Revenue Cycle Management: Tips & Tools

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Revenue Cycle Management: Tips & Tools"

Transcription

1 Revenue Cycle Management: Tips & Tools 2010 Annual Educational Seminar March 10, 2010 Presented By: Cindy Tipton, Coding & Compliance Director

2 What is the Revenue Cycle or Life of a Charge? Important to understand the operations of your practice When and How does patient information get collected and verified? How do charges get processed by your office? Do you have a standard process for charges, payments and denials? Are claims submitted daily? Understand the full process within your office.

3 Tips for filing electronic claims Verify, file, and keep all transmission reports Track clearinghouse claims to ensure successful transmission Verify that your computer software is consistent with the clean claims rules Verify that your software correctly prints a claim Monitor, review, and correct daily all fatal errors

4 Tips for filing paper claims Do Use only original claims forms (printed in red drop-out ink) Avoid folding claims if possible Do not use terms such as re-filed claim, second request, or corrected claim Avoid handwritten claims Use all UPPERCASE letters Stay inside the lines of each block Verify that claims are readable

5 Tips for filing paper claims Don t Use any punctuation or decimals Send unnecessary attachments Use staples or paperclips Attach post-it notes Use highlighters Circle or additional markings Attach labels Add notes or instructional assistance Don t give insurance companies a reason to reject your claim!

6 Additional Tips Always include the providers federal Tax ID & NPI numbers Include the referring physician if applicable Include prior authorization if applicable Include the provider s signature The admitting diagnosis is required for all inpatient claims ICD-9 codes should be coded to the highest level of specificity (4 th & 5 th digits) Correct Place of Service

7 Revenue Cycle ANSWER TELEPHONE Standard Greeting Identify Self Identify Location "May I help you" P & P PATIENT CALLING? P & P Triage Protocol NON PATIENT CALL TRIAGE NO YES PATIENT CALL TRIAGE Personal Call Identify Caller Review "VIP" List Determine availability of physician/ staff member Transfer call/take message, as directed by physican/ staff member Deliver message Another Physician Determine availability of physician If physician w/patient, "Would you like physician interrupted?" If physician unavailable, "Can clinical staff member help?" Transfer call/ take message, as directed caller Deliver message Physician Office- (non physician) Identify Caller Determine nature of call Determine availability of appropriate recipient Transfer call/ take message, as directed Deliver message Hospital/ Ancillary Provider Identify Caller Determine nature of call Pull Patient Chart Determine availability of appropriate recipient Transfer call/ take message, as directed Deliver message Laboratory Determine nature of call "STAT" Results Determine availability of appropriate recipient Transfer call/ take message, as directed Deliver message Pharmacy Call Identify Patient Determine if patient waiting for Rx Determine availability of appropriate recipient Transfer call/ take message, as directed Pull Patient Chart Deliver message Business Call Identify Caller Identify Recipient of Call Determine availability of requested recipient Transfer call/ take message, as directed Deliver message Outgoing Call Patient Cancel Ask reason Re-Book Post Cancel to System (with reason) If no rebook, Chart cancellation Non-Urgent Calls Est Pt NO Presenting Problem Scheduler Next Available for Est Patient NonUrgent Set up Reminder New Pt NO Presenting Problem Scheduler Next Available for New Patient Non Urgent Send New Pt Package Fill out New Pt QuickInfo Est Pt Sick Sick/Urgent Calls Protocol Question 1 Protocol Question 2 Protocol Question 3 Scheduler New Pt Sick Next Available within 1-2 days Pull Chart TX to Clinical Scheduler SDS slot Emergent Calls New/Est Patient Emergent Pull Chart Tx to Clinical Come to Office Go to Emergency Dept Call Copyright 1999 by MED3OOO Group, Inc. Now OV

8 Revenue Cycle

9 Revenue Cycle

10 Revenue Cycle

11 Charge Capture Get Paid For What You Do! 1) Ensure there is a reconciliation process through the practice management system or daily schedule to ensure all office charges have been entered. 1) Use scheduler in practice management system or daily schedule 2) Office charges should be entered daily no lag time! 3) Ensure encounter form is representative of commonly used procedure codes 2) PDA s can be used for daily inpatient charges, if this is not an option print daily census and use as reconciling tool. 1) Inpatient charges should be turned in daily 2) Ensure practice staff have appropriate access for patient demographics, test results, etc. 3) Surgery charges should be reviewed by a certified coder to ensure all services are billed for. 1) Surgery charges should be entered as soon as the dictated operative report is available for coding. 2) Surgery schedule can be put into practice management system to ensure no missing surgery cases!

12 Managing the Revenue Cycle INDICATOR CALCULATION BENCHMARK Days in Accounts Receivable: how many days on average does it take to liquidate a receivable item? 12 months gross charges/365 Primary Care: <50 days Specialty Care< 60 days % of Accounts Receivable >120 days: the older the receivable, the more difficult it is to collect Net Collection Percentage: how much money was collected on the money that could have been collected? Denial Percentage: why are claims not being paid? Total Accounts Receivable/Total Accounts Receivable +120 days Payments/(Charges+ Contractual Adjustments) Total Zero Payments-Denials/Total Payments <20% >95% <7% Bad Debt Total bad debt adjustments (one year)/total charges (one year) <2%

13 Importance of the Front Desk/Check In First Impressions of your office The collection of accurate demographic and insurance information. Registration staff should be well educated with the various insurances your practice participates with. Insurance verification process should be established for your practice.

14 Policies, Procedures and Education of Staff Keeping your staff informed is critical to the AR process Should have established policies and procedures to ensure standardization Have meetings with staff to keep them educated of changes with insurances, processes etc.

15 Charge Capture and Claim Submission Importance of Clean charges Charges should be entered timely (even hospital charges) Scrub charges before they are submitted to the carriers Claims should be sent electronically and daily Clearing House or vendor should provide reports of claims sent and status of claims

16 Accounts Receivable Process How does your staff monitor un-paid claims? When does your staff review un-paid claims? Do you post denials, and how do you track your top denials? Do you have a standard set of monthly reports for the practice? Do you review the reports with your staff and use them as educational tools? Does your current billing system provide the necessary reports to work the AR? Do you monitor staff productivity? Do you have thresholds set for your practice?

17 Information and Reports Turning Data into Information for Improvement Identify Strengths and weaknesses Provide objective, measurable information Establish trends Improve performance

18 Top 5 Reports A/R Reports Unpaid Claims Lag Time Denial Productivity

19 Accounts Receivable Reports Days in AR A/R over 120 days

20 Unpaid Claims Review at days Follow-up with payer

21 Lag Time Submission of claim within hrs. of service Improve cash flow Faster Submission = Faster Payment

22 Denial Denial reason Patient detail

23 Productivity Benchmarks Track trends

24 Checklist for Improving Accounts Receivable What is the 1 st impression of your office Insurance verification Updated Policy & Procedures monthly staff training on updates Staff informed of the A/R process Scrub charges prior to submission Send claims daily Send hospital and/or nursing home claims daily or weekly Review reports from clearing house on denied claims work daily Review monthly reports

25 TOP TEN Most Common Professional Fee Billing Errors Always assigning same level of service Misinterpreted abbreviations No chief complaint listed for each visit Billing of service(s) included in global period Inappropriate or no modifier used No documentation for services billed No signature on documentation Unbundling of procedure services Billing Consult vs. New Patient Visit Invalid codes billed-due to charge ticket not being updated with new/revised codes

26 Documentation of an encounter dominated by counseling or coordination of care In the case where counseling and/or coordination of care dominates (more than 50%) of the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), time is considered the key or controlling factor to qualify for a particular level of E&M services.

27

28 Frequently Used Modifiers 22 Unusual Procedural Service 53 Discontinued Service 24 Unrelated E/M service during post-op 57 Decision for surgery 25 Separately Identifiable E&M 59 Distinct procedural service same day as a procedure service 26 Professional Component 76 repeat procedures 50 Bilateral Procedure 80 Assistant Surgeon 51 Multiple Procedures 91 Repeat clinical test 52 Reduced Service

29 Diagnosis Coding(Do s & Don ts) Non Specific Diagnosis Codes A thing of the past V Codes Preventative Medicine, Screening, Secondary diagnosis code to explain the primary diagnosis code Avoid Rule out codes Guidelines advise us against coding the following: Probable Suspected Questionable Rule Out Code the condition to the highest degree of certainty Using rule out indiscriminately makes it look like a practice is treating a higher level severity of patients- when in fact they were actually follow-up visits to determine whether conditions had subsided. Red Flag for an Audit

30 At the End of the Day, It s Outcomes that Matter! Outcomes for your Practice: Enhanced Revenues Operating Efficiency Stable, Integrated System Ability to Focus on Patient Care Outcomes for your Patients: Increased Accessibility of Practice Recalls and Reminders for Needed Care Evidence-Based

31 Questions?

Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit

Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit Protect and Improve Profitability in Your Practice Positioning Your Organization for a RAC Audit 2011 Annual Educational Seminar March 9, 2011 Presented By: Cindy Tipton-Cain, Exec. Director Physician

More information

Give Your Revenue Cycle a Boost Techniques to Improve Collections for Your Physician Practices

Give Your Revenue Cycle a Boost Techniques to Improve Collections for Your Physician Practices Give Your Revenue Cycle a Boost Techniques to Improve for Your Physician Practices Presented by: Alta Partners, LLC Stan Kasmarcak Susannah Selnick Lacy Sharratt June 8, 2015 2015 Ohio Hospital Association

More information

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice Janice Crocker, MSA, RHIA, CCS, CHP Introduction Reimbursement for medical practices has been impacted by various trends and

More information

BILLING COMPANY STANDARDS

BILLING COMPANY STANDARDS BILLING COMPANY STANDARDS ASSESSING PRACTICE VALUE OF OUTSOURCING Cost Saving Efficiencies gained Improved collections Compliance Once a decision to out source is made the following due diligence should

More information

Practice Management CSRO Fellows Conference February 20, 2016

Practice Management CSRO Fellows Conference February 20, 2016 Practice Management CSRO Fellows Conference February 20, 2016 Ethel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc West Palm Beach, FL Practice Structure Physicians & Administrator

More information

Days in Accounts Receivable Days in Accounts Receivable Greater Than 120 Days Adjusted Collection Rate Denial Rate Average Reimbursement Rate

Days in Accounts Receivable Days in Accounts Receivable Greater Than 120 Days Adjusted Collection Rate Denial Rate Average Reimbursement Rate 1 Many providers are under the impression they can assess the financial health of their practice by evaluating cash flow only. However, cash flow is just one factor. You don't have to be a finance expert

More information

10/14/2015. Common Issues in Practice Management. Industry Trends. Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer

10/14/2015. Common Issues in Practice Management. Industry Trends. Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer Common Issues in Practice Management Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer cpmresults.com Industry Trends cpmresults.com Patient Responsibility Patients are now responsible

More information

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs Don t just trust that your staff is maximizing time and revenue. It is up to you to monitor, analyze

More information

Basics of the Healthcare Professional s Revenue Cycle

Basics of the Healthcare Professional s Revenue Cycle Basics of the Healthcare Professional s Revenue Cycle Payer View of the Claim and Payment Workflow Brenda Fielder, Cigna May 1, 2012 Objective Explain the claim workflow from the initial interaction through

More information

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com

More information

NHA Certified Medical Administrative Assistant (CMAA)

NHA Certified Medical Administrative Assistant (CMAA) NHA Certified Medical Administrative Assistant (CMAA) CMAA/NHA This document describes the correlation between curriculum, supplied by Applied Educational Systems, and the NHA Certified Medical Administrative

More information

Revenue Cycle Management Process

Revenue Cycle Management Process OVERVIEW It is important for everyone involved in the billing cycle process to be familiar with how each step of the encounter provides opportunities to assure successful and compliant billing. The purpose

More information

Trusted Partners for. Revenue Cycle Solutions

Trusted Partners for. Revenue Cycle Solutions Trusted Partners for Revenue Cycle Solutions for over 25 years! 44 Stelton Road Suite 315 Piscataway, NJ 08854 1.800.682.5749 732.752.7052 Fax: 732.424.0084 Revenue Cycle Management Outsourcing Ensuring

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management Optimized Have you heard about Revenue Cycle Management (RCM)? It is the process of managing the healthcare revenue cycle within your office that typically results in increased

More information

Billing Manual for In-State Long Term Care Nursing Facilities

Billing Manual for In-State Long Term Care Nursing Facilities Billing Manual for In-State Long Term Care Nursing Facilities Medical Services North Dakota Department of Human Services 600 E Boulevard Ave, Dept 325 Bismarck, ND 58505 September 2003 INTRODUCTION The

More information

Provider Revenue Cycle Management (RCM) and Proposed Solutions

Provider Revenue Cycle Management (RCM) and Proposed Solutions Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive

More information

REVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC

REVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC REVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC REVENUE CYCLE MANAGEMENT WHAT S THE BIG DEAL? Productivity = Efficiency + Effectiveness How much input (cost) is needed

More information

EMR Technology Checklist

EMR Technology Checklist Patient Accessibility/Scheduling/Account Maintenance: Able to interact with schedule through an online portal pre register VIP status to move patient to the front of the line Access and pre registration

More information

Job Description Billing and Coding Associate

Job Description Billing and Coding Associate Practice Name Job Description Billing and Coding Associate Purpose: The job description of Billing and Coding Associate is a written statement that identifies a job title and its related principal duties

More information

OBJECTIVES. Session 115 How to Manage Accounts Receivable & Cash Flow. M. Aaron Little, CPA. Melinda A. Gaboury, COS-C.

OBJECTIVES. Session 115 How to Manage Accounts Receivable & Cash Flow. M. Aaron Little, CPA. Melinda A. Gaboury, COS-C. Session 115 How to Manage Accounts Receivable & Cash Flow Melinda A. Gaboury, COS-C Healthcare CPAs Provider & ADVISORS Solutions, Inc. Chief Executive Officer mgaboury@healthcareprovidersolutions.com

More information

Learn to understand aged AR Learn to work AR. Learn to manage AR. Get the old stuff paid. Where do we go from here?

Learn to understand aged AR Learn to work AR. Learn to manage AR. Get the old stuff paid. Where do we go from here? Learn to understand aged AR Learn to work AR Get the old stuff paid Learn to manage AR Where do we go from here? Accounts Receivable are unpaid payments/charges that are owed to you by the patients and/or

More information

Best ASC Billing Practices & Potential Issues

Best ASC Billing Practices & Potential Issues Best ASC Billing Practices & Potential Issues Speaker: Stephanie Ellis, R.N., CPC Ellis Medical Consulting, Inc. sellis@ellismedical.com www.ellismedical.com (615) 371-1506 for SourceMedical About STEPHANIE

More information

Claims Procedures. H.2 At a Glance. H.4 Submission Guidelines. H.9 Claims Documentation. H.17 Codes and Modifiers. H.

Claims Procedures. H.2 At a Glance. H.4 Submission Guidelines. H.9 Claims Documentation. H.17 Codes and Modifiers. H. H.2 At a Glance H.4 Submission Guidelines H.9 Claims Documentation H.17 Codes and Modifiers H.22 Reimbursement H.25 Denials and Appeals At a Glance pledges to provide accurate and efficient claims processing.

More information

our group Mission Overview Offering

our group Mission Overview Offering ABOUT OUR COMPANY Mission Infrahealth is dedicated to offering cost-effective infrastructure solutions tailored to achieve maximum results for healthcare professionals. We are focused on delivering medical

More information

Seven revenue-driving best practices

Seven revenue-driving best practices NextGen Revenue Cycle Management Seven revenue-driving best practices 1 2 3 4 5 6 7 Self-pay Collections Measuring Performance Claims Scrubbing Track and Prevent Denials Create and Enforce Write-off Policy

More information

RFP 745-15-P03: Medical Cycle Revenue Management Related to the University of Texas Rio Grande Valley (UTRGV)

RFP 745-15-P03: Medical Cycle Revenue Management Related to the University of Texas Rio Grande Valley (UTRGV) RFP 745-15-P03: Medical Cycle Revenue Management Related to the University of Texas Rio Grande Valley (UTRGV) Clarification No. 1: Questions and Answers Q: Please provide volume information so we can put

More information

University Healthcare Administrative Policy

University Healthcare Administrative Policy Page 1 of 6 APPROVED BY: Signatures on File FINANCIAL POLICY (UH) is a not-for profit teaching hospital committed to providing quality health care services. In order to provide necessary medical services

More information

HFMA MAP Keys Patient Access Measure:

HFMA MAP Keys Patient Access Measure: HFMA MAP Keys Patient Access Pre-Registration Rate Trending indicator that patient access processes are timely, accurate, and efficient Indicates revenue cycle efficiency and effectiveness N: number of

More information

Question and Answer Submissions

Question and Answer Submissions AACE Endocrine Coding Webinar Welcome to the Brave New World: Billing for Endocrine E & M Services in 2010 Question and Answer Submissions Q: If a patient returns after a year or so and takes excessive

More information

SUSTAINING REVENUE INTEGRITY WITH EMR IMPLEMENTATION

SUSTAINING REVENUE INTEGRITY WITH EMR IMPLEMENTATION 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 www.ahia.org

More information

HUSKY Health Program and Charter Oak Health Plan Radiology Benefits Management Program

HUSKY Health Program and Charter Oak Health Plan Radiology Benefits Management Program HUSKY Health Program and Charter Oak Health Plan Radiology Benefits Management Program Training Agenda Presentation Overview Introduction of Presenters Radiology Benefits Management Program Overview Prior

More information

Understanding Your Role in Maximizing Revenue in a FQHC

Understanding Your Role in Maximizing Revenue in a FQHC Understanding Your Role in Maximizing Revenue in a FQHC Cynthia M Patterson President N Charleston SC 29420-1093 Firstchoice.practicesolutions@gmail.com P: (843) 597-8437 F: (888) 697-8923 Have systems

More information

Office Managers Association at Presbyterian Hospital of Plano

Office Managers Association at Presbyterian Hospital of Plano Office Managers Association at Presbyterian Hospital of Plano Update your charge slips annually Team approach Pain management example Grace period discontinued! New CPT, HCPCS and ICD-9 codes Changed definitions

More information

New York University School of Medicine Faculty Group Practice Billing and Collection Policies

New York University School of Medicine Faculty Group Practice Billing and Collection Policies New York University School of Medicine Faculty Group Practice Billing and Collection Policies General Policy Statement New York University School of Medicine Faculty Group Practice (NYUSM- FGP) oversees

More information

Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23, 2015

Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23, 2015 Revenue Cycle Best Practices to Increase Collections, Reduce A/R and Increase Patient Satisfaction Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23,

More information

CHAPTER 17 CREDIT AND COLLECTION

CHAPTER 17 CREDIT AND COLLECTION CHAPTER 17 CREDIT AND COLLECTION 17101. Credit and Collection Section 17102. Purpose 17103. Policy 17104. Procedures NOTE: Rule making authority cited for the formulation of regulations for the Credit

More information

Chapter 8 Billing on the CMS 1500 Claim Form

Chapter 8 Billing on the CMS 1500 Claim Form 8 Billing on the CMS 1500 Claim form INTRODUCTION The CMS 1500 claim form is used to bill for non-facility services, including professional services, freestanding surgery centers, transportation, durable

More information

HI-1018: The Electronic Health Record

HI-1018: The Electronic Health Record Course Introduction Course Introduction HI-1018: The Electronic Health Record 6m Chapter 01 - Introduction Introduction History Medical Record History Medical Records Purpose Paper Electronic EMR versus

More information

Selecting a Billing Service

Selecting a Billing Service Selecting a Billing Service Are you considering a transition from an in-house billing department to a billing service, or thinking of replacing your current billing service? This checklist will help you

More information

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013 Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process

More information

Palliative Care Billing, Coding and Reimbursement

Palliative Care Billing, Coding and Reimbursement Palliative Care Billing, Coding and Reimbursement Anne Monroe, MHA Physician Practice Manager Hospice of the Bluegrass and Palliative Care Center of the Bluegrass Kentucky 1 Objectives Review coding and

More information

SECTION 4. A. Balance Billing Policies. B. Claim Form

SECTION 4. A. Balance Billing Policies. B. Claim Form SECTION 4 Participating Physicians, hospitals and ancillary providers shall be entitled to payment for covered services that are provided to a DMC Care member. Payment is made at the established and prevailing

More information

Split/Shared Services Documentation & Billing

Split/Shared Services Documentation & Billing Split/Shared Services Documentation & Billing Jointly Presented by the Clinical Enterprise Compliance Department and the Department of Revenue Management June 6, 2012 DISCLAIMER Disclaimer This module

More information

Payment Policy. Evaluation and Management

Payment Policy. Evaluation and Management Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions

More information

The ROI of IT: Best Billing Practices

The ROI of IT: Best Billing Practices The ROI of IT: Best Billing Practices 1 R O S E M A R I E N E L S O N M G M A H E A L T H C A R E C O N S U L T I N G G R O U P The information and materials provided and referred to herein are not intended

More information

MEDICAL MUTUAL Self-Assessment Form

MEDICAL MUTUAL Self-Assessment Form MEDICAL MUTUAL Self-Assessment Form PURPOSE: The purpose of the self-assessment form is to highlight those areas within the non-clinical aspect of office practice including documentation of medical records,

More information

Be your Own Consultant Checklist for Practice Manager

Be your Own Consultant Checklist for Practice Manager Be your Own Consultant Checklist for Practice Manager Telephones Are your phones routinely answered in less than three rings? Does your phone tree route your callers to the appropriate person who can assist

More information

Preparing Your Revenue Cycle for ICD-10. Carrie Aiken, CHC Compliance and Consulting Manager

Preparing Your Revenue Cycle for ICD-10. Carrie Aiken, CHC Compliance and Consulting Manager Preparing Your Revenue Cycle for ICD-10 Carrie Aiken, CHC Compliance and Consulting Manager Today s Presenter Carrie Aiken SVA Healthcare Services, LLC 608.826.2451 aikenc@sva.com 1 Objectives Seeing Revenue

More information

To submit electronic claims, use the HIPAA 837 Institutional transaction

To submit electronic claims, use the HIPAA 837 Institutional transaction 3.1 Claim Billing 3.1.1 Which Claim Form to Use Claims that do not require attachments may be billed electronically using Provider Electronic Solutions (PES) software (provided by Electronic Data Systems

More information

Patient Account Services. Patient Reference & Frequently Asked Questions. Admissions

Patient Account Services. Patient Reference & Frequently Asked Questions. Admissions Patient Account Services Patient Reference & Frequently Asked Questions Admissions Each time you present for a new medical service, a new account number will be assigned. You will be asked to pay any patient

More information

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Matt Seefeld CEO & Co-Founder mseefeld@interpointpartners.com www.interpointpartners.com (404)446-0051

More information

Fundamentals for success billing Arkansas Medicaid. Copyright 2010 Hewlett-Packard Development Company, L.P.

Fundamentals for success billing Arkansas Medicaid. Copyright 2010 Hewlett-Packard Development Company, L.P. Fundamentals for success billing Arkansas Medicaid 1 Fundamentals for success Professional series Agenda - Working with PCPs - Verifying eligibility - Learning the aid categories - Billing methods and

More information

Selecting a Billing Service Questionnaire

Selecting a Billing Service Questionnaire How many years have you been in business? Years Have you been in business under any other name? If yes, what name? Business name Do you have a compliance plan in place? Do you have the necessary Health

More information

Early Intervention Central Billing Office. Provider Insurance Billing Procedures

Early Intervention Central Billing Office. Provider Insurance Billing Procedures Early Intervention Central Billing Office Provider Insurance Billing Procedures May 2013 Provider Insurance Billing Procedures Provider Registration Each provider choosing to opt out of billing for one,

More information

Risk Adjustment Data Validation Study Frequently Asked Questions

Risk Adjustment Data Validation Study Frequently Asked Questions Risk Adjustment Data Validation Study Frequently Asked Questions MEDICAL RECORD SUBMISSION Q1: Can medical groups gather all the medical records for the data validation and send them all at once? A1: Please

More information

Front Desk Best Practices

Front Desk Best Practices Front Desk Best Practices Lynne Y Gratton, CPPM PCC 2015 Users' Conference Front Desk Best Practices Overview Take Away Front Desk Best Practices Pre Visit Visit Date Front Desk Best Practices What is

More information

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle Rejection Prevention How Actionable Data Can Drive Results in Your Revenue Cycle Objectives Build a data collection strategy in denials and rejections that drives action and ultimately improved results

More information

01172014_MHP_ProTrain_Billing

01172014_MHP_ProTrain_Billing 01172014_MHP_ProTrain_Billing Welcome to Magnolia Health s Billing Clinic 101! We thank you for being part of or considering Magnolia s network of participating providers, hospitals, and other healthcare

More information

The Power of Revenue Management

The Power of Revenue Management The Power of Revenue Management Presented By Judy Capko Capko & Company www.capko.com The Power of Revenue Management 6/13/07 1 About the Speaker The Power of Revenue Management 6/13/07 2 The Speaker:

More information

Revenue Cycle. Management. The AdvancedMD Training & Companion Guide

Revenue Cycle. Management. The AdvancedMD Training & Companion Guide Revenue Cycle Management The AdvancedMD Training & Companion Guide How to Use the Tools and Reports within AdvancedMD to Support Industry Standard Best Practices in Revenue Cycle Management Table of Contents

More information

Effective Revenue Cycles Are No Accident

Effective Revenue Cycles Are No Accident Effective Revenue Cycles Are No Accident ICAHN Boot Camp October 10, 2014 Jerrie K. Weith, FHFMA, CMPE, CMOM Learning Objectives Characteristics of Best Performers Efficient Encounters = Revenue Cycle

More information

Helping Physicians Drive Better Practice Health

Helping Physicians Drive Better Practice Health McKesson Business Performance Services Revenue Cycle Management Services Helping Physicians Drive Better Practice Health McKesson Business Performance Services Our staff of 7,000+ includes 500+ certified

More information

Optimize Healthcare Facility Revenue in minimum time. Billing /Coding/ Patient Management

Optimize Healthcare Facility Revenue in minimum time. Billing /Coding/ Patient Management TALISMAN SOLUTIONS Optimize Healthcare Facility Revenue in minimum time Billing /Coding/ Patient Management We put together a team of healthcare, financial and management experts to identify ways to optimize

More information

2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010

2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010 2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010 Consultations The Centers for Medicare/Medicaid Services (CMS) finalized its proposal to require claims for consultation services

More information

Top Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com

Top Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com Robin Bradbury 800-355-0410 robin@ereso.com Top Ten Questions 1. What are the key measures for the Revenue Cycle? 2. How do you document and share this information with the Revenue Cycle staff? 3. What

More information

Compliance Department SURGERY AND SURGICAL MODIFIERS 11/2010

Compliance Department SURGERY AND SURGICAL MODIFIERS 11/2010 Compliance Department SURGERY AND SURGICAL MODIFIERS 11/2010 Surgical Care Presence Requirements In order to bill for surgical services, teaching physician must be present during all critical and key portions

More information

CLAIM FORM REQUIREMENTS

CLAIM FORM REQUIREMENTS CLAIM FORM REQUIREMENTS When billing for services, please pay attention to the following points: Submit claims on a current CMS 1500 or UB04 form. Please include the following information: 1. Patient s

More information

Medi-Cal Retroactive Claim Submissions

Medi-Cal Retroactive Claim Submissions Medi-Cal Retroactive Claim Submissions This training made possible by funding from the CMSP Governing Board Presented by Penni Wright, EDS/Medi-Cal, Provider Training Introduction Some CMSP members may

More information

Revenue Cycle Management Excellence Easily improving bottom line!!!!!

Revenue Cycle Management Excellence Easily improving bottom line!!!!! Revenue Cycle Management Excellence Easily improving bottom line!!!!! SN Academy Seminar 9 th May 2014 PRR 5/5/14 Revenue Cycle Management ; Are you doing it right? Are you earning what you deserve? Do

More information

Among the many challenges facing health care

Among the many challenges facing health care The Value of Visit Management at Your Organization BY ELIZABETH WEIDMAN, SENIOR ANALYST Catch Data Systems April 2014 Among the many challenges facing health care organizations today, few have the potential

More information

Granville Health System

Granville Health System Approved by: Granville Health System FINANCIAL POLICY Effective Date: Revised Date(s): FINANCIAL POLICY - DRAFT 09-16-2014 Granville Health System is a not-for profit hospital committed to providing quality

More information

INSURANCE BILLING & COLLECTIONS PROCEDURES

INSURANCE BILLING & COLLECTIONS PROCEDURES INSURANCE BILLING & COLLECTIONS PROCEDURES I. PURPOSE: To establish logical, consistent methods of billing and collections follow-up for Insurance balances to ensure that all staff members possess a good

More information

ICD-10-CM TRANSITION WORKBOOK

ICD-10-CM TRANSITION WORKBOOK ICD-10-CM TRANSITION WORKBOOK The Next Generation of Coding Preparation is the key to success when transitioning your practice from ICD-9 to ICD-10. The federally mandated compliance date is October 1,

More information

Delta Dental of Nebraska. Electronic Claims Submission

Delta Dental of Nebraska. Electronic Claims Submission Delta Dental of Nebraska Electronic Claims Submission Revised 04082009 Table of Contents Introduction... 3 Why Submit Electronically?... 4 Getting Started... 4 Technical Requirements... 5 Submitting Electronic

More information

Revenue Cycle Management: It Takes a Village. Problem Statement

Revenue Cycle Management: It Takes a Village. Problem Statement Revenue Cycle Management: It Takes a Village AHRA 38 th Annual Meeting August 24, 2010 Patricia R. Blank, Executive Vice President, InSight Imaging Nancy Walker, Executive Director, RCM, Insight Imaging

More information

Coding for Evaluation and Management Services

Coding for Evaluation and Management Services Coding for Evaluation and Management Services Joanne Mehmert, CPC Joanne Mehmert & Associates, LLC fmeh@aol.com 2006 CPT E&M Updates May 2006 2 1 E&M Deleted Codes Deleted codes 99261-99263 Follow-up consultation

More information

Tennessee Primary Care Association: 2014 Annual Leadership Conference

Tennessee Primary Care Association: 2014 Annual Leadership Conference CPAs & ADVISORS experience momentum // SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE FQHC REVENUE CYCLE Tennessee Primary Care Association: 2014 Annual Leadership Conference

More information

NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS

NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS CURRENT AS OF APRIL 1, 2010 I. INFORMATION SOURCES Where is information available for medical providers treating patients with injuries/conditions

More information

Revenue Cycle Management. A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN

Revenue Cycle Management. A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN Revenue Cycle Management A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN Discussion Overview The Revenue Cycle demystified: How do appointments turn

More information

Practice management system criteria checklist

Practice management system criteria checklist Practice management system criteria checklist The American Medical Association (AMA) and Medical Group Management Association (MGMA) have created the following checklist as a starting point for assessing

More information

OSCAR Health Insurance Frequently Asked Questions/General Information

OSCAR Health Insurance Frequently Asked Questions/General Information Q: What is the relationship between Oscar and ValueOptions? A. ValueOptions administers the mental health and substance abuse benefits for Oscar Health Insurance. They have contracted with ValueOptions,

More information

Documentation Guidelines for Physicians Interventional Pain Services

Documentation Guidelines for Physicians Interventional Pain Services Documentation Guidelines for Physicians Interventional Pain Services Pamela Gibson, CPC Assistant Director, VMG Coding Anesthesia and Surgical Divisions 343.8791 1 General Principles of Medical Record

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management ~Becoming a patient focused but metrics driven Revenue Cycle team~ Presented by: Kimberly Moore Director, Health Care Revenue Cycle Consulting 701.239.8673 kmoore@eidebailly.com

More information

eclinicalworks EMR Train the Trainer Client/Reseller Program

eclinicalworks EMR Train the Trainer Client/Reseller Program eclinicalworks EMR Train the Trainer Client/Reseller Program eclinicalworks LLC 112 Turnpike Road Westborough, MA 01581 eclinicalworks Train the Trainer Program Syllabus (EMR only) Current Revision Date

More information

Revenue Cycle Management Optimized

Revenue Cycle Management Optimized rreturnsttopbooth2014final.indd 1 6/13/2014 9:32:34 AM Revenue Cycle Management Optimized Powerful technology combined with expert knowledge and resources Innovative Revenue Cycle Management brought to

More information

Family Care Clinic Guidelines: Virtual Telephone Visits

Family Care Clinic Guidelines: Virtual Telephone Visits Family Care Clinic Guidelines: Virtual Telephone Visits Health System Family Health Center Guidelines December 2013 Family Care Clinic Guidelines: Virtual Telephone Visits Table of Contents Background...3

More information

Claims Filing Instructions

Claims Filing Instructions Claims Filing Instructions Table of Contents Procedures for Claim Submission... 3 Claims Filing Deadlines...4 Claim Requests for Reconsideration, Claim Disputes and Corrected Claims...5 Procedures for

More information

POST ACA REVENUE CYCLE TRANSFORMATION

POST ACA REVENUE CYCLE TRANSFORMATION POST ACA REVENUE CYCLE TRANSFORMATION Agenda Intro Revenue cycle features ACA impact areas What did we expect? UDS and PMG data analytics Top to-do items Summary WWW.GOPMG.COM ICD 10 Update* Encounters

More information

Medical Billing. You need to streamline your Medical Billing today! Copyright Pradot Technologies Private Limited. India. United States of America

Medical Billing. You need to streamline your Medical Billing today! Copyright Pradot Technologies Private Limited. India. United States of America Medical Billing Are you aware that a part of all medical practice income is lost on account of Under Pricing, Inaccurate Coding, Missed Charges or Unreimbursed Claims? Have you ever felt that the charges

More information

Updated as of 05/15/13-1 -

Updated as of 05/15/13-1 - Updated as of 05/15/13-1 - GENERAL OFFICE POLICIES Thank you for choosing the Quiroz Adult Medicine Clinic, PA (QAMC) as your health care provider. The following general office policies are provided to

More information

Management Report Services. Staff Training and Education Services

Management Report Services. Staff Training and Education Services Management Report Services Your management team will receive reports that are clear, well defined and serve as a tool for increased performance. These include a brief description emphasizing how the information

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management Manage and Improve Your Results with Origin RCM Financial pressures are escalating for both healthcare providers and patients. In this challenging climate, a wellmanaged revenue

More information

Eligibility Patient s coverage verified prior to visit Coding Medical Records are reviewed and coded by Certified Coders Demographic & Charge Entry

Eligibility Patient s coverage verified prior to visit Coding Medical Records are reviewed and coded by Certified Coders Demographic & Charge Entry Eligibility Patient s coverage is verified prior to visit Coding Medical Records are reviewed and coded by Certified Coders Clearing Clearing Houses Houses For For Electronic Electronic Clearance Clearance

More information

How to Conduct an Old Fashioned Practice Assessment

How to Conduct an Old Fashioned Practice Assessment How to Conduct an Old Fashioned Practice Assessment Why The Need For An Assessment No such thing as the perfect medical practice Need to improve the bottom line Need to improve physician compensation Need

More information

A CONSUMER'S GUIDE TO CANCER INSURANCE. from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE

A CONSUMER'S GUIDE TO CANCER INSURANCE. from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE A CONSUMER'S GUIDE TO from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE IMPORTANT INFORMATION WHAT IS? Cancer insurance provides benefits only if you are diagnosed with cancer, as defined

More information

Isn t this just about coding? Understanding the Impact of ICD 10 on Your Revenue Cycle. 2012 LHIMA Annual Convention 4/18/2012. Session Objectives

Isn t this just about coding? Understanding the Impact of ICD 10 on Your Revenue Cycle. 2012 LHIMA Annual Convention 4/18/2012. Session Objectives Understanding the Impact of ICD 10 on Your Revenue Cycle LHIMA ICD-10 SUMMIT June 18, 2013 Presented by Patty Harper, RHIA AHIMA Approved ICD 10 CM/PCS Trainer Certified EHR Implementation Manager Clinical

More information

Revenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps

Revenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps Common Findings Revealed: Revenue Cycle Review John Bartell, RN, BSN, Partner Tina Nazier, MBA, Director Wipfli LLP Topics for Discussion Revenue Cycle Objectives Challenges Management Goals and Expected

More information

Proprietary information of MedCost LLC. Do not distribute or reproduce without express permission of MedCost.

Proprietary information of MedCost LLC. Do not distribute or reproduce without express permission of MedCost. Provider Manual MedCost Network Updated October 1, 2015 Provider Manual - October 1, 2015 Page 2 Table of Contents Introduction Contracting How to Use This Manual About MedCost When and How to Contact

More information

Business Service and Process Outsourcing. Metropolitan Business Solutions

Business Service and Process Outsourcing. Metropolitan Business Solutions MBS Business Service and Process Outsourcing Who We Are! A provider of business service and process outsourcing committed to enhancing our clients profitability reducing the cost of business operations

More information

E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM

E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM Disclaimer This information is accurate as of December 1, 2014 and is designed

More information