Revenue Cycle Performance: Optimizing Effectiveness June 17, 2014
|
|
- Marsha Parker
- 8 years ago
- Views:
Transcription
1 Revenue Cycle Performance: Optimizing Effectiveness June 17, 2014 CPAs & ADVISORS M. Aaron Little, CPA Managing Director
2 2 OBJECTIVES
3 OBJECTIVES Review key influences on revenue cycle performance Analyze key revenue cycle performance management metrics Assess revenue cycle performance management strategies 3
4 4 REVENUE CYCLE INFLUENCES
5 Payers Technology Process People 5 KEY INFLUENCES
6 Medicare Commercial & other Medicare Advantage Other managed care Medicaid Medicaid managed care 6 PAYERS
7 Intake Eligibility & authorization Service delivery Documentation & orders Pre-billing audit Claims submission Claims tracking & collecting Payment posting & reconciling Reporting 7 PROCESS
8 Eligibility & authorization Initial & reauthorizations Claims submissions Claim capture Clearinghouse services Documentation & orders Face-to-face Orders Tracking Claims tracking & collecting Timely followup Aging management Pre-billing audit Tracking Automation, too much, too little Payment posting & reconciling Timely followup Adjustment & write-off management 8 PROCESS
9 RAP billing requirements Verbal order First billable visit OASIS completed Plan of care completed PPS claim billing requirements OASIS transmitted Episode ended Signed & dated face-to-face encounter Signed & dated order for every visit Visit accounted for every order Therapy reassessment requirements met 9 PROCESS
10 Notice of election billing requirements Patient election Physician certification, verbal FTF encounter, if applicable Initial plan of care Claim billing requirements Patient status Month ended Signed & dated physician certification Pharmacy & infusion pump invoices Levels of care confirmed Services documented Nursing facility room & board 10 PROCESS
11 Clearinghouse vendor MAC systems Medicare specialized vendor Payer portals EDI vendor Data analysis tools Billing/EMR vendor General ledger 11 TECHNOLOGY
12 Intake personnel Prior authorization personnel Coding personnel Clinical personnel Medical records personnel Billing personnel Who are? Problem solvers vs. complainers? Idea generators vs. habit formers? Influencers vs. followers? Accountable vs. unstable? Risk aware vs. risk taker? Compliance & quality personnel Technology personnel Management & leadership personnel 12 PEOPLE
13 Senior financial leader Accountability void Medicare billing specialist(s) Medicaid billing specialist(s) Insurance billing specialist(s) Payment posting specialist(s) Insurance authorization specialist(s) 13 PEOPLE
14 Senior financial leader Billing supervisor Data specialist(s) Medicare billing specialist(s) Medicaid billing specialist(s) Insurance billing specialist(s) Payment posting specialist(s) Insurance authorization specialist(s) 14 PEOPLE
15 Key attributes Responsibility & accountability Problem solving Self motivated Timely Organized Strong communicators Detail oriented Embracing of technology Adaptable Warning signs Undependable Problem complainers Comfortable Un-present Disorganized Poor communicators Casual & inattentive to details Technologically uncomfortable Rigid & unwilling to change 15 PEOPLE
16 16 PERFORMANCE METRICS
17 Suggested Home Health Revenue Cycle Performance Metric Poor Average Best Medicare days in AR 45 days or more 35 days 25 days or less Non-Medicare days in AR 75 days or more 60 to 75 days 60 days or less Total days in AR 60 days or more 50 days 40 days or less Medicare AR older than 120 days Total AR older than 120 days 10% or more 7% 3% or less 15% or more 10% 7% or less Collections Less than 100% 100% More than 100% Medicare write-offs 2% or more 1% 0% Total write-offs 3% or more 2% 1% or less Days to bill RAPs More than 10 days 7 to 10 days Less than 7 days Days to bill claims More than 10 days 7 to 10 days Less than 7 days 17 HOME HEALTH METRICS
18 Suggested Hospice Performance Guidelines Metric Poor Average Best Medicare days in AR 45 days or more 35 days 25 days or less Total days in AR 55 days or more 45 days 40 days or less Medicare AR older than 120 days Total AR older than 120 days 10% or more 7% 3% or less 10% or more 8% 5% or less Collections Less than 100% 100% More than 100% Medicare write-offs 1% or more 0% 0% Total write-offs 3% or more 2% 1% or less Days to bill claims More than 5 days 5 days Less than 5 days 18 HOSPICE METRICS
19 19 PERFORMANCE MANAGEMENT STRATEGIES
20 AGED RECEIVABLES $100,000 >120 $75,000, Traditional Medicare $5,000, Medicaid $20,000, 10 other payers 58 episodes ~ 15 hours 20 claims ~ 4 hours 25 claims ~ 25 hours $100,000 >120 $10,000, Traditional Medicare $5,000, Medicaid $85,000, 25 other payers 8 episodes ~ 2 hours 20 claims ~ 4 hours 106 claims ~ 80 hours 20 PERFORMANCE ANALYSIS
21 Example RAP Billing Analysis Example A Example B Example C Days in month 30 days 30 days 30 days Days before RAPs are billed 8 days 10 days 12 days Days to pay once RAPs are billed 10 days 10 days 10 days Episode beginning deadline Day 12 Day 10 Day 8 RAP billing deadline Day 20 Day 20 Day 20 Payment eligible RAPs 75 RAPs 75 RAPs 75 RAPs RAPs paid during month 50 RAPs 35 RAPs 20 RAPs Missed RAP payments 25 RAPs 40 RAPs 55 RAPs Average RAP payment $ 1,300 $ 1,300 $ 1,300 Lost RAP payment opportunity $ 32,500 $ 52,000 $ 71, PERFORMANCE ANALYSIS
22 Example FTE Analysis Medicare Specialist(s) Medicaid Specialist(s) Insurance Specialist(s) Full time equivalents (FTEs) 1 FTE 1 FTE 1 FTE Annual revenues $ 5,000,000 $ 1,000,000 $ 3,000,000 Average annual transactions 3,700 2,000 3,750 Average revenues per transaction $ 2,700 $ 500 $ 800 Average monthly transactions Average rebill percentage 10% 20% 40% Estimated monthly transactions Average work days per month 20 days 20 days 20 days Average work hours per month 160 hours 160 hours 160 hours Average monthly time available per transaction 28 minutes 48 minutes 22 minutes 22 PERFORMANCE ANALYSIS
23 PERFORMANCE ANALYSIS Identify problem causers Clinical vs. quality vs. billing vs. financial personnel Identify problem payers Evaluate contract stipulations, if applicable Identify technology constraints Assess technology contributions to claim generation & follow-up collections management Assess cost/benefit to filling accountability void Assess potential performance incentives 23
24 24 ACCOUNTABILITY ANALYSIS
25 25 SUMMARY
26 Payers Technology Process People 26 SUMMARY
27 27 QUESTIONS?
28 Revenue Cycle Performance: Optimizing Effectiveness June 17, 2014 CPAs & ADVISORS M. Aaron Little, CPA Managing Director
OBJECTIVES. Session 115 How to Manage Accounts Receivable & Cash Flow. M. Aaron Little, CPA. Melinda A. Gaboury, COS-C.
Session 115 How to Manage Accounts Receivable & Cash Flow Melinda A. Gaboury, COS-C Healthcare CPAs Provider & ADVISORS Solutions, Inc. Chief Executive Officer mgaboury@healthcareprovidersolutions.com
More informationBilling App Update: Version 2.012
Billing App Update: Presented by M. Aaron Little, CPA BKD, LLP Springfield, MO mlittle@bkd.com Today s Agenda 2012 prospective payment system (PPS) rates Timely filing Healthcare Common Procedure Coding
More information4/16/2015. Cost Containment Strategies. Objectives. Introduction
Cost Containment Strategies Michigan Association for Home Care Annual Conference May 13 th 2015 Rob Simione, BS, CPA, Vice President of Simione Financial Monitor 1 SOLVING YOUR CORE HOME CARE AND HOSPICE
More informationSession 303 How to Use Scorecards to Manage Revenue Cycle Compliance
Session 303 Manage Revenue Cycle Compliance M. Aaron Little, CPA CPAs & ADVISORS BKD, LLP Managing Director mlittle@bkd.com Patrick Brown, MBA, MS Penn Home Care & Hospice Services Chief Financial Officer
More informationMelinda A. Gaboury, COS-C. Chief Executive Officer. Healthcare Provider Solutions, Inc. mgaboury@healthcareprovidersolutions.com
Session 301 Home Health Services Revenue Cycle Management Melinda A. Gaboury, COS-C Chief Executive Officer Healthcare Provider Solutions, Inc. mgaboury@healthcareprovidersolutions.com Intake/Referral
More informationTrusted 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 informationAdopting an EHR & Meaningful Use
Adopting an EHR & Meaningful Use Learn how to qualify for the EHR Incentive Program The materials in this presentation, or prepared as part of this presentation, are provided for informational purposes
More informationWhat Your Organization can do to Avoid the Risks. Jane Snecinski Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.
What Your Organization can do to Avoid the Risks Jane Snecinski P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com Any level of care that occurs after an acute care stay LTAC (Long Term Acute Care
More informationYour Speaker. The Elements of the Revenue Cycle MANAGING THE HOME HEALTH REVENUE CYCLE
MANAGING THE HOME HEALTH REVENUE CYCLE Hoosier Home Care & Hospice Conference May 11, 2010 3:15 p.m. 4:45 p.m. Your Speaker Terry Cichon, CPA FR&R Healthcare Consulting, Inc. Frost, Ruttenberg & Rothblatt,
More informationMassachusetts Medicaid EHR Incentive Payment Program
Massachusetts Medicaid EHR Incentive Payment Program Agenda Vision & Goals High-level overview where we are going Medicare vs. Medicaid EHR Incentive Programs Performance and Progress Eligibility Overview
More informationPREPARING FOR ICD-10 IDENTIFYING THE STEPS TO BE TAKEN AND THE TIMELINE MAY 2014
PREPARING FOR ICD-10 IDENTIFYING THE STEPS TO BE TAKEN AND THE TIMELINE MAY 2014 Diane Taylor, BSN, RN Selman-Holman & Associates LLC, Senior Associate Selman-Holman & Associates, LLC Diane Taylor, BSN,
More informationTennessee Primary Care Association: 2014 Annual Leadership Conference
CPAs & ADVISORS experience momentum // SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE FQHC REVENUE CYCLE Tennessee Primary Care Association: 2014 Annual Leadership Conference
More informationPayment Policy. Evaluation and Management
Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions
More informationProtect 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 informationDepartment of Human Services
Department of Human Services Long-Term Care Community Nursing Rule Information and Required Forms Aging and People with Disabilities and Medical Assistance Programs Topics Agency Information Oregon Health
More informationMountain Park Health Center Billing Services. Request for Proposal
Mountain Park Health Center Billing Services Request for Proposal Mountain Park Health Center 2702 North 3 rd Street, Suite 4020 Phoenix, AZ 85004 Page 1 of 8 I. Purpose of Request Mountain Park Health
More information1 13 ESSENTIAL STEPS TO BECOMING ICD-10 COMPLIANT With Practice Management Software. The Beginner s Guide to EHR Meaningful Use
1 13 ESSENTIAL STEPS TO BECOMING ICD-10 COMPLIANT With Practice Management Software The Beginner s Guide to EHR Meaningful Use 2 THE BEGINNER S GUIDE TO EHR MEANINGFUL USE CONTENTS Introduction...3 Components
More informationHorizon Homecare. Giving You the Power to Drive Clinical and Financial Success
Horizon Homecare Giving You the Power to Drive Clinical and Financial Success Manage Care from All Angles Your homecare agency is under constant pressure from competition, reimbursement challenges and
More informationContracting and Clean Claims: Billing Techniques for Success!
Contracting and Clean Claims: Billing Techniques for Success! Top 5 Things to Know for CE: Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance. Carry the Evaluation
More informationGE Healthcare. Electronic data interchange and proactive services for Centricity revenue cycle management customers
GE Healthcare Electronic data interchange and proactive services for Centricity revenue cycle management customers Accelerate revenue perf Key features updates and other payer-specific adjustments are
More informationAmong the many challenges facing health care
The Value of Visit Management at Your Organization BY ELIZABETH WEIDMAN, SENIOR ANALYST Catch Data Systems April 2014 Among the many challenges facing health care organizations today, few have the potential
More informationTab 7: OASIS Questions and Answers
Reference Manual Tab 7: OASIS Questions and Answers RM-429 RM-430 CATEGORY 1 APPLICABILITY [Q&A EDITED 09/09] Q1. To whom do the OASIS requirements apply? A1. The comprehensive assessment and OASIS data
More informationHow To Qualify For EHR Stimulus Funds Under
BEST PRACTICES: How To Qualify For EHR Stimulus Funds Under Meaningful Use & Certified EHR Technology The American Recovery and Reinvestment Act (ARRA) set aside early $20 billion in incentive payments
More informationManaged Care Organization and Provider Forum Region 3 June 24, 2013
Managed Care Organization and Provider Forum Region 3 June 24, 2013 Humana Headquartered in Kentucky Fortune 100 company Leading national healthcare company 12 million medical members 8 million specialty
More informationHow to Best Select an EHR and The new HITECH Stimulus Act What you need to know
How to Best Select an EHR and The new HITECH Stimulus Act What you need to know Presented by Scott Heaton Vice President, Maxwell IT Company 2009 Maxwell IT Company. All Rights Reserved. Session Goals
More informationSUBPART D: PAYMENT FOR NON-INSTITUTIONAL SERVICES
SUBPART D: PAYMENT FOR NON-INSTITUTIONAL SERVICES Section 140.463 Clinic Service Payment a) Definitions ABehavioral Health Services@, for the purposes of this Section, means services provided by a licensed
More informationBILLING 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 informationLOOKING FORWARD TO STAGE 2 MEANINGFUL USE. 2012 Louisiana HIPAA & EHR Conference Presenter: Kathleen Keeley
LOOKING FORWARD TO STAGE 2 MEANINGFUL USE 2012 Louisiana HIPAA & EHR Conference Presenter: Kathleen Keeley Topics of Discussion Stage 2 Eligibility Stage 2 Meaningful Use Clinical Quality Measures Payment
More informationKlamath Tribal Health & Family Services 3949 South 6 th Street Klamath Falls, OR 97603
Klamath Tribal Health & Family Services 3949 South 6 th Street Klamath Falls, OR 97603 Phone: (541) 882-1487 or 1-800-552-6290 H.R. Fax: (541) 273-4564 OPEN: 05/08/2013 CLOSED: 05/24/2013 POSITION: RESPONSIBLE
More informationEHR Incentive Programs
Medicare & Medicaid EHR Incentive Programs Stage 2 Final Rule Elizabeth Holland Elizabeth.Holland@cms.hhs.gov NRHA 9-6-12 What is in the Rule Changes to Stage 1 of meaningful use Stage 2 of meaningful
More informationMASBO Fall seminar 2015 Bozeman. Medicaid in Schools. Direct Care Services ~ Medicaid Administrative Claiming (MAC)
MASBO Fall seminar 2015 Bozeman Medicaid in Schools Direct Care Services ~ Medicaid Administrative Claiming (MAC) So what is new in the world of Medical Billing of School Based Services? Glad you asked.
More informationSecond Annual Florida 2008 Electronic Prescribing Report
Second Annual Florida 2008 Electronic Prescribing Report FLORIDA CENTER FOR HEALTH INFORMATION AND POLICY ANALYSIS AGENCY FOR HEALTH CARE ADMINISTRATION JANUARY 2009 Better Health Care for All Floridians
More informationFinally... maybe? The Long Awaited 340B Mega Guidance. Georgia Healthcare Financial Management Association. October 2015
Finally... maybe? The Long Awaited 340B Mega Guidance Georgia Healthcare Financial Management Association October 2015 Disclaimer This webinar assumes the participant is familiar with the basic operations
More informationRevenue Cycle in Post- Acute Care Deloitte & Touche LLP Victor Shutack, Senior Manager June 2015
6/9/2015 Revenue Cycle in Post- Acute Care Deloitte & Touche LLP Victor Shutack, Senior Manager June 2015 Discussion topics Changing healthcare environment Understanding the home health care environment
More information7/9/2015 SCRIPTPRO 340B SOLUTIONS SHAFI SHILAD, VP BUSINESS DEVELOPMENT SSHILAD@SCRIPTPRO.COM 913.948.2068. A Comprehensive/ Seamless Approach
SCRIPTPRO 340B SOLUTIONS SHAFI SHILAD, VP BUSINESS DEVELOPMENT SSHILAD@SCRIPTPRO.COM 913.948.2068 A Comprehensive Approach 340B Operational Challenges Eligibility o Is the patient eligible? o Is the script
More informationElectronic data interchange and proactive services for customers using revenue cycle management solutions from the Centricity portfolio
GE Healthcare Electronic data interchange and proactive services for customers using revenue cycle management solutions from the Centricity portfolio imagination at work Accelerate revenue cycle performance
More informationHome Health Billing Scenarios - DRAFT. Disclaimer
Home Health Billing Scenarios - DRAFT 1493_1013 Disclaimer National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract
More informationTHE BASICS OF RHC BILLING. Thursday, April 28, 2011 Presented by: Health Services Associates, Inc.
THE BASICS OF RHC BILLING Thursday, April 28, 2011 Presented by: Health Services Associates, Inc. TABLE OF CONTENTS Commercial and Self Pay billing Define RHC Medicaid Specified Medicare RHC billing guidelines
More informationTop Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com
Robin Bradbury 800-355-0410 robin@ereso.com 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
More informationRx for practice management
Rx for practice management Spring 2015 Are you ready for the next step? The ins and outs of Stage 2 meaningful use Dissension in the ranks How to knock out physician conflicts Compensating providers for
More informationOptimizing Your Billing System to Produce Clean Claims
Optimizing Your Billing System to Produce Clean Claims Chris Peters, ACL Laboratories Road to Billing Optimization Missing Billing Information Missing test modifiers Wrong billing address Insurance coverage
More informationHIPAA Certification Requirements and E-Commerce Requirements
HIPAA as Strategy Optimizing Financials via Standardized e-commerce Miriam J. Paramore President & CEO PCI: e-commerce for healthcare President, HIPAA Action Work Group of Kentucky (HAWK) www.hawkonline.org
More informationElectronic data interchange and proactive services for Centricity revenue cycle management customers
GE Healthcare Electronic data interchange and proactive services for Centricity revenue cycle management customers Accelerate revenue perf Key features Tight alignment with payers ensures mandates, updates
More informationeprescribing Incentives, Benefits & Challenges Presentation By Director of Government Affairs
eprescribing Incentives, Benefits & Challenges Presentation By Director of Government Affairs eprescribing That s what it says: one tablespoonful, 300 times a day. Presentation Goals Appreciate the benefits
More informationElectronic Prescribing (erx) Incentive Program
Electronic Prescribing (erx) Incentive Program 4 Electronic Prescribing (erx) Incentive Program Overview Established in 2009, the erx Incentive Program seeks to encourage the use of electronic prescribing
More informationMyCare Ohio Skilled Nursing Facility Orientation
MyCare Ohio Skilled Nursing Facility Orientation Demonstration/Pilot Area Demonstration/Pilot Area 2 Health Plan Options Northwest Southwest West Central Central East Central Northeast Central Northeast
More informationExhausting Other Health Insurance Sources Before Submitting Nursing Home Claims to ForwardHealth
Exhausting Other Health Insurance Sources Before Submitting Nursing Home Claims to ForwardHealth Rose Klaben Third Party Liability Information Systems Business Automation Specialist August 24, 2015 DHS
More informationMedicare Claims Processing Manual Chapter 10 - Home Health Agency Billing
Medicare Claims Processing Manual Chapter 10 - Home Health Agency Billing Table of Contents (Rev. 3268, 05-29-15) Transmittals for Chapter 10 10 - General Guidelines for Processing Home Health Agency (HHA)
More informationCATEGORY 2 - COMPREHENSIVE ASSESSMENT
CATEGORY 2 - COMPREHENSIVE ASSESSMENT [Q&A EDITED 01/11] Q1. When are we required to collect OASIS? A1. The Condition of Participation (CoP) published in January 1999 requires a comprehensive patient assessment
More informationMeaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs
Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs Providence Health & Services is committed to using technology and evidence-based practices to deliver the highest quality care in
More information6/6/2012. Best Practices to Improve Billing and Collections. Overview. On the Front End. Lisa Rock, President National Medical Billing Services
Best Practices to Improve Billing and Collections Lisa Rock, President National Medical Billing Services June 15, 2012 10 th Annual Orthopedic, Spine and Pain Management Driven ASC Conference: Improving
More informationCLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format
Overview The Claims department partners with the Provider Relations, Health Services and Customer Service departments to assist providers with any claims-related questions. The focus of the Claims department
More informationInformation for Eligible Professionals Regarding Program Year 2015 of the Wisconsin Medicaid Electronic Health Record Incentive Program
Update June 2015 No. 2015-24 ffected Programs: BadgerCare Plus, Medicaid To: Advanced Practice Nurse Prescribers with Psychiatric Specialty, Dentists, Federally Qualified Health Centers, Nurse Midwives,
More informationRevenue Cycle Management Optimized
rreturnsttopbooth2014final.indd 1 6/13/2014 9:32:34 AM Revenue Cycle Management Optimized Powerful technology combined with expert knowledge and resources Innovative Revenue Cycle Management brought to
More information6 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 informationMedicaid Health Homes. Integrated Care Conference September 25, 2013
Medicaid Health Homes Integrated Care Conference September 25, 2013 1 Outline Program Background Health Home Overview Objectives Services Eligibility Provider Eligibility Participant Eligibility Health
More informationCATEGORY 5 - HAVEN. Q1. How can we obtain the Home Assessment Validation Entry (HAVEN) software?
CATEGORY 5 - HAVEN Q1. How can we obtain the Home Assessment Validation Entry (HAVEN) software? A1. HAVEN is currently available on the OASIS website under HAVEN Data Entry Software. The website address
More informationProvider Brief June 2014
Provider Brief June 2014 From the Desk of the Medical Directors Thank you for playing a significant role in delivering great care to our patients during this first half of our inaugural year. We continue
More informationTerry McGeeney, MD MBA, President, CEO of TransforMED
Terry McGeeney, MD MBA, President, CEO of TransforMED Terry McGeeney, MD MBA, President, CEO of TransforMED According to the Future of Family Medicine Report: unless there are changes in the broader healthcare
More informationHIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions
HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions ELECTRONIC TRANSACTIONS AND CODE SETS The following frequently asked questions and answers were developed to communicate
More informationImplementing KPIs in your Ambulance Billing Department. By Donna Magnuson. Whitepaper
$ $ $ Implementing KPIs in your Ambulance Billing Department By Donna Magnuson Whitepaper Implementing KPIs in your Ambulance Billing Department Key Performance Indicators (KPIs) are quantifiable measurements
More informationCMS is requesting information to aid in the planning and implementation of the MIPS in the following areas:
Summary of Medicare s Request for Information on the Provisions in MACRA which Allow for Implementation of Alternative Payment Models and a Merit-Based Incentive Payment System On September 28, 2015, the
More information12 16 Memorial Physician Network Billing Cycle Audit Report
O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12 16 Memorial Physician Network Billing Cycle Audit Report September 2012 O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12
More informationFrequently Asked Questions About Quality Data Reporting
Why am I being asked to submit claims for all of my patients if SQCN does not have any payer contracts? SQCN is a Clinical Integration (CI) network. The success of our network will depend upon our CI program
More informationPrescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
More information6 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 informationMEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) ADVANCING CARE INFORMATION PERFORMANCE CATEGORY
MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) ADVANCING CARE INFORMATION PERFORMANCE CATEGORY SUMMARY OF PROVISIONS Brief Synopsis MACRA sunsets the Electronic
More informationMeaningful Use: Terms & Timelines, Changes to Stage 1, and Stage 2 Overview
Meaningful Use: Terms & Timelines, Changes to Stage 1, and Stage 2 Overview NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene 1 Agenda Terms & Timelines of Meaningful
More informationMinnesota EHR Incentive Program
Minnesota EHR Incentive Program Meaningful Use in Minnesota: Changes in the Medicaid EHR Incentive Program Landscape June 2016 Today s Speaker Dean Ewald MN EHR incentive program (MEIP) Team Lead Government
More informationIndependent Insurance Eligibility Verification A Cost/Benefit Review for Immunization Billing
Independent Insurance Eligibility Verification A Cost/Benefit Review for Immunization Billing Developed for The Arizona Partnership for Immunization-TAPI 700 E. Jefferson Street, Suite 100 Phoenix, AZ
More informationOptum Intelligent EDI. Achieve higher first-pass payment rates and help your organization get paid quickly and accurately.
Optum Intelligent EDI Achieve higher first-pass payment rates and help your organization get paid quickly and accurately. The new benchmark for EDI performance Health care has outgrown commoditized EDI,
More informationHome Health Face-to-Face Encounter Question & Answers
Home Health Face-to-Face Encounter Question & Answers Question 1: Will requirements be met if a community physician certifies a patient and completes a plan of care when a face-to-face encounter was conducted
More informationREQUIREMENTS GUIDE: How to Qualify for EHR Stimulus Funds under ARRA
REQUIREMENTS GUIDE: How to Qualify for EHR Stimulus Funds under ARRA Meaningful Use & Certified EHR Technology The American Recovery and Reinvestment Act (ARRA) set aside nearly $20 billion in incentive
More informationWhat 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 informationThe International Statistical Classification of Disease and Related Health Problems, ICD- 10, is a medical classification system for coding of:
ICD-10-CMs OVERVIEW The International Statistical Classification of Disease and Related Health Problems, ICD- 10, is a medical classification system for coding of: Diseases Injuries Symptoms Procedures
More informationLTC Monthly Claims Training How to Bill UB04 on Web Portal
LTC Monthly Claims Training How to Bill UB04 on Web Portal Statewide Medicaid Managed Care: Key Components STATEWIDE MEDICAID MANAGED CARE PROGRAM MANAGED MEDICAL ASSISTANCE PROGRAM LONG-TERM CARE PROGRAM
More informationDirect Costs - definition
How To Analyze and Contain Costs Session 202 2015 NAHC Annual Meeting Nashville, Tennessee Andrea Devoti, MSN,MBA,RN President and CEO Neighborhood Health October 29, 2015 Walter Borginis III, CPA, CGMA,
More informationHome Health Face-to-Face Changes
Home Health Face-to-Face Changes 2015 http://www.selectdata.com/events/webinar-face-to-face-encounter-changes-2015/ LINK TO HANDOUT 1 Presenter Laura is a nationally-recognized home health and hospice
More information6 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 informationSelecting Your Stage 1 Meaningful Use MENU Objectives
Selecting Your Stage 1 Meaningful Use MENU Objectives Highlights The EHR Incentive Program Stage 1 Meaningful Use program requires each provider to choose 5 meaningful use objectives from a list of 10.
More informationReducing the Cost to Collect Using cloud-based workflow tools to reduce collection costs by up to 50%
Revenue Cycle Basics Series Part Eight Reducing the Cost to Collect Using cloud-based workflow tools to reduce collection costs by up to 50% Derek Morkel, President & CEO, HealthTech Solutions Group Revenue
More informationHow To File A Claim Electronically
Revenue Cycle Management: Tips & Tools 2010 Annual Educational Seminar March 10, 2010 Presented By: Cindy Tipton, Coding & Compliance Director cindy_tipton@med3000.com What is the Revenue Cycle or Life
More informationMay 18, 2010. Dear Director Verdugo,
May 18, 2010 Director Georgina Verdugo U.S. Department of Health and Human Services, Office for Civil Rights Attention: HITECH Accounting of Disclosures Hubert H. Humphrey Building, Room 509F 200 Independence
More informationPayment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals Last Updated: March 2014
Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals Last Updated: March 2014 Overview As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress mandated payment
More informationRevenue Cycle Management Process
OVERVIEW It is important for everyone involved in the billing cycle process to be familiar with how each step of the encounter provides opportunities to assure successful and compliant billing. The purpose
More informationAPPENDIX E DATA REPORTING REGULATIONS
APPENDIX E DATA REPORTING REGULATIONS DATA REPORTING REGULATION Section 4602(e) of the Balanced Budget Act of 1997 authorizes the Secretary of the Department of Health and Human Services (HHS) to require
More informationGuide To Meaningful Use
Guide To Meaningful Use Volume 1 Collecting the Data Contents INTRODUCTION... 3 CORE SET... 4 1. DEMOGRAPHICS... 5 2. VITAL SIGNS... 6 3. PROBLEM LIST... 8 4. MAINTAIN ACTIVE MEDICATIONS LIST... 9 5. MEDICATION
More informationThe benefits of electronic claims submission improve practice efficiencies
The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer
More informationOPEN STANDARDS BENCHMARKING MEASURE LIST
ABOUT APQC's The APQC Open Standards Benchmarking measure list concisely lists all of the measures currently available through APQC's benchmarking portal for its members. These measures are organized by
More informationEDI Solutions Your guide to getting started -- and ensuring smooth transactions bcbsga.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions 00175GAPENBGA Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic submitters. It
More informationLTC Online Portal Security Training Manual
LTC Online Portal Security Training Manual Texas Medicaid & Healthcare Partnership Page 1 of 16 Print Date: 8/22/2006 Table of Contents 1.0 Texas Medicaid & Healthcare Partnership (TMHP) Website Security
More informationRelated CR Transmittal #: 412 Implementation Date: January 24, 2005
MLN Matters Number: MM3592 Revised Related Change Request (CR) #: 3592 Related CR Release Date: December 23, 2004 Effective Date: May 21, 2004 Related CR Transmittal #: 412 Implementation Date: January
More informationAccounts Receivable Tool Kit (Excerpts from Realizing Your Viability The Tenets of A Successful Organization )
Accounts Receivable Tool Kit (Excerpts from Realizing Your Viability The Tenets of A Successful Organization ) o Components of an Effective Month-End Close Process o Procedure for Processing and Posting
More informationMEANINGFUL USE STAGE 3 AND CERTIFICATION PROPOSED RULES
MEANINGFUL USE STAGE 3 AND CERTIFICATION PROPOSED RULES The following provides a brief summary of the Meaningful Use (MU) Stage 3 and 2015 Edition certification proposed rules. Comments on the rules are
More informationEHR Incentive Payment: What Qualifies for the Medicare Cost Report. Kevin E. Wellen, CPA January 18, 2013
EHR Incentive Payment: What Qualifies for the Medicare Cost Report Kevin E. Wellen, CPA January 18, 2013 EHR Incentive Payments Path to Payment Register Attest Payments Uses the Medicare and Medicaid EHR
More informationFrequently Asked Questions on the Medicare FQHC PPS 1
Frequently Asked Questions on the Medicare FQHC PPS 1 (Rev. 12-1-15) Topics FQHC PPS Rate and GAFs New Patient, IPPE, and AWV Adjustments Per-diem Payment Exceptions FQHC PPS Payment Codes Preventive Services
More informationMEANINGFUL USE STAGE 2 2015 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY
MEANINGFUL USE STAGE 2 2015 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY STAGE 2 REQUIREMENTS EPs must meet or qualify for an exclusion to 17 core objectives EPs must meet 3 of the 6 menu measures.
More informationREVENUE CYCLE PRINCIPLES SERIES
REVENUE CYCLE PRINCIPLES SERIES Part 8 Reducing the Cost to Collect Derek Morkel, President & CEO, GAFFEY Healthcare Introduction REVENUE CYCLE BASICS SERIES Part 8: Reducing the Cost to Collect Using
More information