KPI & SLA Management: Achieving Excellence

KPI & SLA Management Achieving Excellence Through Performance Indicators Ascent Business Solutions | Confidential | www.ascenthealthcare.com "What do you think is the primary difference between KPIs and SLAs?" Ascent Business Solutions | Confidential |...

KPI & SLA Management Achieving Excellence Through Performance Indicators Ascent Business Solutions | Confidential | www.ascenthealthcare.com "What do you think is the primary difference between KPIs and SLAs?" Ascent Business Solutions | Confidential | www.ascenthealthcare.com Café Perfection Ascent Business Solutions | Confidential | www.ascenthealthcare.com Objectiv es 1. Differentiate between KPIs and SLAs 2. Understand the impact of KPIs. 3. Examine the relationship between KPIs and SLAs in driving team performance. 4. Adapt KPIs and SLAs to effectively drive organizational goals. Ascent Business Solutions | Confidential | www.ascenthealthcare.com "What KPIs or SLAs have you encountered in your current role? How do you monitor them?" Ascent Business Solutions | Confidential | www.ascenthealthcare.com Definitions – What is KPI & SLA KPI: KPI stands for key performance indicator, a quantifiable measure of performance over time for a specific objective. KPIs provide targets for teams to shoot for, milestones to gauge progress, and insights that help people across the organization make better decisions. SLA: A service-level agreement defines the level of service expected by a customer from a supplier, laying out metrics by which that service is measured, and the remedies or penalties, if any, should service levels not be achieved. Usually, SLAs are between companies and external suppliers, but they may also be between two departments within a company. Ascent Business Solutions | Confidential | www.ascenthealthcare.com Difference between KPI & SLA Aspect KPI (Key Performance Indicator) SLA (Service Level Agreement) A contractual agreement defining the expected service Definition A measurable metric used to track and improve performance. standards. To monitor and optimize Billing, Coding, EVBV, and AR To ensure service commitments between a provider and a Purpose processes. client are met. Focus Internal performance improvement. External service expectations. Example in "Process all claims within 24 hours" (Defines service "Reduce claim denials to below 5%" (Tracks efficiency). RCM commitment). Managers & teams to measure success and identify areas for Who Uses It? Clients & providers to ensure service quality and compliance. improvement. Flexibility Adjusted based on business needs. Pre-defined and legally binding. Measurement Monitored via dashboards and reports. Enforced through contractual penalties or service credits. Ascent Business Solutions | Confidential | www.ascenthealthcare.com KPI Pyramid Focus: Organizational Strategic KPIs success and financial Business Impact goals Tactical KPIs Focus: Departmental Process Performance efficiency and workflow optimization Operational KPIs Focus: Employee Daily Execution productivity and task- level performance Ascent Business Solutions | Confidential | www.ascenthealthcare.com SLA Lifecycle Define & Implement & Establish Communicate SLA Monitor & Optimize & Measure Improve Performance Review & Analyze Ascent Business Solutions | Confidential | www.ascenthealthcare.com KPI-SLA Relationship How Do KPIs & SLAs Work Together? KPIs measure internal performance, helping teams track progress and improve efficiency. SLAs define the expected level of service, often agreed upon between a service provider and a client. Connection: SLAs set service expectations, while KPIs ensure those expectations are met. Example in US Healthcare RCM SLA Commitment: "All medical claims must be processed within 24 hours." Supporting KPI Metric: "Ensure 98% of claims are processed within the 24- hour SLA." ✅ If KPIs are consistently met, SLAs remain compliant. ❌ If KPIs fall below the target, SLA commitments may be breached, leading to penalties. Ascent Business Solutions | Confidential | www.ascenthealthcare.com How KPIs Drive Success 1. Aligning with Team Goals 2. Motivating Performance 3. Identifying Areas for Improvement Ascent Business Solutions | Confidential | www.ascenthealthcare.com Scenario-Based Exercise: Mastering KPIs & SLAs in Medical Claims Processing Your team is responsible for processing medical claims in a US Healthcare Revenue Cycle Management (RCM) organization. KPI: Process 200 claims per day SLA: Resolve any escalated claims within 48 hours Challenge: With increasing claim volumes and possible payer rejections, how will your team efficiently meet both KPI and SLA requirements while maintaining accuracy and compliance? Ascent Business Solutions | Confidential | www.ascenthealthcare.com Case Study Background Ascent Healthcare’s Claims Processing Team is responsible for handling medical insurance claims within the Revenue Cycle Management (RCM) process. Their role is to ensure claims are accurately processed and submitted for payment while also addressing escalations efficiently. Performance Targets Key Performance Indicator (KPI): Each associate must process 200 claims per day to maintain productivity standards. Service Level Agreement (SLA): Any escalated claim must be resolved within 48 hours to maintain compliance with contractual agreements and avoid penalties. Microsoft Word Document Ascent Business Solutions | Confidential | www.ascenthealthcare.com Thank you Rise Beyond. Ascent Business Solutions | Confidential | www.ascenthealthcare.com