Top Ten Questions. Time and Energy. Robin Bradbury

Size: px
Start display at page:

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

Transcription

1 Robin Bradbury 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 is our cost to collect a dollar? 4. Do we have expectations and performance standards for our Revenue Cycle staff and do we monitor performance and provide incentives for excellence? 5. How are we managing the patient-responsible dollar? 6. Has a Chargemaster and charge capture review and assessment been performed recently? 7. What are our days in Discharge to Final Bill? 8. Are we getting paid what we should be paid for services performed? 9. Do we have an unpaid claims tracking mechanism? 10. Do revenue cycle stakeholders regularly engage in clearing open items and process improvement meetings? Time and Energy 1

2 Revenue Cycle 101 When performance is measured, performance improves. Revenue Cycle 102 Objective measures are always better than subjective measures. Question # 1 What are the key measures for the Revenue Cycle? 2

3 Key Measures Days in Revenue Outstanding Cash Collections Cash as a % of Net Revenue Write-offs as a % of Revenue Aged AR Greater than 90 Days Days in Discharge to Final Bill Up-front Cash Collections Benchmark Data HARA report Geographic region Your facility Free Benchmark Study Sample Information: Facility Bed Size: 122 Average Daily Census: 38 Total Accounts Receivable: $8,000,000 Cash Receipts per Month $900,000 Gross Revenue per Month: $2,000,000 A/R Over 90 Days: $3,500,000 Monthly Cost of BO: $45,000 Write Offs per Month: $150,000 Number of Open Accounts: 19,000 Number of FTE's in BO: 12 Percent A/R in Self Pay: 40% 3

4 Value Proposition Actual Example Hospital Peer Group Difference Cash Opportunity AR Days Reduction $1,476,815 Days over 90 Reduction 31.7% 24.4% 7.3% $217,374 DNFB Reduction Cost to Collect Reduction $ $ $ Bad Debt Write off Reduction 8.9% 2.3% 6.6% Charity Write off Reduction 1.9% 6.9% -5.0% $652,439 $33,356 $855,290 NA Question #2 How do you document and share this information with the Revenue Cycle staff? 4

5 Primary Communication Methods KPI Dashboard daily, weekly, monthly Key metrics and actual to goal performance posted in Revenue Cycle areas Formal team meetings and huddles (daily, weekly, monthly) Process improvement teams updates on progress and wins Other? Does consistent communication with employees really matter? Meetings Frequency and Type Do Matter Source: HFMA Strategies for a High Performance Revenue Cycle; Patient Friendly Billing Project 2009 Question #3 What is our cost to collect a dollar? 5

6 Benchmarks Good comparative measure (common definition) Some times flies under the radar if other metrics are good Important consideration when evaluating investment in resources more cash intake may be worth it National average for hospitals is $.03 per dollar collected Smaller and Critical Access hospitals closer to $.05 to $.10 per dollar collected Question #4 Do we have expectations and performance standards for our Revenue Cycle staff and.. Question #4 (continued) do we monitor performance and provide incentives for excellence? 6

7 Expectations and Performance Standards Measure metrics and behaviors Front end, middle and back office resources Raise performance level awareness Align goals Creates healthy competition Cream will rise to the top Expectations and Performance Standards Set by function/position and then globally Measure outcomes and behaviors Raise performance level awareness Create healthy competition Incentive plans Align goals Cream will rise to the top Wildly Important Goal 1 Teams need to be engaged in pursuit of the goal Teams should be involved in goal setting based on higher level plan developed Where do you want to go and what do you want to be and how do you want to perform and be recognized in the industry? 1 Drawn from text The 4 Disciplines of Execution by McChesney, Covey and Huling 7

8 Lead Measures Lead & Lag Measures 1 Those measures that are impacted and measured on a daily basis that impact the Lag Measures Quantity of calls made, quantity of accounts or credits resolved, promises to pay, etc Lag Measures Measures that occur after the fact Gross Days, Cash, Net Days, % of AR > 90 days, etc 1 Drawn from text The 4 Disciplines of Execution by McChesney, Covey and Huling Employee Engagement Q12 Questions from Gallup 1 In the last year, I have had opportunities at work to Learn and Grow. In the last six months, someone at work has talked to me about Progress. I have a Best Friend at work. My associates or fellow employees are Committed to Doing Quality Work. The Mission or Purpose of my company makes me feel my job is important. At work, my Opinions Seem to Count. There is someone at work who encourages my Development. My supervisor, or someone at work, seems to Care About Me as a person. In the last seven days, I have received Recognition or praise for doing good work. At work, I have the Opportunity to Do What I Do Best every day. I have the Materials and Equipment I need to do my work right. I Know What s Expected of me at work. 1 Drawn from Gallup Q12 https://q12.gallup.com/public/en-us/features?ref=homepage#section12q Changing the Paradigm 20 th vs 21 st century Impact of technology tools on performance expectations and standards and outcomes. Example follow-up Many operations across the country still deploy dated AR management techniques Pulling ATBs from PA systems and converting.txt files to Excel or using PA based account ticklers Then there is the painful process of filtering and sorting based on the strategy of the week How many labor hours are involved and how much overlap is there? Are your staff members focusing on the accounts that matter most? Are they able to stratify the accounts based on disposition? These same ATBs are then worked for multiple weeks with no targeted approach other than to filter based on the data elements available Bill date D/C date Account Balance Financial Class 8

9 Changing the Paradigm 20 th vs 21 st century What if each employee could have a defined workflow engine that was customized to their AR that segmented their accounts based on: Defined rules Real time claim status Focus on claims that require intervention, not those set to pay If you could reduce the number of accounts your staff had to touch by 65%-75% or more each week, would your staff be more effective? Would expectations and work standards change? Would you need the same quality/quantity of employees? Would you obtain different results? Question #5 How are we managing the patient-responsible dollar? The Process.. Registration Patient Data Charges Payer Contract Billing Claim Payment Cash Adjustments Self-Pay Collection Other Payers Cash Bad Debt 9

10 Common Profile of At Risk Hospital Self-pay A/R accounting for 40% or more of total A/R Ineffective or non-existent pre-registration, insurance verification, eligibility checking, and financial counseling No point of service collection efforts No management of early-out and primary bad debt vendor partners Inconsistent application of bad debt write off and charity policies No or very few tools used to maximize the self-pay portfolio Institute for Health Care Revenue Cycle Research - A Division of Zimmerman, LLC. National Pledge to Reform Uncompensated Care Reform Underway: Adopting Best Practices to Reduce Uncompensated Care and Improve the Patient Experience. a special supplement to PATIENT PAYMENT BLUEPRINT 10

11 When Respondents Who Had Received Recent Medical Care Learned the Cost of their Treatment 63% don t know the treatment costs until the medical bill arrives; 10% never know the cost. When did you learn what the total cost of the treatment would be, including the amount that the insurance company would pay? Source: Great-West Healthcare 2005 Consumer attitude toward healthcare survey Emergency Room 1/3 of ER patients have no insurance 29% national average collect in ER Discharge collection process Need centralized exit point Joint effort (nursing and registration) Give yourself a chance to collect Potential Affordable Care Act Impacts on Self-Pay, Bad Debt, and Charity Uninsured but eligible patients CMS certified application counselor organizations; employee training In-network vs. out of network coverage ACA regulations cap OOP expense for in-network but not for out of network Benefit/eligibility verification nuances may need more diligence to identify plan details and to ensure that hospital and physicians are in the network for the patient s plan Patient responsibility assume patients won t know their deductible and copayment requirements Unpaid premiums delinquency impact consumers vs. providers; consider starting a reserve fund Charity care analyze early experience and adjust policies accordingly 11

12 Best Practices? Estimate, Validate, and Advocate Estimate charges, insurance coverage and patient portion (Eligibility and Benefit Verification) Validate demographic, financial, and insurance information (Demographic Data Validation) Advocate for the patient to deal with the obligation (Propensity to Pay) -Cash, Check or Credit Card -Payment plan -Medicaid Eligibility (Payer Search) -Charity Care (Presumptive Charity) -Reschedule? Technology solutions available to support these functions Self Pay Strategy Platform Deliverables Patient Demographic Data and Diagnosis Financial Data Financial Assessment Algorithm Client Specific Payment History Estimated Charges Eligibility Verification Estimated Income Charity Recommendation Maximum Payment Recommendation Payment Propensity Work-Flow Management 12

13 Results Measurable Results from Presumptive Charity Policy and Self Pay Stratification Reduced placements of self pay accounts to collection agencies by nearly 50% within first six months Increased cash receipts on self pay accounts by over 22% during first 90 days Reduced FTE allocation for follow up on self pay accounts by 25% Reallocated 60% of FTE staff previously assigned to charity application processing Where Are Your Peers Spending Money and Time? Source: HFMA Strategies for a High Performance Revenue Cycle; Patient Friendly Billing Project 2009 Question #6 Has a Chargemaster and charge capture review and assessment been performed recently? 13

14 Inpatient Treatment Outpatient Treatment EKG EKG DRG Coding APC Coding EKG DRG Payment APC Charge Capture Review Outpatient revenues are significant particularly in rural/community hospitals CMS indicates a 50% underpayment Better performers have these common aspects: Dedicated ownership of process (75%) Supported by technology (47%) Independent reviews (46%) Marshalltown example Effective Charge Capture Review Program Quarterly review of outpatient payments compared to charts Utilize a Nurse Auditor Change processes to capture all charges Retroactively re-bill when appropriate Improve reimbursement 14

15 Question #7 What are our days in Discharge to Final Bill? Days from Discharge to Final Bill Indicator of effective front end, charge capture and coding process Clients have wide range from 3 25 days Break into parts Sample accounts Determine where the bottlenecks are Doctors sign-off Coding Daily billing Potential Solutions Outsource some of the Coding Use Super Coders on an as needed basis train staff Set goals and expectations Monitor top ten DNFB accounts 15

16 Question #8 Are we getting paid what we should be paid for services performed? Reimbursement % by Payer EOB review sampling Compare to net revenue calculation Use of software to monitor payment Outside review on contingency fee Payer report cards and payer meetings Most hospitals are leaving 2% to 5% on the table of non-government reimbursement if not using a contract management service Best Practice Payer Collaboration Source: HFMA Strategies for a High Performance Revenue Cycle; Patient Friendly Billing Project

17 Question #9 Do we have an unpaid claims tracking mechanism? Unpaid Claims Tracking Monitoring Trends Improve the front end processes Unpaid claims versus denial tracking Should take a systemic view - unbilled and denials Unpaid Claims Measurement Tool 17

18 Question #10 Do revenue cycle stakeholders regularly engage in clearing open items and process improvement meetings? Regular Clearing Meetings Collaboration between multiple functions, backgrounds, and skill sets Focus on large dollars use a top ten concept Recurring errors Open communication and no finger pointing May require senior management involvement Next Steps Discuss these questions with Revenue Cycle leader or key stakeholders Perform Benchmark Indicator Analysis (BIA) As a Revenue Cycle team, review the results Set realistic goals and expectations and achieve them 18

19 Same Services More Dollars Learn from the mistakes of others you can't make them all yourself. E. Roosevelt About re solution Founded in consultants Safety net concept There when you need us. Gone when you don t. Reducing cost to collect through proprietary technology Customized software and services leading to process improvement We increase cash by implementing best practices along with technology when appropriate 57 19

20 About re solution Services include: -Insourcing -Cash Acceleration -Revenue Cycle Assessments -Training and Mentoring -Interim Management and Staffing Focus on rural and community hospitals Questions? 20

21 Robin Bradbury

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

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

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

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

Making Revenue Cycle Outsourcing an Organization Wide Responsibility

Making Revenue Cycle Outsourcing an Organization Wide Responsibility Making Revenue Cycle Outsourcing an Organization Wide Responsibility Michael S. Browning Chief Financial Officer Madison County Hospital Jeffrey Ellerbrock Consultant (formerly with The Outsource Group)

More information

5 KPIs That Require Revenue Cycle Managers' Attention. Devendra Saharia FEATURE STORY. healthcare financial management association www.hfma.

5 KPIs That Require Revenue Cycle Managers' Attention. Devendra Saharia FEATURE STORY. healthcare financial management association www.hfma. SEPTEMBER 2014 healthcare financial management association www.hfma.org FEATURE STORY 5 KPIs That Require Revenue Cycle Managers' Attention Devendra Saharia Devendra Saharia REPRINT September 2014 healthcare

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Our Journey to the MAP Award. Thursday, March 19, 2015

Our Journey to the MAP Award. Thursday, March 19, 2015 Our Journey to the MAP Award Thursday, March 19, 2015 Mission As a Catholic Healthcare Ministry, we provide comprehensive and compassionate care that improves the health of the people we serve. Snapshot

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Improving Your Bottom Line through Bad Debt Management. October 2011 Deloitte Consulting LLP

Improving Your Bottom Line through Bad Debt Management. October 2011 Deloitte Consulting LLP Improving Your Bottom Line through October 2011 Deloitte Consulting LLP Meet the presenters Karen Matjucha, Principal, Deloitte Consulting LLP Northeast Lead for the Health Care Provider Practice, and

More information

Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings

Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Huron Healthcare s Performance

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Understanding Revenue Cycle Strategy How to Optimize Process and Performance

Understanding Revenue Cycle Strategy How to Optimize Process and Performance Understanding Revenue Cycle Strategy How to Optimize Process and Performance White Paper 1.800.4BEACON BeaconPartners.com BOSTON CLEVELAND SAN FRANCISCO TORONTO The revenue cycle can no longer be seen

More information

The Importance of Patient Access to Revenue Cycle Success

The Importance of Patient Access to Revenue Cycle Success MOBILE ONE DAY OCTOBER 28, 2014 USA CHILDREN S & WOMEN S HOSPITAL The Importance of Patient Access to Revenue Cycle Success Presented by: Paul Shorrosh, MSW, MBA, CHAM Founder & CEO Session Agenda Challenges

More information

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

Beyond the Basics: Accelerating the Revenue Cycle Through Advanced KPI s

Beyond the Basics: Accelerating the Revenue Cycle Through Advanced KPI s Optimizing the business of healthcare Beyond the Basics: Table of Contents Overview 1 The Importance of Metrics 1 Taking the Next Step 1 Baseline KPI s 2 Why Advanced KPI s 2 Advanced KPI s In Action 3

More information

How a Pre-Service Center at MetroHealth System Improved Satisfaction, Efficiency, and Revenue

How a Pre-Service Center at MetroHealth System Improved Satisfaction, Efficiency, and Revenue How a Pre-Service Center at MetroHealth System Improved Satisfaction, Efficiency, and Revenue Craig Richmond The MetroHealth System Associate Chief Financial Officer & Vice President, Revenue Cycle Introduction

More information

Utilizing Credit Scoring to Predict Patient Outcomes. An Equifax Predictive Sciences Research Paper September 2005

Utilizing Credit Scoring to Predict Patient Outcomes. An Equifax Predictive Sciences Research Paper September 2005 Utilizing Credit Scoring to Predict Patient Outcomes An Equifax Predictive Sciences Research Paper September 2005 Introduction Improving Your Revenue Cycle Performance Through Financial Management Solutions

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

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

Revenue Cycle Management

Revenue Cycle Management UNITED COLLECTION BUREAU, INC. 5620 Southwyck Blvd. Toledo, OH 43614 866.209.0622 ucbinc.com The Business Case for Outsourcing Revenue Cycle Management Getting reimbursed for services rendered is more

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

Using Six Sigma Concepts to Improve Revenue Cycle

Using Six Sigma Concepts to Improve Revenue Cycle Using Six Sigma Concepts to Improve Revenue Cycle Presented by Joseph Koons, MHSA, FHFMA, CRCE-I Managing Director, Revenue Cycle Centra Health Lynchburg Virginia March 4, 2014 Agenda Introduction to

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

Rural Hospital Performance Improvement (RHPI) Project

Rural Hospital Performance Improvement (RHPI) Project Rural Hospital Performance Improvement (RHPI) Project Best Practice Concepts in Revenue Cycle Management August 8, 2014 600 East Superior Street, Suite 404 Duluth, Minnesota 55802 Phone: 218-727-9390 info@ruralcenter.org

More information

Conifer Health Solutions Tenet Investor Webinar

Conifer Health Solutions Tenet Investor Webinar Conifer Health Solutions Tenet Investor Webinar May 16, 2012 Stephen Mooney President, Conifer Health Solutions 1 2012 Conifer Health Solutions, LLC. All Rights Reserved. Forward Looking Statements Certain

More information

Back 2 Basics: Revenue Cycle: KPI, Risk Factors, and Compliance

Back 2 Basics: Revenue Cycle: KPI, Risk Factors, and Compliance Back 2 Basics: Revenue Cycle: KPI, Risk Factors, and Compliance March 25, 2010 Claudia Birkenshaw Garabelli, MSA President Modern Management Muse, Inc -- the ART of HealthCare Finance 1 Our Time Together

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

Top Performing PFS Sustaining Revenue Cycle Excellence. Greg West COO, Healthcare Resource Group

Top Performing PFS Sustaining Revenue Cycle Excellence. Greg West COO, Healthcare Resource Group Top Performing PFS Sustaining Revenue Cycle Excellence Greg West COO, Healthcare Resource Group Competition target Why so few super bowl repeats Free agents turnover Rule changes laws and regs and industry

More information

Making the right choice: Evaluating outsourced revenue cycle services vendors

Making the right choice: Evaluating outsourced revenue cycle services vendors Making the right choice: Evaluating outsourced revenue cycle services vendors Page 1 Managing resources at today s hospitals and health systems is an ongoing challenge, considering the numerous clinical

More information

Key Performance Indicators for Physician Practices. Sam Eddy Director, Physician Practice Consulting, QHR

Key Performance Indicators for Physician Practices. Sam Eddy Director, Physician Practice Consulting, QHR Key Performance Indicators for Physician Practices Sam Eddy Director, Physician Practice Consulting, QHR You can ask a question by clicking the blue? icon or through the orange speech bubble icon. 2 Evaluate

More information

EMDEON PATIENT ACCESS SOLUTIONS AND SERVICES

EMDEON PATIENT ACCESS SOLUTIONS AND SERVICES EMDEON PATIENT ACCESS SOLUTIONS AND SERVICES Healthcare is complex. Getting paid shouldn t be. While we offer many solutions and services, they are all are designed to do just two things. Collect patient

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

Cycle Dashboard. G2N, Inc. Honest & Healthy Bottom Lines

Cycle Dashboard. G2N, Inc. Honest & Healthy Bottom Lines Managing Operations By A Revenue Cycle Dashboard Mission of G2N We work to ensure America s healthcare providers have honest & healthy bottom lines in order to continue to fulfill their mission of improving

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management The Keys to Revenue Cycle Success: Aligning People, Process and Technology Presented by: Marie Murphy Revenue Cycle Manager 701.476.8321 mcmurphy@eidebailly.com Agenda Introductions

More information

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle.

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. This Revenue Cycle Overview training will establish a

More information

NEVADA RURAL HOSPITAL BENCHMARKING INITIATIVE AND NEVADA RURAL HOSPITAL REVENUE CYCLE INITIATIVE

NEVADA RURAL HOSPITAL BENCHMARKING INITIATIVE AND NEVADA RURAL HOSPITAL REVENUE CYCLE INITIATIVE NEVADA RURAL HOSPITAL BENCHMARKING INITIATIVE AND NEVADA RURAL HOSPITAL REVENUE CYCLE INITIATIVE Nevada Rural Hospital Benchmarking Two core, cross cutting initiatives undertaken by Nevada Flex Program

More information

1.1 Applicable Entities: This policy applies to Texas Health Rockwall. 1.2 Applicable Departments: This policy applies to all departments.

1.1 Applicable Entities: This policy applies to Texas Health Rockwall. 1.2 Applicable Departments: This policy applies to all departments. Policy Name: Charity Care Program Owner : President, VP Revenue Cycle Effective Date: 6/19/13 Approved By: Texas Health Rockwall Board of Trustees Last Reviewed Date: 10/16/2013 ; 2/4/14 Page 1 of 11 1.0

More information

University of Mississippi Medical Center. Access Management. Patient Access Specialists II

University of Mississippi Medical Center. Access Management. Patient Access Specialists II Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue

More information

Certified Healthcare Financial Professional

Certified Healthcare Financial Professional Certified Healthcare Financial Professional Certification Basics Friday, February 25, 2016 Courtney Stevenson, MSA WA/AK HFMA Certification Committee Co-Chair Agenda Module I The Business of Healthcare

More information

Successfully Implementing a Revenue Cycle Self-Pay Solution by Marty Callahan

Successfully Implementing a Revenue Cycle Self-Pay Solution by Marty Callahan This article appeared in the September 2008, issue of hfm, published by the Healthcare Financial Management Association. Successfully Implementing a Revenue Cycle Self-Pay Solution by Marty Callahan At

More information

EFFICIENCY UP. COSTS DOWN. The Benefits of an Automated Healthcare Revenue Cycle

EFFICIENCY UP. COSTS DOWN. The Benefits of an Automated Healthcare Revenue Cycle EFFICIENCY UP. COSTS DOWN. The Benefits of an Automated Healthcare Revenue Cycle 1 Executive Summary Do more with less. It s a tall order for healthcare providers facing elevated quality expectations,

More information

The Future of Healthcare Collections

The Future of Healthcare Collections Collector Published by ACA International www.acainternational.org February 2015 The Future of Healthcare Collections Healthcare providers and collection agencies will need to focus on people, processes

More information

BILLING MANAGER INDICATORS: HOW DOES YOUR ORGANIZATION STACK UP?

BILLING MANAGER INDICATORS: HOW DOES YOUR ORGANIZATION STACK UP? CPAs & ADVISORS experience direction // BILLING MANAGER INDICATORS: HOW DOES YOUR ORGANIZATION STACK UP? OHIO ASSOCIATION OF COMMUNITY HEALTH CENTERS ~ 2014 ANNUAL CONFERENCE Wednesday, March 12, 2014

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

The Changing Landscape of Healthcare and What it means to you!

The Changing Landscape of Healthcare and What it means to you! The Changing Landscape of Healthcare and What it means to you! Marc Leighton Imagination at work. How do hospitals/providers get paid? Introduction to Payment Mechanisms DRG- or APDRG-based mechanisms

More information

Washington HFMA. October 15, 2013. Teresa Spalding VP - One Revenue Cycle Providence and Swedish Health Systems

Washington HFMA. October 15, 2013. Teresa Spalding VP - One Revenue Cycle Providence and Swedish Health Systems Washington HFMA October 15, 2013 Teresa Spalding VP - One Revenue Cycle Providence and Swedish Health Systems Providence Health & Services Swedish Health System Mission As People of Providence we reveal

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

The Power of Metrics Part Two. By Rob Borchert, CPAM Altarum Institute: Revenue Cycle Management Practice

The Power of Metrics Part Two. By Rob Borchert, CPAM Altarum Institute: Revenue Cycle Management Practice The Power of Metrics Part Two By Rob Borchert, CPAM July 2009 The Power of Metrics Part Two By Rob Borchert, CPAM Altarum Institute: Revenue Cycle Management Practice July 2009 THE POWER OF METRICS PART

More information

Revenue Cycle Academy. E-Learning

Revenue Cycle Academy. E-Learning Revenue Cycle Academy E-Learning CONTENTS Revenue Cycle Fundamentals 3 Courseware Index 4 Certifications Patient Access... 6 Documentation & Charge Capture... 7 Billing & Collections... 8 Strategic Revenue

More information

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I Your Revenue Cycle It s not just billing anymore Presented by: Candy Edie, MBA, CRCE-I POSITIONS Staff Accountant Chief Financial Officer Financial Systems Analyst Patient Access Director Patient Financial

More information

SUBJECT: CHARITY AND UNCOMPENSATED CARE 1 of 13 DEPARTMENT: BUSINESS OFFICE REVISED: 10/2012

SUBJECT: CHARITY AND UNCOMPENSATED CARE 1 of 13 DEPARTMENT: BUSINESS OFFICE REVISED: 10/2012 REFERENCE # SUBJECT: CHARITY AND UNCOMPENSATED CARE 1 of 13 DEPARTMENT: BUSINESS OFFICE REVISED: 10/2012 CHARITY AND UNCOMPENSATED CARE Purpose To provide definition of health care assistance to eligible

More information

Current Trends in Revenue Cycle Performance Benchmarks, Outsourcing and Reform

Current Trends in Revenue Cycle Performance Benchmarks, Outsourcing and Reform Current Trends in Revenue Cycle Performance Benchmarks, Outsourcing and Reform 1 Discussion Outline Discussion Objectives and Approach Process Definition Leading Practice Comparison Trends in Outsourcing

More information

Avoid Vendor Fatigue in the Revenue Cycle:

Avoid Vendor Fatigue in the Revenue Cycle: - Avoid Vendor Fatigue in the Revenue Cycle: Thrive and Survive in the Evolving Healthcare World LITMOS HEALTHCARE DIVISION It s challenging to stay up-to-date with rules and regulations, technology, staffing,

More information

The New Gold Standard in PASC s and Regional Service Centers RSC s: Best Practices for Centralizing Operations that Improves Revenue Cycle

The New Gold Standard in PASC s and Regional Service Centers RSC s: Best Practices for Centralizing Operations that Improves Revenue Cycle The New Gold Standard in PASC s and Regional Service Centers RSC s: Best Practices for Centralizing Operations that Improves Revenue Cycle Today s Learning Lab Panel Mary Anne Pace Vice President, Consulting

More information

The Road to Performance. Evaluating Metrics and Benchmark Trends in the Revenue Cycle June 2012

The Road to Performance. Evaluating Metrics and Benchmark Trends in the Revenue Cycle June 2012 The Road to Performance Evaluating Metrics and Benchmark Trends in the Revenue Cycle June 2012 1. philosophy 2. resources 3. framework 2 Confidential Services 3 Confidential Services 4 Confidential Services

More information

Revenue Cycle Assessment

Revenue Cycle Assessment Revenue Cycle Assessment Your Challenge Maintaining the status quo can be costly. As health care operating margins shrink, hospitals need to find efficient and innovative ways to capture and collect revenues.

More information

Revenue Cycle InsIGHTS PRE-REGISTRATION: WORKING THE HEALTH CARE REVENUE CYCLE AT THE EARLIEST PATIENT ENCOUNTER

Revenue Cycle InsIGHTS PRE-REGISTRATION: WORKING THE HEALTH CARE REVENUE CYCLE AT THE EARLIEST PATIENT ENCOUNTER Revenue Cycle InsIGHTS Patient Access PRE-REGISTRATION: WORKING THE HEALTH CARE REVENUE CYCLE AT THE EARLIEST PATIENT ENCOUNTER Executive Summary According to publications from the Healthcare Financial

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

A Measure of Success Using KPIs to Accelerate Revenue Cycle Performance

A Measure of Success Using KPIs to Accelerate Revenue Cycle Performance A Measure of Success Using KPIs to Accelerate Revenue Cycle Performance Sandy Richman, Director of Advisory Services Daniel Bergantz, Director of Advisory Services PNC Healthcare March 23, 2015 Today s

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

KERN MEDICAL CENTER. Department: Collections. Policy No. COL-IM-407

KERN MEDICAL CENTER. Department: Collections. Policy No. COL-IM-407 KERN MEDICAL CENTER Standard Structure Department: Collections Policy No. Effective Date: Review Date: Page COL-IM-407 March 2013 March 2016 1 of 18 Title of Procedure: Financial Screening Process I. PURPOSE:

More information

Better Analysis of Revenue Cycle and Value-Based Purchasing Data Improves Bottom Line

Better Analysis of Revenue Cycle and Value-Based Purchasing Data Improves Bottom Line Better Analysis of Revenue Cycle and Value-Based Purchasing Data Improves Bottom Line Written by Katy Smith Senior Business Analyst Health Care DataWorks Better Analysis of Revenue Cycle and Value-Based

More information

MANAGING THE REVENUE CYCLE WITH BUSINESS INTELLIGENCE: June 30, 2006 BUSINESS INTELLIGENCE FOR HEALTHCARE

MANAGING THE REVENUE CYCLE WITH BUSINESS INTELLIGENCE: June 30, 2006 BUSINESS INTELLIGENCE FOR HEALTHCARE MANAGING THE REVENUE CYCLE WITH BUSINESS INTELLIGENCE: June 30, 2006 BUSINESS INTELLIGENCE FOR HEALTHCARE Hospital manager and leadership positions face many challenges in today s healthcare environment

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

Patient Finance Services Policy

Patient Finance Services Policy Patient Finance Services Policy CONEMAUGH HEALTH SYSTEM FINANCIAL ASSISTANCE POLICY I. PURPOSE Conemaugh Health System is a community of persons committed to being a transforming, healing presence in the

More information

The Power of Business Intelligence in the Revenue Cycle

The Power of Business Intelligence in the Revenue Cycle The Power of Business Intelligence in the Revenue Cycle Increasing Cash Flow with Actionable Information John Garcia August 4, 2011 Table of Contents Revenue Cycle Challenges... 3 The Goal of Business

More information

Empowering healthcare organizations with data, analytics and insight

Empowering healthcare organizations with data, analytics and insight Empowering healthcare organizations with data, analytics and insight Integrated patient access, claims and contract management and collections products and consultative services for redefining your healthcare

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

Retrospective Denials Management

Retrospective Denials Management Retrospective Denials Management Weaving together the Clinical, Technical, and Legal Components Glen Reiner, RN, BSN, VP of Clinical Operations Nicole Guido, VP Business Development Our goals for our time

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

Managing and Enhancing Hospital Revenue Cycles 1

Managing and Enhancing Hospital Revenue Cycles 1 Managing and Enhancing Hospital Revenue Cycles Introduction Though providing high-quality care with improved health outcomes remains the primary concern of hospitals of all sizes, geography, and demographics,

More information

Presentation Agenda. Keith Lilek @ a Glance. Go Beyond Collections Starting Now! Keith Lilek, President 1-800-874-2848 klilek@arallegiance.

Presentation Agenda. Keith Lilek @ a Glance. Go Beyond Collections Starting Now! Keith Lilek, President 1-800-874-2848 klilek@arallegiance. Go Beyond Collections Starting Now! Keith Lilek, President 1-800-874-2848 klilek@arallegiance.com 1 Presentation Agenda A Brief Background (About Us ) The A/R Management Landscape (About You ) The Reality

More information

treating technology as a luxury?

treating technology as a luxury? FEBRUARY 2007 healthcare financial management Steven H. Berger treating technology as a luxury? 10 necessary tools If you ve been thinking that technology for improving healthcare financial management

More information

REVENUE CYCLE IMPROVEMENT

REVENUE CYCLE IMPROVEMENT EVIDENCE-BASED REVENUE CYCLE IMPROVEMENT Suzanne Lestina Director, Revenue Cycle MAP Healthcare Financial Management Association REVENUE CYCLE IMPROVEMENT. It is a violation of federal copyright law to

More information

Speaker Bio. About Robin Bradbury Founder and President re solution

Speaker Bio. About Robin Bradbury Founder and President re solution Speaker Bio About Founder and President is the founder and President of (www.ereso.com), a revenue cycle optimization organization providing solutions for the business challenges faced by health care providers.

More information

Preventative Care for Hospitals Mitigating Risk of Revenue Loss from ACA

Preventative Care for Hospitals Mitigating Risk of Revenue Loss from ACA Preventative Care for Hospitals Mitigating Risk of Revenue Loss from ACA By Susan McBride and Randy Notes, KPMG LLP (U.S.) The Affordable Care Act (ACA) presents significant revenue risks to providers

More information

What the New Health Economy Means for your Revenue Cycle

What the New Health Economy Means for your Revenue Cycle www.pwc.com/healthcare What the New Health Economy Means for your Revenue Cycle South Carolina HFMA Annual Institute Our Agenda for Today I. Today s Revenue Cycle The Case for Change II. Healthcare Reform

More information

Portfolio Reviews: Unleashing the Power of External Data Sets and Predictive Analytics TRANSUNION WHITE PAPER TRANSUNION HEALTHCARE WHITE PAPER

Portfolio Reviews: Unleashing the Power of External Data Sets and Predictive Analytics TRANSUNION WHITE PAPER TRANSUNION HEALTHCARE WHITE PAPER TRANSUNION WHITE PAPER TRANSUNION HEALTHCARE WHITE PAPER Portfolio Reviews: Data-Driven Monitor for Risk, Healthcare Catalyst Decisioning: for Action By Ezra D. Becker, Director, Consulting and Strategy,

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

Accelerating your Revenue Cycle: From Patient Encounter Through Account

Accelerating your Revenue Cycle: From Patient Encounter Through Account Accelerating your Revenue Cycle: From Patient Encounter Through Account Resolution Anders Health Care Webinar Series July 17th, 2013 Jerrie K. Weith, FHFMA, CMPE Chastity D. Werner, RHIT, CMPE, NCP Learning

More information

Financial Assistance Program AKA Charity Care/Uncompensated Care Program

Financial Assistance Program AKA Charity Care/Uncompensated Care Program Policy POLICY NO. 100. 85300.600 EFFECTIVE 12/90 REVISED 03/2014 Page 1 of 12 SUBJECT: APPLICATION: PURPOSE: POLICY: Financial Assistance Program AKA Charity Care/Uncompensated Care Program All Departments

More information

Response to Serving the Medi Cal SPD Population in Alameda County

Response to Serving the Medi Cal SPD Population in Alameda County Expanding Health Coverage and Increasing Access to High Quality Care Response to Serving the Medi Cal SPD Population in Alameda County As the State has acknowledged in the 1115 waiver concept paper, the

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

The Joint Commission Page 1 of 6

The Joint Commission Page 1 of 6 The Joint Commission Page 1 of 6 PURPOSE The Regional Medical Center recognizes that as part of its mission, there will be instances where care is provided to individuals that do not have healthcare insurance,

More information

Self-Pay in an ACA World: Optimizing Resources with Soarian Tools, Workflows and Partners

Self-Pay in an ACA World: Optimizing Resources with Soarian Tools, Workflows and Partners Self-Pay in an ACA World: Optimizing Resources with Soarian Tools, Workflows and Partners Kathy Peterson, FHFMA Director of Patient Financial Services October 11, 2015 Our focus today Marketplace changes

More information

Hospital Denials Management In-source, Outsource or Both?

Hospital Denials Management In-source, Outsource or Both? Page 1 Hospital Denials Management In-source, Outsource or Both? by Holly Pelaia Summary A strong revenue stream case is made for intelligent outsourcing of hospital denials up to 20% more effective in

More information

Provider Solutions. Sutherland Healthcare Solutions

Provider Solutions. Sutherland Healthcare Solutions Provider Solutions Sutherland Healthcare Solutions What is your TRUE RETURN? 2 The financial strength you need to offer great patient experience today and tomorrow. Our healthcare experts are ready to

More information

Provider Solutions. Sutherland Healthcare Solutions

Provider Solutions. Sutherland Healthcare Solutions Provider Solutions Sutherland Healthcare Solutions What is your TRUE RETURN? The financial strength you need to offer great patient experience today and tomorrow. Our healthcare experts are ready to partner

More information

Revenue Cycle Management Rod Garrison

Revenue Cycle Management Rod Garrison Revenue Cycle Management Rod Garrison MGMA Certified Representative Agenda Challenges medical practices are facing How to communicate with your patients Effectively collecting patient payments Eliminating

More information

CAH Revenue Cycle Assessment Project 2012

CAH Revenue Cycle Assessment Project 2012 CAH Revenue Cycle Assessment Project 2012 Our Mission: To protect and improve the health and environment of all Kansans. The first step in improving a process is measuring current performance. How did

More information

US Hospital Information Systems Overview and Outlook, 2013 2020 Managing Information in an Era of Reform

US Hospital Information Systems Overview and Outlook, 2013 2020 Managing Information in an Era of Reform US Hospital Information Systems Overview and Outlook, 2013 2020 Managing Information in an Era of Reform December 2014 Contents Section Slide Number Executive Summary 11 Market Background 19 The EHR Landscape

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

SELF-PAY COLLECTIONS BEST PRACTICES

SELF-PAY COLLECTIONS BEST PRACTICES WHITE PAPER SELF-PAY COLLECTIONS BEST PRACTICES Guidelines for increasing compensated care from patients who can pay. INTRODUCTION The American Hospital Association reported that in 2012, U.S. hospitals

More information

GE Healthcare. Centricity Solutions Financial Management for Business Process Outsourcing

GE Healthcare. Centricity Solutions Financial Management for Business Process Outsourcing GE Healthcare Centricity Solutions Financial Management for Business Process Outsourcing Our workflows are clearly more efficient than before. We re collecting cash more quickly, which means we re able

More information

TRANSUNION WHITE PAPER. Allocating bad debt and charity care to better meet IRS Form 990 Schedule H compliance

TRANSUNION WHITE PAPER. Allocating bad debt and charity care to better meet IRS Form 990 Schedule H compliance TRANSUNION WHITE PAPER Allocating bad debt and charity care to better meet IRS Form 990 Schedule H compliance 1 Introduction: What is IRS 990 Schedule H? 2 New regulations require more detailed reporting

More information

8.2000: HOSPITAL PROVIDER FEE COLLECTION AND DISBURSEMENT

8.2000: HOSPITAL PROVIDER FEE COLLECTION AND DISBURSEMENT DEPARTMENT OF HEALTH CARE POLICY AND FINANCING MEDICAL ASSISTANCE SECTION 8.2000 [Editor s Notes follow the text of the rules at the end of this CCR Document.] 8.2000: HOSPITAL PROVIDER FEE COLLECTION

More information

TransUnion Healthcare Solutions Overview

TransUnion Healthcare Solutions Overview TransUnion Healthcare Solutions Overview Thank you for your interest in TransUnion Healthcare. We invite you to use this booklet as a quick reference guide. Included is a brief overview of TransUnion Healthcare

More information

Policy: Charity Care Application Policy # 4.70 Department: Patient Access Policy Manual: USMD Hospital Revenue Cycle Manual Effective date:

Policy: Charity Care Application Policy # 4.70 Department: Patient Access Policy Manual: USMD Hospital Revenue Cycle Manual Effective date: Approved by: Page: 1 SCOPE: This policy applies to USMD Hospitals. PURPOSE: USMD Hospitals will provide charity care to patients who incur a significant financial burden as a result of receiving medically

More information

Altru Health System Collection Policy

Altru Health System Collection Policy Altru Health System Collection Policy PHILOSOPHY Altru Health System (AHS) is committed to improving the health of our patients and the health of the region it serves. In support of our social mission,

More information