BEST PRACTICE BILLING WORKFLOW

Transcription

1 BEST PRACTICE BILLING WORKFLOW Penny Gilmore, Professional Medical Management, Inc. Philip Collins, Southwest Diagnostic Imaging Center Jeffrey Atkin, Reston Radiology Consultants Facilitated by Shannon Marshall, Merge Healthcare Monday, August 27, Merge Healthcare

2 session objectives 2 Provide attendees with real-world case studies on optimizing the Merge Financials system Enable discussion and problem solving with peers on additional Merge Financials situations Learn to use Merge Financials in new and different ways Connect with peers and Merge Financials best practice users

3 discussion topics 3 Introductions Case studies Panel Q&A

4 DOWNLOADS/INTERFACES Penny Gilmore, Billing Office Manager Professional Medical Management

5 my background 5 I have been with Professional Medical Management (PMM) for 12 years I have a B.S. in Business Management 16 years of medical billing experience 14 years of billing professional services 12 years working with Merge and its predecessors Transitioned from Sentinel to Merge Financials in October 2008

6 Professional Medical Management s background PMM is a multispecialty billing company Bill for nine tax id #s (practices) Five specialties (radiology, family practice, wound healing, mental health, and chiropractic) In 2011 we billed 323,466 procedures 298,311 were radiology procedures Iowa Radiology were hospital based procedures were clinic based procedures 20 radiologists Reading at 12 Iowa hospitals Over reads from local physicians group Five clinics

7 Merge products utilized at PMM Merge PACS Merge RIS Merge Financials Moved from Sentinel Merge Dashboards Merge Documents

8 my case study 8 With interfaces into Merge Financials we are able to import demographics from 11 of the 12 hospitals Iowa Radiology provides radiology services Merge RIS is used in all five clinics We utilize RIS Charge Outs to import demographics into Merge Financials We have an interface from Coderyte into Merge Financials for all our charges Our office used to have shelves full of demographics & charges waiting to be manually entered into Sentinel. You will not find a shelf like this at PMM today! Results Our average time from DOS to date of claim is five days We have our 1 st payment in day Our net collection % for 201 Hospital based 88.65% Clinic based 96.61%

9 while I have the microphone. 9 I wish I had time to explain other benefits that Merge Financials provides over Sentinel Use the credit card portal to import & post patient payments made directly on Iowa Radiology s website Reduction of paper Increase of patient satisfaction of our billing practices I would also like to explain how we use Documents in conjunction with Financials I am interested in learning about the eligibility feature in Merge Financials If someone uses this feature, I would like to hear your best practices on this topic

10 CASE STUDY: A/R MANAGEMENT Philip Collins, Director, Business Services Southwest Diagnostic Imaging Center

11 my background 11 Some things to know about me 28 years experience in healthcare finance including: Hospital Physician Cardiology Radiology Revenue cycle consulting Merge RIS user since April 2010 Merge Dashboards since April 2010 Merge Financials since January 2011

12 Southwest Diagnostic Imaging Center 12 Some things to know about my billing business 26 years in business One 35,000 sq. ft. location Eight modalities 60,000 avg procedures annually Bill for TC only Staff of 18 YTD Cash collection percentage is 98.96% A/R days = 26 Bad debt = <1.8% net & 0.89% gross Key products used Merge RIS v7.2, Merge Financials v6.1.4, Merge Dashboards Soon will have Merge Referral Portal & iconnect Market: DFW metro area 3 major competitors 6,000 referring physicians

13 Merge products at Southwest Merge CADstream Merge RIS Merge Financials Moved from Sentinel Merge Dashboards Merge Documents

14 my case study 14 Merge Financials provided effective: A/R management Staff productivity and accountability The legacy way Manual approach using Excel spreadsheets by employee Manual review of account action per employee by management WORK QUEUES!! Alleviated the manual approach Staff account assignments Breakout of denials, insurance, and patient accounts Ability to sort by payor Clear staff productivity; Accountability Coverage possible during staff absence Financials reporting capability A/R days decreased from upper 30s to mid to upper 20s Increased cash intake; Lower percentages in aging categories

15 work queue at a glance 15

16 work queue at a glance 16

17 while I have the microphone 17 Additional best practices exist! I wish I had more time to share See me after the session if you want to collaborate about Merge RIS/Merge Financials integration or any other process functions Looking for peers to share / collaborate about Interest payments show on actual account Adjustment reason more easily shown

18 COST SAVINGS WITH FINANCIALS Jeffrey Atkin, Chief Operating Officer Reston Radiology Consultants

19 my background 19 COO at Reston Radiology for the past four years Prior work PACs/RIS Account Exec w/mckesson Director Financial Systems w/prince William Health System Education BS in Nuclear Medicine MBA MISM CPHIMS IT Certification CIIP PACs Admin Nuclear Certification NMTCB

20 Reston Radiology Consultants 20 Bill for five Practices One hospital 200 Bed Large MRI center PET practice Two outpatient imaging centers Billing Office 6.5 FTE s Billing manager

21 Reston has multiple Merge products iconnect Access Merge RIS Has attested for Meaningful Use Merge Financials Integrated with Instamed patient portal Previous Sentinel user Merge Dashboards Merge Documents

22 cost savings 22 Cost savings with Merge Financials Coding Director sending less charges to alife for coding Decrease in staff Currently have six full time, one part time, + Billing Manager Decrease of 4.5 FTEs and outside consulting Payroll has been cut in half Annually from $900,000 to $470,000 Overtime dropped from $50,000/year to $0.00 Zero overtime shop $30.00 in OT in first six months of 2012 Increased electronic footprint Less paper in the office Payments are the only paper in office Fighting denials is a quicker process More Room for front office 4.5 FTE reduction allowed pre-authorization team to relocate to billing More procedures administered

23 relocating staff and more 23 Relocating Pre Authorization Moved from the front end to the back end Staff is now sitting with the billing department Allows the staff to be more up to date on billing rules and regulations Newest upgrade to Merge RIS Can use Merge RIS Work Queue s in a much more manageable way Moved from resource based assignment to work queue priority Each user works the queue according to priority Went from losing significant sum of money to virtually zero loss in per cert issues The process was fully manual before

24 integration with Instamed 24 Increased collections Integrated with Instamed Patients sign onto a portal and make payments online Scan/track patient checks from front office Working with Instamed s eligibility

25 if I could go on 25 I would discuss the relationship between the Merge Products Merge RIS and Merge Financials Merge RIS/FIN and Dashboards Merge Financials and Documents Implemented multiple products and systems Breadth of offerings elsewhere not as complete

26 PANEL DISCUSSION

27 session objectives met? 27 Provide attendees with real-world case studies on optimizing Financials Enable discussion and problem solving with peers on additional Financials situations Learn to use Financials in new and different ways Connect with peers and Financials best practice users