ROBERT SKEFFINGTON, CHBME

Transcription

1 How Much Is Poor Communication in the Revenue Cycle Hurting Your CHC's Cash Flow? ROBERT SKEFFINGTON, CHBME PRIORITY MANAGEMENT GROUP INC. 700 SCHOOL ST. PAWTUCKET, RI

2 How Much Is Poor Communication in the Revenue Cycle Hurting Your CHC's Cash Flow? "IT'S THE BILLING DEPARTMENT'S FAULT." I HEAR IT OVER AND OVER DURING VISITS TO CHCS AND IN DISCUSSIONS WITH ADMINISTRATORS. IF THE ORGANIZATION'S CASH FLOW IS WILDLY INCONSISTENT, CHANCES ARE BILLING IS THE SCAPEGOAT. While billing may be a contributing factor or even the root cause for cash- flow problems, though, it's not always the sole reason. Often it's an organization- wide set of issues that's to blame. In fact, the two main causes for claims denials in the CHC market are 1) front- desk issues, followed by 2) provider coding. In the current environment, cash flow is needed more than ever. The days of using grant funds to cover cash- flow problems is a thing of the past. Asking your board to fundraise to cover these issues is more difficult as well. What should you do as an administrator of a CHC with cash- flow issues? Based on my experience, take a close look at a likely culprit: poor communication between staff and departments. Wanted: Transparent & Meaningful Dialogue Depending on how a CHC functions, the patient encounter is often touched by many different staff prior to receiving reimbursement from a payer. One common issue is the lack of regular and meaningful dialogue when a visit occurs. Whether it's the billing department needing some piece of information from the front desk or an explanation from a provider related to diagnosis coding, simple discussions tend to end up in finger- pointing or worse. ABOUT PRIORITY MANAGEMENT GROUP PMG is an industry- leading third- party medical billing company offering services to CHCs and look- alike organizations since We speak the CHC language and have dramatically increased revenues at each of our CHC clients. For more information please visit or call Robert Skeffington (401) ) PRIORITY MANAGEMENT GROUP 700 School St. Pawtucket, RI

3 For a CHC to function well, communication among these different entities needs to occur frequently and successfully. This is a prevalent problem at many CHCs nationally. So prevalent, in fact, that we now have a name for it: "The Triangle of Miscommunication." (There, I said it. Forgive me for using management consultantese.) Part of the blame for the Triangle may well reside with billing. But responsibility for collections also needs to be shared by the much- maligned front desk and medical/dental providers as well. All three of these parties may interrupt collections in some way, leading to cash- flow problems and thus hurting the CHC's ability to carry out its mission. Amidst these three points of the triangle is another oft overlooked cause of claim denials: billing and electronic medical record (EMR) systems. Let's place these systems in the middle of the triangle, and discuss the three corners and how they interact with these critical systems. Front Desk Front- desk work is often high- pressure and challenging. When the front desk is operating at a high level of efficiency, it becomes a point of pride for CHCs because: The staff is well- trained. Patients are greeted in their language of choice. Registration and billing software are expertly managed. Communication with other departments is lively and productive. As the experienced reader/chc administrator knows, however, this utopia is rarely achieved. The front desk is a high- turnover spot with staff trained on the fly. Skills are lacking around systems, variable payer requirements, sliding fees and program eligibility. And the front desk is usually not strong from the standpoint of intra- organizational communication. Medical and Dental Providers We've all heard that providers arrive at a CHC with a desire to help patients, especially those less fortunate. These providers are now tackling EMRs and a somewhat new focus on both proper coding of the visit and productivity requirements. Add the fact that many patients in the CHC universe don't speak English as a primary language, and CHC providers are being asked to do more every day. Communication with (and education of) providers with information related to billing and reimbursement can be inconsistent and in some cases nonexistent. Ask one of your pediatricians about which managed Medicaid carrier pays for the administration of state- supplied vaccines, and you'll probably get a blank stare in response. 2

4 Billing Department Similar to their front- desk brethren, CHC billing staff is usually not offered sufficient training. Nor do they understand how to optimize the CHC's practice- management system, except for what's necessary to fulfill their daily job function. Lack of consistent and objective feedback on their job performance related to billing and mistakes only compounds the challenges. Exposure to other departments in the organization is limited and can result in decisions being made or processes being developed in a vacuum obviously affecting cash flow. Billing and EMR Systems While not an official part of the Triangle of Miscommunication (trust me, the term will grow on you), billing and EMR systems are integrated into all of the previously described areas. If implemented correctly and with staff members entering data in the required format, these systems usually offer reporting options that can pinpoint reasons for claim errors. The resulting reports offer a treasure trove of newfound revenue for the CHC. The Triangle I chose the triangle to simply illustrate the connection among the departments and communication required to make the revenue cycle actually work. All of the departments are related, whether staff members like it or not. It's up to the administrators to ensure the organization is responsive to requests. Also, the administration needs to develop reports a) that are regularly shared with the affected staff members, 3

5 and b) specify reasons for claim denial and other factors that limit or delay reimbursement. A monthly spreadsheet showing claim denials by reason is a great first step in this process. In the end, the CHC will benefit from increased cash flow. When functioning properly, the Triangle of Communication (not Miscommunication) will result in expanded and expedited reimbursement to the CHC. And these days, finger- pointing and acrimonious discussions among staff members aren't increasing deposits. Strong communication and CHC administrators pushing for collaboration in the organization will result in better and more consistent cash flow. Although a very common financial phrase is uttered rarely in the CHC market, I think it should be: "Cash flow is king." Let's take this obstacle of poor communication in the revenue cycle and the Triangle of Miscommunication, and turn it into a success story for CHCs. PUBISHED BY PRIORITY MANAGEMENT GROUP 700 School St. Pawtucket, RI