussions occurred with the revenue cycle vendor, but visibility into performance was limited
- Denial reporting did not clearly show inflow, resolution, and backlog
- A significant number of accounts were being routed back to hospital staff for final decisions
- Productivity metrics were focused on volume rather than financial impact
This created inefficiencies and limited the team’s ability to prioritize high-value work.
Reporting Did Not Support Decision-Making
Across multiple areas, reports contained data but did not provide actionable insight.
- Accounts receivable reports focused on gross dollars rather than trends or movement
- Limited visibility into payer-specific issues or root causes
- Daily reporting included metrics that did not clearly connect to organizational goals
In several cases, additional data analysis revealed trends that were not visible in standard reporting formats.
Front-End and Workflow Gaps Impacted Downstream Performance
Opportunities were identified across front-end processes that directly influenced claim quality and denials.
- Inconsistent review of claim edits before submission
- Lack of standardized workflows for different claim types
- Limited automation in key areas
These issues contributed to avoidable denials and rework downstream.
Underutilized Data in Key Areas
DMH had access to important data sets, including payer contracts and denial information, but they were not consistently leveraged.
- Contract terms were documented but not actively used in denial resolution
- Denial data was not consistently analyzed across multiple dimensions
- Credit balance work uncovered additional process issues that required attention
Results: A Clear Path to a More Structured and Accountable Revenue Cycle
The assessment resulted in a set of prioritized, actionable recommendations focused on improving performance and accountability.
Establishing a KPI-Driven Management Approach
- Defined KPI targets aligned with organizational goals
- Monthly review cadence with leadership
- Trend-based reporting to highlight movement over time
- Use of KPIs to guide team discussions and operational priorities
Restructuring Denials Management
- Clear tracking of denial inflow, backlog, and resolution
- Focus on root cause analysis and top denial drivers
- Shift from volume-based productivity to cash-focused performance
Rules were established to define when work should be escalated versus resolved by the vendor.
Improving Reporting for Actionability
- Simplified reports to highlight key issues and trends
- Expanded use of payer-specific and service-line data
- Development of new reports to better understand AR performance and drivers of Days in AR
Strengthening Front-End Processes
- Standardized workflows for claim preparation and submission
- Increased focus on clean claims before submission
- Expanded use of automation where appropriate
Enhancing Accountability Across Teams and Vendors
- Clear expectations tied to performance metrics
- Improved visibility into vendor activity and outcomes
- Alignment between internal leadership and external partners
Impact
This work established the foundation for a more structured and accountable revenue cycle at DMH.
The organization now has:
- A defined framework for measuring and managing performance
- Clear visibility into key drivers of revenue cycle outcomes
- A more aligned approach across internal teams and external partners
Key Takeaway
Revenue cycle performance is not limited by access to data. It is driven by how that data is used. For DMH, aligning reporting, workflows, and accountability created a clear path toward more consistent and measurable improvement.
To learn more about improving revenue cycle performance, connect with our team.
