Revenue Cycle Management Best Practices. Presenter: Rich Flaherty, VP of Sales

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1 Revenue Cycle Management Best Practices Presenter: Rich Flaherty, VP of Sales

2 RCM Best Practices Overview Patient engagement Front office processing Managing your provider s credentialing and enrollment status Building a technology-driven claims processing strategy Ensuring correct payment through payor contract compliance ICD-10 preparation and readiness

3 Historical Approach to RCM Appointment Scheduling Super Bill/ Charge Capture Denial Management Billing Follow Up

4 2014 Approach to RCM Patient Engagement Physician Charge Capture Denial Analysis Denial Mitigation Payor Contract UnderPayments Billing Follow Up

5 Patient Consumerism Consumerism of healthcare on the rise High-deductible health plans Cost sharing models Health insurance exchanges Focus on interactive tools to engage your patients

6 Online Appointment Scheduling Patient (Consumer) convenience Available 24/7 Reduces resource time and costs Captures key communication modalities through the process Allows for consumer ownership Drives the patient to your website for additional communication

7 Keeping Appointments Create interactive tools for patient reminders Allow links to update personal calendars when booking online Establish automated and interactive reminder messages Automated phone calls s Text messages POLL 5-7% No Show Source: MGMA

8 Understanding Patient Responsibility Create tools to allow patients to estimate cost for services Communicate to patients their payment obligations Communicate terms and timing of payment expectations Promote tools for patients to verify their insurance coverage

9 Growing Your Volume Institute a recall and preventative marketing strategy Chronic disease management Health assessments

10 Eligibility Verification Automated 270/271 responses allow for real-time verification Creates flags and alerts to identify demographic capture errors in scheduling process Automated identification of patient responsibilities POLL

11 Creating an Effective Front End Collections Set expectations early with patients Educate staff on effective ways to request payment Understand co-pay and deductible responsibilities Cost estimation tool for key payors and services provided Collect co-pays and estimates prior to services Establish payments plans with automated withdrawal

12 Streamlining Your Charge Capture Process System solution and tools need to allow for quick and easy searching Enhances complete capture of services provided Decreases lag in charge submission and potential for missing charges Allows for point-of-service edits and consistent provider communication to billing

13 PQRS Incentive payments and payment adjustments to promote reporting of quality measures Impacts eligible professionals including Medicare physicians, practitioners, and therapists Reported via single claim or qualified registry submission 2014 last year to receive bonus 2015 will have payment adjustments for non-compliance Requires 9 measures from NQS across 3 domains Requires reporting on 50% of the eligible population for the calendar year

14 Provider Credentialing and Enrollment Partner with an experienced organization: Avoid delays and loss of revenue Knowledge on specific payor and state requirements Track and monitor re-certification timelines Manage/communicate status of enrollment

15 Denial Mitigation Automated claims/scrubber rules engine at charge entry: Automated and built into the system and process Payor and Provider specific Creates alerts and direction Prevents claim submission until defect is resolved

16 Denial Mitigation Examples of typical Denial Prevention edits: Services requiring authorization or referral Insurance verification failure LCD exclusions Dx and CPT inconsistency Appropriate modifier utilization Bundling/inclusive procedures Initial vs. subsequent visits Vaccination and administration capture POLL

17 Technology-Driven Claims Processing Initiate an automated claims status verification Streamline follow-up activities and eliminate claim not on file Replace Denial Management with Denial Analysis Review denials on occurrence to develop an edit to prevent prior to submission Adopt Appeal and Prevent mentality

18 Enforcing Payor Contract Compliance Commercial payors on average underpay on 10% of their claim adjudication Create a system knowledge repository on fee schedules and reimbursement rules for key payor population Create system flags and alerts to identify underpayments for every line item Create individual appeals with payor to set precedent and follow with bulk appeals POLL

19 Patient-Friendly Statements Clear and Bold: branded with your logo and contact information Legible Fonts: Use fonts to highlight pertinent sections of the statement: account, guarantor, amount due, due date, and remittance address Concise and Correct: State only what is needed and ensure what is stated is correct Multiple Delivery Options: USPS, online statements, statement notices

20 Online Bill Payments Faster and easier than the checkand-stamp method Eliminates payment procrastination Verifies the availability of funds at processing Eliminates manual processing and deposits Easy access to patient data for tax purposes Eliminates late fees, overdrafts POLL

21 ICD-10 Increases Dx value from 5 to 7 characters Complete and concise documentation is a must Focuses on specificity, location, and laterality Billing and Coding staff will require many hours of training and re-certification Delays in cash flow should be anticipated POLL

22 Key Takeaways Embrace patient engagement and the role they have as a consumer in the healthcare market Surround front office staff with tools and technology to streamline the patient experience and reduce claim defects Use preventative treatment plans as a way to grow your volume Manage your providers enrollment status Monitor your payors processing according to contract requirements Increase visibility and preparation for ICD-10

23 About MDeverywhere Leader in Revenue Cycle Management Serving 7,000 physicians, 40+ specialties MDe clients increase collections 10-15% Decrease denials by 95% NCQA CVO certified Free practice assessment offer...

24 Contact MDeverywhere , option 4#

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