Optimizing Business Office Operations. Presented By D. Paul Davis, CPA, CMA

Transcription

1 Optimizing Business Office Operations Presented By D. Paul Davis, CPA, CMA

2 ASC Challenges Declining reimbursement Increasing costs Increased competition More government regulations Changing technology Difficult economic times Aging medical staff Recruiting and retaining employees Limited resources

3 Business Office Functions

4 Revenue Cycle Process

5 Revenue Cycle A Strategic View A Strategic Function Core competency of the ASC Customized solution Dedicated resources Human Technology Policies and procedures Controls Training and Education An investment in the business Not A Strategic Function Viewed as a commodity Necessary but not a differentiator Focus is on Cost reduction Process improvement Decreasing operational head aches Outsourcing Expense versus investment

6 Optimization The dictionary definition of optimization is: to make the most of; develop or realize to the utmost extent; obtain the most efficient or optimum use of

7 Revenue Cycle Optimization Technology Process People

8 Revenue Cycle Management Focus Areas Processes Productivity AR Management RC Optimization Performance

9 Common ASC Revenue Cycle Issues Inadequate patient information capture Inability to verify insurance or collect co-payments Inaccurate billing or posting of payments Untimely billing and or appeals Incomplete physician documentation Physicians lack of collaboration on revenue issues Staff training needs Accountability of staff performance Capturing and billing for implants Sequencing codes to maximize reimbursements

10 60% Average ASC Accounts Receivable Aging Profile 50% 40% 30% 20% 10% 0% 0-30 days days days days >120 days Data Source: VMG Health Intellimarker 2010, page 21

11 70% Optimal ASC Accounts Receivable Aging Profile 60% 50% 40% 30% 20% 10% 0% 0-30 days days days days >120 days

12 Best Practices Verify coverage and pre-authorization of services for all patients Payor contracts accurately loaded into your health information system to facilitate an accurate expected payment to be calculated Pre-op phone call from the business office with every patient make financial arrangements on the front-end Registration checklist (all information needed for complete claim submission) completed for 100% of patients Collect co-payment and deductible at time of service Enter charges on a daily basis

13 Best Practices Cont. Review and fix all claims and edits on a daily basis Submit all outstanding claims electronically (primary and secondary) on a daily basis Receive remittances (ERAs) electronically and have the ERAs electronically post to your health information system Appeal all payor payments less than the amount owed. Transfer account balances to secondary payor or to patient responsibility on a daily basis Enter payments and adjustments on a daily basis Balance all charges, payments and adjustments with services provided, bank deposits, EOB and ERAs received, and with your computer system on a daily basis

14 Tools and Solutions Tools Implement a revenue cycle training program Develop process maps and policies and procedures Implement a Dashboard report to monitor revenue cycle measures Implement incentive program Solutions Automate insurance verification and remittances Upgrade your Health Information System Have a business office assessment performed Consider and evaluate outsourcing revenue cycle functions Implement best practices discussed

15 Revenue Cycle Indicators Performance Measures Revenue Cycle Measures Prior Period Change Inc./(Dec.) Current Cash Collections As % of Gross Charges 38.5% 38.9% -0.4% Cash Collections As % of Net Revenue 98.6% 99.7% -1.1% Accounts Receivable Resolve Rate 98.8% 93.7% 5.1% Change in Accounts Receivable Balance $ 30,901 $ 156,347 $ (125,446) Average Revenue Days in Accounts Receivable Change in % of Accounts Receivable >90 Days -1.1% -2.9% 1.8% Change in Number of Open Accounts 2,676 2,710 (34) Bad Debt Expense As % of Net Revenue 1.2% 1.7% -0.5% Revenue Cycle Costs As % of Net Revenue 1.5% 1.3% 0.3% Gross Revenue Per Case $ 3,484 $ 3,261 $ 223 Net Revenue Per Case $ 1,359 $ 1,272 $ 87 Collections Per Case $ 1,340 $ 1,268 $ 72 Productivity Measures Average # of Case Per Day Average # of Claims Submitted Per Day Average # of Payments Posted Per Day Average # of Adjustments Posted Per Day Average # of Patient Accounts Resolved Per Day Average # of Revenue Cycle Staff Hours Per Case Revenue Cycle Costs As % of Net Revenue 1.5% 1.3% 0.3% Revenue Cycle Costs Per Case $ $ $ 4.79 Process Measures Front-End of Revenue Cycle % of Cases Insurance Coverage Verified 99.8% 98.2% 1.6% % of Patients Receiving Pre-Surgery Call From Bus. Office 78.4% 47.9% 30.5% % of Cash Receipts Received at Time of Service 3.1% 1.3% 1.8% Billing and Claims Submission Average # of Days to Complete Medical Record Average # of Days to Complete Coding Average # of Days to File a Claim Average # of Days From File Date to Insurance Payment Average # of Days From File Date to Payment In Full - Zero Balance % of Claims Submitted Electronically 82.7% 84.5% -1.8% % of Claims Denied 2.3% 2.7% -0.5% Ratio of Denials/Appeals Back-End of Revenue Cycle % of Payors Sending Electronic Remittances 5.4% 4.7% 0.8% % of Payments Received Electronically 15.5% 10.2% 5.3% % of Payments Posted to HST Electronically 15.5% 10.2% 5.3% % of Adjustments Posted to HST Electronically 15.5% 11.4% 4.1% Accounts Receivable Statistics Current Prior Period Change Inc./(Dec.) Accounts Receivable Total AR $ Balance $ 2,521, $ 2,490, $ 30, Total AR Debit $ Balance $ 2,577, $ 2,542, $ 35, Total AR Credit $ Balance $ (55,727.72) $ (51,616.96) $ (4,110.76) Number of Open Accounts 2,676 2,710 (34) Number of Open Debit Balance Accounts 2,590 2,628 (38) Number of Open Credit Balance Accounts Average $ Balance Per Open Account $ $ $ Average $ Balance Per Debit Account $ $ $ Average $ Balance Per Credit Account $ (648.00) $ (629.48) $ (18.52) Accounts Receivable Aging AR $ Balance 0-30 Days $ 1,497, $ 1,406, $ 90, AR $ Balance Days $ 240, $ 275, $ (34,884.05) AR $ Balance Days $ 118, $ 124, $ (6,000.00) AR $ Balance >90 Days $ 665, $ 684, $ (19,080.58) AR Balance % 0-30 Days 59.4% 56.5% 2.9% AR Balance % Days 9.5% 11.0% -1.5% AR Balance % Days 4.7% 5.0% -0.3% AR Balance % >90 Days 26.4% 27.5% -1.1% Number of Open Accounts 0-30 Days 1,211 1, Number of Open Accounts Days (12) Number of Open Accounts Days (53) Number of Open Accounts >90 Days (60)

16 Sample ASC Dashboard

17 Revenue Cycle Optimization Exercise Optimizing Revenue Cycle Interactive Model

18 Summary 1. Healthcare revenue cycle process is complicated, time consuming and has many parts 2. We have asked the question whether the revenue cycle function is a strategic or non-strategic function 3. Revenue cycle optimization occurs when employees, processes and your information technology works in conjunction with each other 4. Implementing revenue cycle best practices will significantly improve revenue, cash flow, shorten the revenue cycle and will reduce costs 5. We have identified tools/solutions available to help optimize the revenue cycle 6. We have reviewed a revenue cycle dashboard that monitors revenue cycle processes, productivity, performance, and accounts receivable management 7. You have participated in an example, using a model, how implementing a couple of the best practices impacts the revenue cycle

19 Questions and Answers