How to Improve Revenue Cycle Performance through HFMA. Chris Burke, Greg Brown, Gerilynn Sevenikar

Transcription

1 How to Improve Revenue Cycle Performance through HFMA Chris Burke, Greg Brown, Gerilynn Sevenikar January 27, 2013

2 Outline Background Info HFMA s Certified Revenue Cycle Representative Program (CRCR) HFMA s MAP Program

3 C-Suite Focus Increasing attention to revenue cycle management - Cash flow - Revenues Focusing on specific process improvement - Cash collection - Work flow - Customer satisfaction - Reduction in process variation Use of metrics to track performance

4 Revenue Cycle Implications With so many competing priorities assessing needs is critical Where is your focus? - Declining reimbursement levels - New payment models - Multiple unfunded mandates How do you set priorities? How do you measure progress? How do you achieve success?

5 Why Continue to Aim Higher? Declining reimbursement levels demand efficiency and effectiveness Regulatory change is making payment processes increasingly complex Consumers expect high levels of revenue cycle service (transparent pricing, prompt and accurate billing, seamless payment experiences) As the industry has shifted toward front-end processes, much of the low-hanging fruit already has been pursued

6 Why Is Measuring Performance Important? Forecast performance Identify opportunities for process improvement Compare performance with similar organizations Trigger corrective action Use data to change behaviors

7 Invest in Human Capital You can t have an exception driven process if you don t have exceptional staff Competence Knowledge and skills to perform Compassion Empathy and awareness of others emotions for better customer service Focus on the professional growth of your staff Tools to support the process Training/Skill development

8 HFMA s Certified Revenue Cycle Representative (CRCR) Program

9 HFMA s Certified Revenue Cycle Representative (CRCR) Program Revenue Cycle Staffing Issues High turnover Tight labor market Lack of experience with healthcare processes and requirements Minimal formal training programs Lack of equitable pay Little accountability * Patient Friendly Billing Project

10 HFMA s Certified Revenue Cycle Representative (CRCR) Program Educate and Train Your Staff Identify the different learning styles Develop education delivery strategies Create a resilient, flexible education program based on: all process points of the revenue cycle identified skill sets core competencies * Patient Friendly Billing Project

11 HFMA s Certified Revenue Cycle Representative (CRCR) Program What is CRCR? HFMA s Certified Revenue Cycle Representative (CRCR) Program is a professional designation earned by completing a review course (approximately hours of study) and passing a 3-hour online exam. The CRCR examination covers key areas including: Compliance Patient access Claims processing Account resolution Cash Financial management Support departments

12 HFMA s Certified Revenue Cycle Representative (CRCR) Program Development Task force: Vickie Dorward, Crouse Hospital: Syracuse, NY Christine Fontaine, Shore Health: Annapolis, MD Steven Fossey, Mayo Health System: Albert Lea, MN Shirlisa Hampton, Parkland Health and Hospital System: Dallas, TX Sherry Keck, Catawba Medical System: Hickory, NC Nancy Klock, Denver Hospital and Health Authority: Denver, CO Karen Newton, Clinton A. Harkins: Marietta, GA Vickie Nitschke, Veteran s Health Administration: Washington, DC Craig Pergrem, Orlando Regional Health: Orlando, FL Gerilynn Sevenikar, Sharp Health System: San Diego, CA Diane Wilson, BroMenn Healthcare System: Normal, IL Debra Youngblook, Catholic Healthcare Partners, Toledo, OH

13 HFMA s Certified Revenue Cycle Representative (CRCR) Program Why do hospitals recognize the CRCR designation? CRCR adds value to our current team as it denotes a Team Leader capacity CRCR documents an individual s understanding of the broader picture; tactical and strategic CRCR validates a national level of competency and assumes higher performance CRCR will help streamline revenue cycle knowledge by ensuring that staff are all working off of the most current industry wide revenue cycle best practices

14 HFMA s Certified Revenue Cycle Representative (CRCR) Program Online exam with online study guide Validates a national level of achievement Covers front and back end revenue cycle competencies Open to HFMA members and non-members

15 HFMA s Certified Revenue Cycle Representative (CRCR) Program Establishes a broader understanding of the entire revenue cycle process Improves knowledge of industry best practices Promotes a higher standard of performance among staff Supports compliance initiatives Develops talent and promotes staff retention Aids in expansion and growth of Team Leaders

16 HFMA s Certified Revenue Cycle Representative (CRCR) Program Parameters and scope defined by Advisory Committee Comprehensive online study guide covering: Compliance Patient Access Claims Processing Account Resolution Cash Financial Management Support Departments Approximately hours of study Engages learners using various interactivities to check learning and retention Chapter review questions modeled after CRCR exam for fully preparatory experience

17 HFMA s Certified Revenue Cycle Representative (CRCR) Program Exam specifics Online, held in your computer lab or personal computer Exam auto-off in 3 hours 150 multiple-choice questions presented in random order (from pool of 250) Questions weighted by chapter as defined by Advisory Committee Calculator needed Real-time scoring; 75% test score to pass the exam

18 HFMA s Certified Revenue Cycle Representative (CRCR) Program Recommended CRCR Participants Patient Access Financial Representatives Patient Accounts Compliance Managed Care Operations Decision Support Health Information Management Case Management Finance

19 HFMA s Certified Revenue Cycle Representative (CRCR) Program CRCR Experience Testers should have a working knowledge of revenue cycle Approximately 50% pass first exam; 70% pass with retest Most achievers have 3 years experience Experience does not equal knowledge: staff with over 20 years experience have not passed Program used as means to recognize individual initiative versus tenure Directors notice difference with inter-department communications Directors notice difference in Billing/Collections conversations with payers

20 HFMA s Certified Revenue Cycle Representative (CRCR) Program CRCR Testimonial CRCR designee sense of accomplishment: I will be able to show and prove not only my years of hands-on work experience within healthcare finance but also my will and desire to further my knowledge base and grow with the ever changing healthcare financial world as a whole. Jennifer Brantley, NCICS, CPC-H. CRCR; Patient Accounts Specialist III My congratulations to HFMA for putting together such a comprehensive and useful course such as CRCR I wish it had been available years ago as it would have alleviated the need for me to learn much of this information the hard way! Luann Longtine, Director, Extended Business Office

21 CRCR DEMO

22 HFMA MAP App

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24 WHAT IS MAP? MAP is a comprehensive performance improvement strategy Identify indicators Track and improve performance Recognize excellence Share successful practices

25 Defining the industry s standards

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27 Why External Comparison? External comparisons provide performance context to help you better: Forecast performance and quickly recognize signs of improvement or slippage Identify where labor, technology, and other resources are likely to give you the greatest impact Determine if it makes financial sense to invest in a performance change. And if so, by how much Identify practices with proven positive outcomes

28 Industry Expectations Moody s looks for: Comparison against a carefully selected set of peers Frequency and depth with which senior leadership and board members review comparative data Leadership actions based on hospital performance relative to key indicators Source: Governance and Management of Not-for-Profit Healthcare Organizations: A Key Driver of Ratings, Moody s Investors Services

29 MAP App Demo

30 2011 MAP Award Winner - CRCR

31 Required Days Of Initial Revenue Cycle Training High Performers >10 days 5-10 days 3-5 days 2-3 days Registrars 57% 14% 14% 14% 0% Billers 57% 14% 14% 14% 0% Collectors 50% 21% 21% 7% 0% Financial Counselors 64% 14% 14% 7% 0% All Others >10 days 5-10 days 3-5 days 2-3 days Registrars 42% 25% 15% 11% 7% Billers 54% 25% 7% 10% 4% Collectors 47% 30% 10% 9% 5% Financial Counselors 52% 26% 10% 7% 5% 1 day or less 1 day or less * Patient Friendly Billing Project

32 Staffing Strategies Provide incentives for staff who meet goals Increase front-line staff salaries (beyond average organizational increase) 31% 44% 64% 86% Increase back-office staff salaries (beyond average organizational increase) 19% 43% 0% 50% 100% High Performing All Others * Patient Friendly Billing Project

33 Sharp HealthCare San Diego, California Aggressive pre-employment competency testing and peer interviews for all levels Focus on training: 2 educator positions CRCR offered to all Revenue Cycle Staff Condition of promotion and/or leadership Acknowledged by Senior Leadership Conduct Monthly Proctored Exams Leadership skill development Quarterly Sharp University Local College affiliations $1,000 education fund to all employees annually 33

34 Sharp HealthCare CRCR Impact Component of staff growth and development plan Communicated benefit sponsored by Sharp HealthCare demonstrating commitment to excellence Inclusive of Net Revenue Analysts and Internal Audit Certification acknowledged on ID 91 staff system wide

35 2011 MAP Award Winner - MAPAPP

36 Sharp HealthCare A/R Day Dashboard

37 Sharp HealthCare A/R Days

38 Sharp HealthCare A/R Day Calculation

39 Sharp HealthCare A/R Aging

40 Sharp HealthCare Days DNFB

41 Sharp HealthCare POS

42 Define Opportunity Statement The team drafted the Opportunity Statement for our workgroup: Optimize patient collections with an awareness of the economic climate by designing a process for unfunded patients that: works with public in an advocacy role to find reasonable payment options that are patient sensitive and fiscally responsible, and secures state/local/federal funding when appropriate. Additional elements included: Ensure that there was adequate education on the program options. Ensure that the patients understand their responsibility in the process (i.e., follow through). Simplify as much as possible. Provide a clear decision tree for reps with the tools necessary to ensure consistency.

43 Next Steps Leverage data from revenue cycle departments to measure performance Create internal discussions among your revenue cycle department leaders Work with your Human Resources/Training departments to create Career ladders, training opportunities for your staff Visit the HFMA booth at Region 11 to learn more

44 Questions? THANK YOU!