Accelerating your Revenue Cycle: From Patient Encounter Through Account

Transcription

1 Accelerating your Revenue Cycle: From Patient Encounter Through Account Resolution Anders Health Care Webinar Series July 17th, 2013 Jerrie K. Weith, FHFMA, CMPE Chastity D. Werner, RHIT, CMPE, NCP

2 Learning Objectives Characteristics of Best Performers Efficient Encounters = Revenue Cycle Success Measuring Revenue Cycle Performance Identifying Your Opportunities

3 Accelerating your Revenue Cycle: From Patient Encounter Through Account Resolution Characteristics of Best Performers Technology Staff Payers Process

4 Characteristics of Best Performers Technology Systems HIE

5 Characteristics of Best Performers Technology EHR/PMS communicate Upgraded regularly Continued education

6 Characteristics of Best Performers Staff Right fit Productivity Re-invest Weekly meetings The Why factor

7 Characteristics of Best Performers The lowest level of performance by any employee, allowed to continue without corrective action, becomes the highest level of performance that can be required of any other employee in a similar position with the employer. Reference: Rosemarie Nelson MGMA Healthcare Consultant The ROI of IT: Best Billing Practices

8 Characteristics of Best Performers Payers Set-up Rules Options Changes Reference: AMA 2012 National Health Insurer Report Card

9 Characteristics of Best Performers Process Does it make sense? Uniform Set expectations

10 EFFICIENT ENCOUNTERS = REVENUE CYCLE SUCCESS

11 Accelerating your Revenue Cycle: From Patient Encounter Through Account Resolution Efficient encounters Scheduling Eligibility & benefits verification TOS Claims generation Payment processes Account resolution Collection process

12 Efficient Encounters = Revenue Cycle Success Patient demographics Capture the right information Account review Patient expectations We expect payment at the time of service. Work #, cell phone, Insurance details Guarantor Ms. Smith, details I see you have a past due amount of $ How would you like to take care of that Employer today? We information accept Visa, MasterCard, or do you have an FSA?

13 Efficient Encounters = Revenue Cycle Success National health expenditures are expected to increase from $2.9 trillion to $5.5 5 trillion. Business and households are projected to pay half of total nation health care costs in 2023, while the federal government will pay 32% and state t and local l governments will pay 18%. Percentage of Covered Workers Enrolled in a Plan with a General Annual Deductible of $1,000 or More for Single Coverage Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward High Performance Health Care System Note: These estimates include workers enrolled in HDHP/SO and other plan types. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,

14 Efficient Encounters = Revenue Cycle Success It costs between $0.05-$0.74 to check eligibility ibilit % of providers who knew patient responsibility at the TOS % of patients who knew their financial responsibility How much will it save you to know what your patient owes at the TOS? Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012

15 Efficient Encounters = Revenue Cycle Success Eligibility & benefits verification Increase time with patients Faster payments Increased efficiency Reference:

16 Efficient Encounters = Revenue Cycle Success Is it worth it? Automate Centralize Payer websites Choose your criteria: Services Payers Everything Use the information obtained! 3 days in advance

17 Efficient Encounters = Revenue Cycle Success Compare coverage to expected treatment & fee schedule Contact patient patient counseling Set alerts in system & schedule Collect at TOS

18 Efficient Encounters = Revenue Cycle Success TOS Confirm information Collect at check-in Collect at check-out How would you like to pay today? We accept Visa, MasterCard, cash and checks.

19 Efficient Encounters = Revenue Cycle Success If patient payments are not managed correctly, they can cost three to five times more to collect than payer payments due to paper-based, manual processes. These costs are further escalated by rising patient bad debt, which was estimated to have been more than $65 billion in TOS Collection % for Providers Reason the provider did not collect Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012

20 Efficient Encounters = Revenue Cycle Success TOS Complete record 24 hours Computer Assisted Coding (CAC) Interface charges

21 Efficient Encounters = Revenue Cycle Success Claim generation Charge lag 24 hours (48 hours out of office services) Claim scrubbing Edits Correction Do you update your claim edits on a regular basis?

22 Efficient Encounters = Revenue Cycle Success Utilize a clearinghouse 997 claim rejection report Submit charges within hours 277u claim status report Initial follow-up 24 hours Level 1 rejections

23 Efficient Encounters = Revenue Cycle Success 6% increase over 2 year period 46% 51% Reason payer payments were not received electronically Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012

24 Efficient Encounters = Revenue Cycle Success Payment processing PPACA Changed to 10/1/2014! Reference:

25 Efficient Encounters = Revenue Cycle Success Claim Adjustment Reason Codes 204 The (CARC) 16 Claim/service 96 Non-covered service/equipment/drug lacks information charge(s). is At not least covered which under is needed for one Remark the Code patient s adjudication. current At least one Remark Code must be provided. plan. must be provided. Claim adjustment reason codes communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code. Reference: AMA 2012 National Health Insurer Report Card

26 Efficient Encounters = Revenue Cycle Success Remittance Advice Remark Codes (RARC) N386 The decision was N179 Additional based on a National information has Coverage been Determination requested from (NCD). the An NCD provides a member. The charges coverage will determination as to be reconsidered whether upon a particular item or receipt of that information. service is covered. N130 Consult plan benefit documents or guidelines for information about restrictions for this service. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a CARC or to convey information about remittance processing. Each RARC identifies a specific message as shown in the RARC List. There are two types of RARCs- majority are supplemental to the CARC codes, but some are for information purposes only. Reference: AMA 2012 National Health Insurer Report Card

27 Efficient Encounters = Revenue Cycle Success Payment Processing Contractual Non-contractual t Post all zero pays Utilize system automation Reconciliation

28 Efficient Encounters = Revenue Cycle Success Payment processing Reconciliation Process: 1)Separate deposits 2)One batch per deposit (i.e. ERA/EFT) 3)Uniform batch description» (i.e. $34, Anthem 5/6/2013) 4) Match to bank deposits to system» Download each into Excel format» Data sort by dollar amount» Utilize other data to compare if needed

29 Efficient Encounters = Revenue Cycle Success Patient Statements Electronic statements Make it convenient Two statements Day 0 Day 30 Collection letter Day 60 Day 75 turnover Increased 7% from E-statements save providers approximately 42% compared to paper statements. In paying their medical receiving bills electronically % of patients medical bills via It is estimated that consumers in the U.S. will spend more than $300 billion online in Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012 Reference: Gartner Group, HFMA, and HH&N Research

30 Efficient Encounters = Revenue Cycle Success Account resolution Automate when possible 277/997 reports 24 hours after submission days clearinghouse 31+ days payer website/phone Universal note area Appropriate reports Review notes & tasks Payer High $$$ Down DOS Group by Patient

31 Efficient Encounters = Revenue Cycle Success

32 Efficient Encounters = Revenue Cycle Success 100 claims a day X 20 days a month 2,000 claims 20% denial rate 2,000 claims X 20% = 400 claims 33% of denials are never recovered 400 X 33% = X $ (average reimbursement) = $13,200 monthly Source: The Physician Billing Process: 12 potholes to avoid in the road to getting paid, ed 2, Walker-Keegan, Woodcock, Larch.13

33 Efficient Encounters = Revenue Cycle Success $10.67 staff time $ 1.50 supplies $ 1.75 interest $ 1.00 overhead $14.92 $5,968 x 400 x 12 $5,968 Monthly $14.92 $203,016 $71,616 Annually Source: The Physician Billing Process: 12 potholes to avoid in the road to getting paid, ed 2, Walker-Keegan, Woodcock, Larch.13

34 Efficient Encounters = Revenue Cycle Success Should it be written off? Contractual versus non-contractual adjustment If Is so, a correction & resubmit! needed? Collect data, follow Should payer it process, be involve appealed? patient & track status

35 Efficient Encounters = Revenue Cycle Success Collection process Automate process Monitor results Write-off at turnover Write off utilizing specific Write off utilizing specific code; create reports by specific code to track agency results.

36 Efficient Encounters = Revenue Cycle Success Where do you go from here? Decide what is right for your practice! Investigate your options Automate when possible Centralize processes Stay up-to-date on new options Partner with your clearinghouse Think outside the box Keep an open mind Reference:

37 Advanced Staff Training Dismissal Process Eligibility Bad Debt Collection Process Cost Estimation TOS Collection Counsel Patient

38 MEASURING REVENUE CYCLE PERFORMANCE

39 Accelerating gyour Revenue Cycle: From Patient Encounter Through Account Resolution Measuring Revenue Cycle Performance What is important? Reporting and analysis Tracking and acting

40 Measuring Revenue Cycle Performance What is important? Collections Cash in the door Production Units to produce the cash

41 Measuring Revenue Cycle Performance What is important? Collections! A/R Charges, payments, & adjustments Provider Practice Days outstanding Payer mix Collections per RVU Service line Provider

42 Measuring Revenue Cycle Performance What is important? Collections Payments Third party Underpayments Denials and rejections Patient TOS collections Commitment to payment plans

43 Measuring Revenue Cycle Performance What is important? Collections Credit balances Patient Third party Bad debt % bad debt to total revenue Collection agency recovery

44 Measuring Revenue Cycle Performance What is important? Production! CPT/RVU production Location Provider Case mix Location Provider

45 Measuring Revenue Cycle Performance

46 Measuring Revenue Cycle Performance Reporting and analysis Audience Content Presentation method Frequency

47 Measuring Revenue Cycle Performance Reporting and analysis Audience - Providers Short & sweet Personalized Audience - Executive Broader content Presentation method Narrative Columnar Graphical

48 Measuring Revenue Cycle Performance Reporting and analysis Daily Denials and rejections TOS collections Appointments with no charges EFT/ERA reconciliations

49 Measuring Revenue Cycle Performance Reporting and analysis Weekly Third party underpayments TOS collections

50 Measuring Revenue Cycle Performance Reporting and analysis Monthly Charges/payments/adjustments CPT/RVU utilization Denials and rejections summary Bad debt Credit balances Patient underpayments

51 Measuring Revenue Cycle Performance Reporting and analysis Quarterly Capitation plan performance Payer mix Charges Payments Annually Fee schedule assessment Capitation plan performance Budgeted revenue vs. actual revenue Budget production vs. actual production

52 Measuring Revenue Cycle Performance Tracking and acting KPI Data point or criteria Benchmark Type of KPI Data point to measure results against Internal or external

53 Measuring Revenue Cycle Performance Tracking and acting Why use KPI s? Measure what s important Identify trends Compare progress to expectations Incentivize desired behaviors

54 Measuring Revenue Cycle Performance Tracking and acting KPIs %Co-pays collected vs. total possible co-pays Charge lags Office visits Off-site services Budgeted charges % clean claims Unbilled charges Staff production standards Denials Payer mix

55 Measuring Revenue Cycle Performance Tracking and acting How do you use KPI s? Dashboard Snapshot summary of key results Internal benchmarks»historical External benchmarks» Marketplace» Industry

56 Measuring Revenue Cycle Performance Tracking and acting Dashboard Decide what s most important Identify the data point to measure Identify the benchmark for comparison Design dashboard to meet your practice s needs Populate dashboard Act on variances to the benchmark

57 Measuring Revenue Cycle Performance Key Indicators Indicator Calculation Significance Frequency Trend Gross Days Receivable Outstanding (DRO) Total A/R divided by Average Daily Charge Total YTD Payments Gross Calculation divided by Total YTD Ratio Charges Total YTD Payments divided by Total YTD Charges less YTD Contractual Net Collection Ratio Adjustments % Insurance A/R 90+ Days Insurance A/R greater than 90 days divided by Total Insurance A/R Indicates how long it takes to convert a claim into cash. Monthly Should be downward trend Less than 30 Indicates proportion of charges that are converted to cash. Monthly Should be upward trend. Indicates effectiveness of collection efforts on potential dollars, including point of Should be upward trend. 96% service payments. Monthly or greater. Low proportion indicates that accounts are collected effectively. Should be downward trend Monthly Less than 10%

58 Measuring Revenue Cycle Performance

59 Measuring Revenue Cycle Performance Month Charges Adjustments Payments Feb-12 $ 52, $31, $47, Mar-12 $ 86, $37, $48, Apr-12 $105, $39, $54, $140, May-12 $ 98, $46, $60, $120, Jun-12 $ 96, $36, $47, $100, Jul-12 $ 98, $51, $68, $80, Aug-12 $ 99, $38, $53, $60, Sep-12 $114, $31, $46, Oct-12 $120, $63, $78, $40, Nov-12 $ 85, $41, $55, $20, Dec-12 $ 99, $47, $60, $- Jan-13 $117, $47, $64, Feb-13 $ 84, $35, $47, Decrease in charges one month means decrease in payments succeeding month! Charges Adjustments Payments Analyze charges, adjustments & payments monthly. Correlate with practice/provider production.

60 Measuring Revenue Cycle Performance Payment Analysis Payer Name Encounter Chg Amt Count Adj Amt Allowed Amount Fee Schedule Variance Anthem Blue Choice PPO $ $ $ $ $ Anthem Blue Choice PPO $ $ $ $ $ Anthem Blue Choice PPO $ $ $ $ $ Anthem Blue Choice PPO $ $ $ $ $ Anthem Blue Choice PPO $ $ $ $ $ Anthem Blue Choice PPO $ $ $40.00 $ $ Anthem Blue Choice PPO $ $ $40.00 $ $ Anthem Blue Choice PPO $ $ $85.93 $ $ Anthem Blue Choice PPO $ $ $85.93 $ $ Anthem Blue Choice PPO $ $ $20.00 $ $ Anthem Blue Choice PPO $ $ $ $ $ Anthem Blue Choice PPO $ $99.07 $ $ $ Anthem Blue Choice PPO $ $99.07 $ $ $ Anthem Blue Choice PPO $ $ $ $ $ Anthem Blue Choice PPO $ $99.07 $ $ $ Anthem Blue Choice PPO $ $99.07Compare $ allowed $ $ Anthem Blue Choice PPO $ $ $85.93 $ $ Anthem Blue Choice PPO $ $99.07 amount $ not paid $ $ Anthem Blue Choice PPO $ $ $ $ $1.35 amount Anthem Blue Choice PPO $ $99.07 $ $ $ Anthem Blue Choice PPO $ $99.07 $ $ $ Anthem Blue Choice PPO $ $99.07 $ $ $ Anthem Blue Choice PPO $ $99.07 $ $ $0.00

61 Measuring Revenue Cycle Performance Start here tracking results Date of Claim submission to Payer Adjudication Date of Payer Adjudication to Patient Statement/Denial Worked and resubmitted DOS to date of documentation (DOD) Date of Charge Entry to Claim Submission Total Lag Time from DOS to Fully Adjudicated Date of Documentation to date of coding (if not utilizing CAC) Date of Coding to Date of Charge Entry

62 IDENTIFYING YOUR OPPORTUNITIES

63 Accelerating gyour Revenue Cycle: From Patient Encounter Through Account Resolution Identifying Your Opportunities Assess the situation Revenue cycle assessment System assessment Prioritize the opportunities Develop plan for capitalizing Implement plan Monitor and track results

64 Identifying Your Opportunities Revenue cycle assessment Lost revenue Staff productivity and quality Provider documentation Payer billing issues Common denials Missing links in process

65 Identifying Your Opportunities Revenue cycle assessment Select span of time 90, 120 or 180 days? Set expectations Charge lag time 24 hours Bill lag time 48 hours Claim note 30 days Work denial 24 hours Collection agency turnover 90 days from patient responsibility

66 Identifying Your Opportunities Patient Name (L, F) Payer DOS Code(s) Charges DCE DCF Legend: DCE Date Charge Entered DCF Date Claim Filed Date Paid Paid Adj. Balance Activity Status Rating Total Average

67 Identifying Your Opportunities System assessment EHR PMS Interfaces Set criteria Is it measurable? Select expectations Tasking Automation Uniform processes

68 Accelerating your Revenue Cycle From Patient Encounter Through Account Resolution What Does An Accelerated Revenue Cycle Mean? Communication Efficient processes Effective procedures Optimal systems utilization Effective use of resources Attentive management

69 Accelerating your Revenue Cycle From Patient Encounter Through Account Resolution What Does An Accelerated Revenue Cycle Mean? Maximum return on investment on accounts receivables. More Revenue. More Quickly!

70 Accelerating your Revenue Cycle From Patient Encounter Through Account Resolution

71 September 18 Sustainable Compensation Models that Incentivize: Trends & Examples November 6 Operational Effectiveness and Profitability: Identifying and Prioritizing Opportunities December 4 Keeping the Financial Pulse of Your Practice Healthy: Benchmarking and Trends

72 Anders Health Care Services Anders Health Care Services optimizes staff, resources and revenue for hospitals and physicians by offering solutions and direction to complex practice management issues. We provide an integrated approach from the financial, operational, compliance and strategic perspectives.

73 Anders Health Care Services Jerrie K. Weith, FHFMA, CMPE Chastity D. Werner, RHIT, CMPE, NCP

74 Anders Health Care Services Jessica Johnson Brian McCook John McGuire Brian Meyers