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

Transcription

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

2 REVENUE CYCLE MANAGEMENT WHAT S THE BIG DEAL? Productivity = Efficiency + Effectiveness How much input (cost) is needed to obtain output (revenue) Billing and Collections = Rethinking the Revenue Cycle

3 CHALLENGES Increased Regulatory Environment HIPAA Omnibus Act Coding System Complexities ICD 10 (October 2015) Shifting Reimbursement Dynamics Value Based Medicine Reimbursement

4 EMPLOYEE TRENDS Employee contributions outpacing Employer contributions Higher Deductibles Increased Copays/Co-insurance Managed Care 50/50 Plans Decreased Benefits Coverage HSA

5 TRENDS WITH PAYERS Increased Automation / Reduced Paperwork Claims Submittal Claims Paid Increased Denials/Appeals Timeliness Authorizations Modifiers Global Charges

6 INSURANCE CLIMATE Shrinking Reimbursements In Network/Out of Network Agreements Increased compliance issues Eligibility

7 MEDICAL GROUP TRENDS Increasing Operating Cost Administrative Burden Verifications Clean Claims Submittal Pressure for Patient Self Pay Collections Pressure to Optimize Insurance Collections

8 RESPONSIBILITIES Employee Responsibilities Employer Responsibilities Payer Responsibilities Patient Responsibilities

9 WHAT ARE THE BEST PRACTICES FOR REVENUE-DRIVING INDICATORS? 1. Self Pay Collections 2. Measuring Performance 3. Claims Scrubbing 4. Track/Prevent Denials 5. Create/Enforce Write-Off Policies 6. Remind Patients of the Financial Policy

10 SELF PAY COLLECTIONS Communicate Financial Policy Cash Obtain accurate Demographic Data Confirm address at Visits Stop seeing patients who owe you Money! Up front Collections Payment Plans

11 USE OF TECHNOLOGY (LET S AUTOMATE) Online Eligibility Verification Electronic Scrubbing of the Claims Cost to Produce a Clean Paper Claim $ 6.63 Cost to Produce a Clean Electronic Claim $ 2.90 Auto Posting of EOB s Electronic Claim Submission Paper Claims take 6-8 weeks on average to reimburse Electronic Claims take 2 weeks on average to reimburse Patient Portal E Statements Online Bill Pay Payment Plans

12 MEASURING PERFORMANCE Dashboard Indicators Percentages of Denials Gross Collections Net Collections Charges Payments Insurance Claims vs Patient Claims

13 PAYMENTS How fast are you getting paid? Who is not paying you? Why are you not getting paid?

14 CLAIMS SCRUBBING Demographic Information Review CPT and Diagnosis Combinations Reduce Rejections/Denials What are the Required Fields?

15 TRACK/PREVENT DENIALS CAPTURE, ANALYZE, AND ACT Top Reasons Eligibility Non-Covered Service Verification Credentialing Authorization Duplicate Billing Treatment and Coding Incorrect Information

16 CREATE/ENFORCE WRITE-OFF POLICIES Contractual Write-Offs Small Balance Write-Offs Approved Write-Offs Unnecessary Write-Offs Collection Agency Write Offs

17 FINANCIAL POLICY WITH CONSENT FORMS Prompt Payment Discounts for Cash Expectations should be set from Day One Policy for No Shows/Late Cancellations Payment Plans

18 GUARANTOR PROGRAMS AND THE EFFECT ON RCM Who has them, raise your hand? How many of you know, by Physician, the Success Rate? How many of you know, by Physician, the cost per patient? How many of you tract this information: monthly, quarterly, annually How many of you review this as Owners, as Lab, as Clinic, as Practice

19 3 RD PARTY BILLING, IS IT RIGHT FOR YOU? What are the Hidden Cost of a Billing Staff? Human Resources, Training and Development, Management, Physical Space? The effect of: You don t know, what you don t know Accountability?

20 IS A SHAKE-UP NEEDED? The Cost of Comfort, does your practice have this Disease? The Shake-up Premise Asking for Help, its ok When was the Last: Review, Analysis, Audit done in your Practice?

21 NOW THAT YOU KNOW WHAT RCM IS, WHAT DOES IT MEAN TO YOUR PRACTICE? Why are you in Private Practice? Cash Flow Profitability Support Staff Patients

22 STRATEGIC TASK FOR A THRIVING ORGANIZATION 1. Identify and Fix Revenue Cycle Leaks 2. Benchmark Business Achievements 3. Better manage daily, weekly, and monthly to-do list for steady cash flow

23 WHY GOOD ENOUGH IS NO LONGER GOOD ENOUGH TO KEEP PACE WITH TODAY S HEALTHCARE ENVIRONMENT Now, what can you do to thrive?

24 The Future is Now

25 Questions? THANK YOU