Utilizing Needs Assessment and Benchmarking Tools to Evaluate and Improve Revenue Cycle Management Practices. Jim Knight CEO, ACU Serve Corp.

Transcription

1 Utilizing Needs Assessment and Benchmarking Tools to Evaluate and Improve Revenue Cycle Management Practices Jim Knight CEO, ACU Serve Corp.

2 Disclosure Jim Knight is an employee of ACU Serve. Clinical trials and off label/investigational uses will not be discussed during this presentation. 2

3 Learning Objectives Determine accounts receivable (A/R) dashboard metrics that best convey the company's overall financial health Methodologies for prioritizing your accounts receivable workload that will lead to optimization of cash flow Clarify how A/R metrics can be used to identify high and low performing staff and apply that knowledge in the establishment of individual goals and incentives to amplify employee engagement 3

4 Let s get this out of the way 4

5 Presentation Rules Audience Participation is REQUIRED! Please interrupt me! This is an interactive presentation - any and all questions are welcome. (We will make fun of your questions later.) I will be asking you questions so be ready! A copy of this presentation is available to you so don t worry about writing everything down. 5

6 Assumptions Your DSO (Days Sales Outstanding) is > 30 You have more than one A/R worker A/R team is struggling to get through the A/R over 30 days old within 30 days Having difficulty with fixing issues upstream Hiring more staff is not an option or you have tried it, and it isn t working 6

7 Learning Objectives Determine the accounts receivable (A/R) dashboard metrics that best convey the company's overall financial health. 7

8 Why Chart Your Numbers? You can only manage what is measured Trending numbers over a period of time is the true way of knowing if changes in processes are achieving positive or negative results Consolidate the reports on your desk Identify problem areas easier. Cash is down why?? Sales Issue Order Posting Issue On Hold Issue A/R Issue 8

9 What Do You See? The KPIs (Key Performance Indicators) that are tracked Cash $$$ Adjustments further broken down into manual adjustments Revenue Expected/Rentals vs. Sales (if possible) On Hold Revenue from Unbilled Orders A/R Breakdown (Minimum) Overall Billed Patient Insurance 9

10 What Do You See? Formulas & Calculations Collection % The % of Cash + Allowable Adjustments of Revenue from Months prior Benchmark is 92% or higher Daily Sales Allowable created for last 3 months divided by 90. Used in DSO (Days Sales Outstanding) Calculations DSOs On Hold Revenue Should be less than 5 days Overall A/R Should be less than 60 days % of A/R for Insurances Current A/R % Should be greater than 50% Over 90 A/R % Should be less than 20% 10

11 What Do You Get? The Dashboard Tool has 3 Sections: Summary Sheet Shows this Month versus the Previous Month Months Sheet Trends up to 12 Months of Data Graphs Sheet Charts several of the data points giving you a Visual representation 11

12 Summary Section 12

13 Graphs Section 13

14 Month Section 14

15 Month Section (cont d) 15

16 This is the Goal! Trending and using % s allows you to see that NOT all A/R increases are BAD! 16

17 Learning Objectives Methodologies for prioritizing accounts receivable workload and optimizing cash flow. 17

18 Common Ways to Allocate A/R By insurance company Patient alpha split Inside of insurance companies By patient split and handles all insurances Branch (handles all payers for a branch) Insurance type (Medicare, Commercial, Medicaid) 18

19 Common Ways to Allocate A/R (cont d) Denial Focused Hand out paper A/R or generic aging search Why do it these ways? Easier to track performance, right? 19

20 Pitfalls of Common Allocations No cross training Not using economies of scale Difficult to spread your best A/R workers in other needed areas May not work the highest risk accounts 20

21 Pitfalls of Common Allocations (cont d) Re working claims too soon Lose the benefits of 2 nd set of eyes Lose opportunities to train No feedback loop for employee improvement Built in QA (Quality Assurance) process Workload not distributed evenly or fairly 21

22 A Better Way It is critical to the success of a billing organization to track and trend the following items: What is being worked and why? We track every invoice worked using an Invoice Note Code and a Sub Code Reason Write offs and adjustments We use very specific reasons as to WHY the claim needed written off or adjusted 22

23 What Do We Measure? Denials but: Reason codes can be vague One reason code can often represent multiple issues Remark codes can give more specific reason Definitions can vary greatly across payors Often denials are not descriptive enough as to WHY denied 23

24 Why Do We Measure? Control is gained by tracking invoice touches Freedom to move resources across payors Identify Low and High performing staff Gain quantifiable data Create a feedback loop for intake and other departments Create objective feedback for your staff Identify quickly what needs addressed 24

25 Why Not Ask Your Staff? 25

26 What Needs Tracked? Utilize your A/R system to record the following: Invoice Note Code: Action Sub Code: Reason for Action Who Touched the Claim When Was the Claim Touched 26

27 Definition of Terms Invoice Note Code: The action that was taken on the invoice. These are the codes we use: A Appealed A0 Pre Payment Audit A1 Redetermination A2 Reconsideration A3 ALJ A4 Appeals Board Review A5 Federal Court Review A6 Reopening AA Adjust Allowable BT Balance Transfer CA Credit Adjustment K Keyed NonWorked Not yet worked P Processing PD Paid R Rebilled \ Resubmitted S Suspend T Task W Write Off WT Write Off Task 27

28 Definition of Terms Sub Code: Explains why the invoice needed touched Here is our list for R- Rebill: Corrected Insurance Info Cost Invoice Needed Date Span DX Issue EOB Needed Front End Error Incorrect Billing Address Incorrect Policy Number Modifier CSR Modifier Order Confirmation Modifier Price Table Modifier Unpreventable Narrative Added NCOF New Insurance Order Confirmation Error Other Paid Incorrectly Primary Non Covered Procedure Code Correction Prove Medical Necessity Quantity Correction Rebilled with new DOS due to SNF Reload CMN 28

29 How to Use the Data Use your tracking fields to provide valuable feedback for continuous improvement Determine how much $$ and how many invoices are affected quantified data! Learn easily where your money is and WHY! Payor Issues NCOF, Paid incorrectly, Delayed payments Front End Issues Modifier missing, Order confirmation, Creation issues Preventable! 29

30 Example Data 30

31 Why Rebilling? 3/10/ NHIA Annual Conference Find out why and Fix it! 31

32 Manage Write Offs Using History: Intake Issues Note: Touch Counts may not correlate to $ Take Action!! 32

33 Learning Objectives Clarify how A/R metrics can be used to identify high and low performing staff and apply that knowledge in the establishment of individual goals and incentives to amplify employee engagement 33

34 Use Their Invoice Notes to Track Their Productivity Measure Weekly Activity by Employee 34

35 Trend Their Activity Trend output overall and by employee Use these as Benchmarks and for Incentive plans 35

36 Individual Tracking What did Ginnifer DO when she touched the claims? 36

37 Quantified Data Why did she have to rebill these claims? Fix These PREVENTABLE issues and get more out of existing staff!! 37

38 Individual Tracking What ELSE did she find when she touched the claims? Change WHAT is worked and WHEN to get more EFFECTIVE!! 38

39 Incentivize for Production The power is in the Data. There is NO DATA if claims are NOT WORKED. How do you get more output? Create incentive for working above average invoices Determine average across all A/R staff Eliminate High and Low to get best average Example 15 cents for all touches above 45 with a maximum earned per month We gained a 20% increase in productivity when implemented!! 39

40 Summary Start trending more than just your A/R numbers over time Track and measure what your employees are doing and WHY they are working the claims Use the data collected to QUANTIFY issues that need changed upstream and with A/R staff Use the power of tracking activity to freely move resources around your A/R and gain the power of your entire team Incentivize your team to get more activity RESULTS will equal getting MORE done with LESS!! 40

41 Q & A 41

42 Thank You 42