HIT-Byte: Top 3 Mistakes in Electronic Revenue Cycle Management. June 16, 2015

Transcription

1 HIT-Byte: Top 3 Mistakes in Electronic Revenue Cycle Management June 16, 2015

2 Learning Objectives By the end of this session, you will be able to: 1. Name at least 3 common Revenue Cycle Management (RCM) mistakes made; and 2. Describe at least one strategy to address RCM with an electronic Practice Management system.

3 Revenue Cycle Management Definition: The Healthcare Financial Management Association (HFMA) defines revenue cycle as "All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. Very important to know where revenue cycle begins and ends.

4 Revenue Cycle Management

5 Mistake #1 Failure to effectively select and implement EHR/PM Presenter: Thomas Dawson Principal Consultant Full Circle Projects

6 Mistake #1 Failure to effectively select and implement EHR/PM The landscape EHR/PM systems now include the features and functions of practice management systems When implemented, your EHR/PM will touch practically every process across all departments in your organization Even if ONC-ACB certified, all EHR/PM systems are different

7 Mistake #1 Failure to effectively select and implement EHR/PM To achieve optimal revenue cycle management using an EHR/PM a clinic must Document key EHR/PM requirements Select an EHR/PM vendor that knows your requirements and can meet them Manage the vendor s EHR/PM implementation consultants to make sure the system is configured to meet your needs

8 Mistake #1 Failure to effectively select and implement EHR/PM Why is this important? What could possibly go wrong? Case One: Clinic selected and implemented EHR/PM with input only from clinicians o Outcome: EHR/PM was not able to effectively bill the main payer for over 9 months. Resolution cost over $100,000 Case Two: The clinic selected a capable EHR/PM but did not effectively manage implementation o Outcome: EHR/PM was not configured during implementation to bill or report to key payer specifications. Re-implementation was required to resolve the issue, costing over $50,000

9 Mistake #1 Failure to effectively select and implement EHR/PM Essential steps to prepare for a new EHR/PM Document key processes and work flows Select and initiate a multi-disciplinary EHR/PM team Communicate with staff at all levels, in all departments

10 Mistake #1 Failure to effectively select and implement EHR/PM Select an EHR/PM Make a short list of EHR/PMs with proven success with similar providers Send RFP to the vendor short list Evaluate proposals and eliminate non-viable vendors/ehr/pms Conduct formal demos with real, key clinic scenarios Conduct a due diligence process on at least two competing EHR/PM vendors Negotiate contract terms that mitigate risks

11 Mistake #1 Failure to effectively select and implement EHR/PM Implement an EHR/PM Share documentation with your selected EHR/PM implementation consultant about how your organization operates o o o o Documentation of key work flow/processes A list of all payers and programs Copies of data collection forms Copies of reports or forms from clinic data Commit time and resources to the implementation Manage the vendor, don t skimp on training and testing

12 Mistake #1 Failure to effectively select and implement EHR/PM Conclusion Effective revenue cycle management requires an effective EHR/PM In other words

13 Mistake #1 Failure to effectively select and implement EHR/PM

14 Mistake #2 Inputting incorrect data Presenter: Breione St. Claire Project Director California Family Health Council

15 Mistake #2 Inputting incorrect data Failure to verify patient information Using wrong diagnosis or procedure codes

16 Mistake #2 Inputting incorrect data Failure to verify patient information Insurance o Coverage terminated o Services unauthorized Demographics

17 Mistake #2 Inputting incorrect data Using wrong diagnosis or procedure codes Non-specific codes used Upcoding and/or Unbundling Software updates needed ICD-10 transition!

18 Mistake #3 Failure to use reports to optimize RCM processes Presenter: Sue Gillies Chief Operating Officer HD Consult

19 Mistake #3 Failure to use reports to optimize RCM processes Charge capture: Getting the providers to select the correct codes in the first place Education and training Monitoring (Identify relevant reports in the system, spot checks) Feedback loop/continuous process improvement Denial reports

20 Mistake #3 Failure to use reports to optimize RCM processes Reporting and reconciliation Report examples o Understand how each number is calculated, where the data is pulled from, and the timing of the data o Charges, Payments, Adjustments/Practice Management Report o Aged Trial Balance

21 Mistake #3 Failure to use reports to optimize RCM processes Clearinghouse and error reports What edits does your EMR perform? What edits does your clearinghouse perform? Looking for trends Feedback Loop Who is responsible for monitoring the reports and correcting the errors in a timely fashion? Data -> Information -> Knowledge

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