PrimeRCM. Improve Your Financial Outcomes with Clinically Driven RCM
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1 PrimeRCM Improve Your Financial Outcomes with Clinically Driven RCM 1
2 Lisa Bridwell Lisa Bridwell PrimeRCM Sales Consultant Greenway Medical Technologies 2
3 PrimeRCM what is it? In a nutshell, Greenway s revenue cycle management (RCM) solution integrates billing intelligence throughout the patient care process to speed collections, optimize revenue, eliminate financial uncertainty and position your organization for the future. 3
4 Revenue Cycle Management Basics Significance A health care institution must adequately manage revenues to stay financially afloat. Without sound revenue cycle management procedures, a health care institution might experience financial distress and file for bankruptcy 4
5 5 Outsourcing vs PrimeRCM
6 Outsourcing Outsource Company does not follow the policies and procedures of the parent business Loss of Control on the part of the parent business Less flexibility Lack of a dedicated team 6
7 PrimeRCM co-sourcing model Dedicated Team Flexible Collaborative Utilizes the policies and procedures of the parent company 7
8 PrimeRCM Why? Patient-Focused 8
9 9 PrimeRCM Why?
10 PrimeRCM Why? Improved Business Health 10
11 11 PrimeRCM Why?
12 PrimeRCM Why? Reduced Cost 12
13 13
14 14 PrimeRCM Why?
15 What services do we deliver? Coding Charge Posting Payment Posting Insurance Accounts Receivable/ Denial Management Patient Accounts Receivable 15
16 How does it work? Charges from PrimeSuite Charges from Paper Tickets Rules Engine Charges from Electronic Interface 16
17 How does it work? Exceptions Review by CPC/Charges Team Rules Engine Clean Claims Sent to Clearinghouse for processing 17
18 How does it work? AR Follow up Denials Payment Posting 18
19 So how are we structured? Management Specialty Account Manager Dedicated Team Charge Specialist Headed by AAPC Certified Coder Payments Specialist Insurance AR Specialist Patient AR Specialist 19
20 Benchmarks Days in AR Less than 35 AR over 90 Less than 15% Net Collections 97%+ Charge Turn Around 48 hrs. 20 Payment Turn Around 48 hrs.
21 Case Studies St. Luke s Cornwall Medical Group Increases Cash Collections with Clinically Driven RCM and Integrated PrimeSUITE EHR 21
22 Case Studies Otolaryngology Physicians of Lancaster Improves Financials, Maintains Control with Greenway Revenue Cycle Service 22
23 It only makes sense PrimeRCM is the smart solution to manage the burden of billing, optimize revenue today, and best position your organization for the future. 23
24 Potomac Obstetrics & Gynecology: Delivering a new medical practice in Maryland in 2012 Our partnership with Greenway through PrimeRCM Presented by: Eric Ashkin, MD
25 Things we needed to consider Leaving one private practice and starting a new one EMR/Practice Management Systems are not transferable How to keep a top of the line EHR/Practice Management system in place without incurring prohibitive startup costs?
26 Partnering with RCM We were able to continue to work with a top of the line product we were familiar with and roll costs of implementation up into billing fees Needed to, at very least outsource billing Partnering with Greenway and being able to use the same GUI for EHR, Practice Management, and patient account management invaluable
27 Looking Forward Old Practice In-House Billing Days in AR 2 months Relationship with Billing Department - Limited No ability to report out progress on charges and accounts Salaried employees compensation not linked to job performance New Practice RCM Easy to see Payments for Big Ticket Items coming in in less than 9 business days RCM Working in our site virtually next to us all day long s for charge entry questions in real time in the system, HIPPA compliant Account manager on the phone in real time
28 Looking Forward Old Practice In-house Patient calls and query s had to be handled in-house by same people that were supposed to be posting charges and working claims Staff limited, if someone calls out, work is not done New Practice RCM Charge entry team Patient account specialist to work on the phone with customer questions Separate person for managing denials Account manager Cross trained personnel Accountability
29 Looking Forward Old Practice In-house Billing Old practice had 8 Providers supported by 35 full-time employees Billing Manager(s) Coders Charge Entry Payment Posters New Practice RCM New practice has 3 providers and 5 full-time and 1 part-time employee
30 How far we have come together 18 months into new practice and only 4% of AR is > 90 days Claims are being paid on average in 2 weeks, most are less Adding new service lines as we grow is collaborative and seamless Physician ownership over billing and coding is unanimously satisfying
31 How far we have come together On site support staff is focused on customer service and medical care Offsite our RCM partners are keeping the lights on and making sure we collect on our work and efforts!
32 Questions? Please type your questions in the panel to the right of your screen, and our team will answer your questions. All questions will be answered; if not on the air, you will receive an from our team with the answer. You will receive the webinar recording and slides postwebinar. View upcoming webinars and events on our web page: 32
33 PrimeRCM You ve earned it, now capture it! 33
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