SUSTAINING REVENUE INTEGRITY WITH EMR IMPLEMENTATION
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1 1 SUSTAINING REVENUE INTEGRITY WITH EMR IMPLEMENTATION MICHAEL BRENNAN SENIOR MANAGER CAROLINE RADER ZNANIEC EXPERIENCED MANAGER AHIA 32 nd Annual Conference August 25-28, 2013 Chicago, Illinois
2 Today s Session 2 Health care providers of various size, capabilities and means are implementing i healthcare h technologies, such as EMR systems at a growing rate. Implementing such a system is a large effort and often the communication not only between the information technology, but also the human stakeholders can be the greatest barrier to a successful implementation; and most especially when it comes time to connect the clinical processes to those that result in revenue. This course will describe the responsibilities of each stakeholder as it relates to revenue integrity from planning to post-implementation monitoring. Participants will be provided with a general planning tool to including an implementation checklist, implementation work plan template, example audit reports and troubleshooting guide.
3 What is Revenue Integrity? 3 Revenue integrity activities focus more on process improvement and include those processes most closely involved in the front, middle and back-end revenue cycle processes. Sound activities iti can provide for the following: Identification and correction to the processes and systems that lead to lost revenue opportunities through the creation of processes to ensure the accurate capture and reporting, translation and use of data to support strategic initiatives, and Assurance that every chargeable procedure, item or service is coded, documented, captured, billed and paid according to the terms of government guidelines and payer contracts
4 4 Who are the Stakeholders?
5 Stakeholders and the Successful EMR 5 Key Strategies: Identification of stakeholders Ownership by stakeholders Proactive participation of stakeholders Designation of a liaison between IT and Revenue Cycle Establishing a culture of revenue integrity Establish standard key indicators for monitoring Actively monitoring change and opportunities Prompt response to issues and opportunities
6 Key Revenue Integrity Indicators 6 Eligibility Verification Benchmark Monitoring Scheduled Services 98% verified prior to service System generated report F R O N T E N D ED Services 90% verified prior to discharge System generated report Insurance Verification Benchmark Monitoring OP Scheduled Services 95% verified prior to service System generated report Inpatient Services 100% of patients verified System generated report Financial Counseling Benchmark Monitoring Inpatients >95% cleared prior to System generated report (uninsured/underinsured) discharge Inpatient Services 100% of patients verified System generated report Registration Benchmark Monitoring Registration errors <3% error rate System generated report
7 Implementation Monitoring Indicators 7 F R O N T E N D Core Metrics Week 1 Week 2 Week 3 Week 4 Insurance Verification Rate 95% 93% 90% 93% Pre Registration 90% 85% 80% 85% Rate Financial Screening 95% 90% 85% 90% Rate Registration Errors 4% 8% 12% 8% Rate Registration Wait 10 Min 12 Min 14 Min 12 Min Times Eligibility 98% 95% 92% 95% Scheduled services
8 Key Revenue Integrity Indicators 8 Interface Reporting Benchmark Monitoring Error Reports/Ques <10% of encounters System Generated Report M I D D L E Documentation Quality Benchmark Monitoring Coding Queries 30% concurrent System Generated Report 10% retrospective Query Response Rate 86 90% System Generated Report Coding Backlog Benchmark Monitoring Transcription Turnaround <24 hours H&P, OP <2 days Discharge Summary System Generated Report Coder Productivity it Inpatient t 24/day System Generated Report Outpatient/Amb Surg 40/day Emergency 120/day Ancillaries 240/day Late Charges Benchmark Monitoring Late Charge Report < = 2% of total gross charges System Generated Report
9 Implementation Monitoring Indicators 9 M I D D L E Core Metrics Week 1 Week 2 Week 3 Week 4 Pharmacy Error 20% 15% 15% 10% Work Que Query Response 50% 50% 60% 65% Rate Retrospective 25% 25% 23% 23% Query Coder Productivity - Inpatient 17/day 17/day 19/day 19/day - Amb. Surgery 28/day 30/day 30/day 30/day Late Charges 15% 20% 20% 15%
10 Key Revenue Integrity Indicators 10 Claim Editing Benchmark Monitoring Electronic claim scrubbing > 95% clean claim submission Daily claims edit report Claims requiring editing Worked within 24 hours Daily claims edit report B A Follow-up Benchmark Monitoring C Large balance unit Account inventory <1000 System generated work K Productivity > 50 accts per day lists E N D Small balance unit Account inventory <3000 Productivity > 90 accounts per day Discharged Not Final Billed Benchmark System generated work lists Monitoring Outpatient 6 hold days System generated report Inpatient 4 hold days System generated report
11 Implementation Monitoring Indicators 11 B A C K E N D Core Metrics Week 1 Week 2 Week 3 Week 4 Clean Claim % 95% 90% 85% 90% Claim backlog (days) Large Balance Unit Outstanding Volume Small Balance Unit Outstanding Volume OP DNFB 6 Days 8 Days 10 Days 8 Days IP DNFB 4 Days 6 Days 8 Days 6 Days
12 Case Study #1 12 A large hospital has implemented a new EMR solution. Registration errors have increased from 2% before implementation to an alarming 10%. Registration wait times and verification rates have remained stable and acceptable.
13 Case Study #2 13 Hospital A is meeting if not exceeding all coding benchmark expectations prior to the implementation of the EMR solution. Immediately post go-live the hospital experiences declines in sustaining the benchmarks in the following ow KPIs: Error reports/ques Late charges Coding queries Query response rate
14 Case Study #3 14 Hospital A has 6 Days of DNFB (6 x AGDR) before implementing an enterprise EMR solution. During implementation, DNFB increases to 10 Days. Coding productivity remains the same. Billing productivity remains the same.
15 Common Pitfalls 15 Not evaluating all revenue cycle processing vendor relationships Not involving the appropriate stakeholders at the optimal time, task and activity i Not taking advantage of automation to optimize processes for financial and operational improvements Not developing processes to sustain improvements Over reacting to immediate KPI deterioration Minimal claims testing in both systems Not defining and outlining measurement tools, methodologies and expectations
16 Preparing for Implementation 16 Establish a revenue cycle command center Daily revenue cycle meetings Overstaff high volume areas Dedicated liaison between IT and revenue cycle departments Risk mitigation activities Show staff as many visuals as possible, make them comfortable for implementation *Review of handouts
17 Today s Presenters 17 Michael Brennan Grant Thornton LLP T E mike.brennan@us.gt.com Caroline Rader Znaniec Grant Thornton LLP T E caroline.znaniec@us.gt.com
18 Save the Date September 21-24, rd Annual Conference Austin, Texas 18
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