Aged Accounts Receivable

Transcription

1 Aged Accounts Receivable

2 Agenda Introduction Objectives About Us Overview Benefits Process Analysis Reporting Investment Next Steps

3 Introduction John Boland John Boland is vice president at MedSynergies (MSI) and responsible for advising healthcare billing organizations on selecting services to enhance their revenue cycle. Prior to joining MSI in 2005, John directed national and regional client services with IDX Systems Corporation, where he provided revenue cycle outsourcing solutions to medical group practices. He received a bachelor of arts in economics from the University of Chicago in Illinois.

4 Objectives Describe MedSynergies service for processing old AR. Show examples. Let you know how you can take advantage of the service.

5 MedSynergies About Us Founded in September 1996 by physicians 13 years of investment in processes and technology to optimize Centricity Group Management Business service provider to medical billing organizations Billing optimization consulting Payment processing services Denial management services Business analytics Technology services Including ASP hosting of GE Centricity Group Management (formerly IDX Groupcast ) Patient self-pay services

6 MedSynergies About Us Headquarters: Irving, Texas Regional offices: Little Rock, Chicago, Orlando and Phoenix 240 Employees Serving over 3,600 providers and 55 specialties in 37 states and supporting more than 4,500 concurrent end users Providers like: Physician practices Hospitalists Corporate Home healthcare/infusion therapy Surgery centers Emergency departments

7 Service Overview Work 100% of your aged insurance receivables! Sorting through old accounts receivable (AR) is time-consuming and labor intensive for most physician groups. You specify which receivable accounts need to be worked 90 days or older. Comprehensive analysis will classify all aged accounts by status including: Denial reasons Balance type No response You can choose to purchase the comprehensive aged AR analysis or both the analysis and the processing of the accounts. The service is offered as either a one-time project or on an ongoing basis. The analysis can be completed in 2-3 weeks.

8 Benefits Some of the benefits to working your old AR: Process unresolved accounts in an accelerated time frame Increase revenues with an average positive return on investment of over 200% Eliminate unnecessary write-offs Focus your management time on caring for patients Understand and address root causes for aged AR trends The chart below illustrates the return on investment for a recent client:

9 Benefits "Our A/R collections have increased and our business office costs have decreased significantly!" Wesley Jones Chief Financial Officer Central Utah Clinic

10 The Process High Level Initiation Analysis Research Follow-up Ongoing Follow-up Reporting

11 Analysis

12 Analysis A/R Inventory Waterfall The source of the waterfall is MedSynergies consulting business: Practice assessments System configuration assessments Process redesign Financial assessments The A/R waterfall is a financial and operational assessment tool. Used to align human resources with the workload. Provides guidance on where to invest in automation. Manufacturing view of every CPT with touches and stopping points. Total A/R at a given point in time. < 60 days from charge posting date and > 60 days from charge posting date. While specific to A/R, it can be used as a process map for your organization. As a result, we ve divided our own organization into various operational units to better align our staff with the work.

13 Analysis The Waterfall Open Credit Balance Total I 42,896 4,751 47,647 W 1, ,044 P 25, ,044 C Total 70,692 5,321 76,013 Insurance A/R world Insurance % of total Self Pay % of total Pending Exhaust % of total Total Open Credit Balance Total 44,849 4,842 49, % 6.37% 65.37% 33.70% 0.56% 34.26% 0-30 Days 0.30% 0.07% 0.37% 93.00% 7.00% % 0 > 60 Days from D.O.C.P. <=60 days from D.O.C.P. I 20,693 22, Days W 718 1,235 Total 21,411 23,438 0 Printed On Hold Not Printed Printed On Hold Not Printed I 15,008 4, ,133 3, W Total 15,435 4, ,646 4, % of bucket 72.09% 21.16% 2.08% 79.55% 17.13% 3.32% % of Total 21.83% 6.41% 0.63% 26.38% 5.68% 1.10% 0-30 Days Response No Response Response No Response I 10,684 4,324 5,593 12,540 W Total 10,879 4,556 5,632 13, Days % of bucket 70.48% 29.52% 30.20% 69.80% % of Total 15.39% 6.44% 7.97% 18.41% 0 C R A P D C R A P D I 0 3, , ,017 1,666 1,910 W Total 0 0 4, , ,037 1,667 1,928 % of bucket 0.00% 0.00% 37.01% 5.63% 66.56% 0.00% 0.00% 36.17% 29.60% 34.23% % of Total 0.00% 0.00% 5.70% 0.87% 10.24% 0.00% 0.00% 2.88% 2.36% 2.73%

14 Analysis The Waterfall

15 Example: Multi-Specialty Practice Composition of A/R (Units) No Response > 60 6% Credit Balance 7% Collections 0% Claims Issues 13% Self Pay 34% Self Pay Workable No Response <=60 17% Workable 23% No Response <=60 Claims Issues Credit Balance No Response > 60 Composition of the Workable % (Units) Straight Payments 13% Denials 52% Adjustment with Payment 35% Straight Payments Adjustment with Payment Denials

16 Example: Multi-Specialty Practice Composition of A/R (Dollars) No Response > 60 6% Credit Balance 5% Collections 0% Self Pay 24% Claims Issues 15% Self Pay Workable Composition of Workable A/R (Dollars) No Response <=60 27% Workable 23% No Response <=60 Claims Issues Credit Balance No Response > 60 Straight Payments 11% Adjustment with Payment 18% Denials 71% Straight Payments Adjustment with Payment Denials

17 Example: Analysis AR Categories Initial Analysis Denial transaction message codes Current balance type Age Root Cause Analysis Payer Provider Revenue center Department BRDHOS Place of service Insurance class

18 Analysis Sample Recommendations Sample Clinic Old A/R Summary Recommendations Charges Greater Than 1.5 Years Project PAYER OPTIONS RECOMMENDATIONS LOGIC 1. Send detailed report to payer for 1. Move forward with option 1 Primary Insurance Type = HMO last chance of adjudication. The Charge 540 days+ since DOS detailed report will include claim 2. Work unidentified credit balances Current Insurance = Primary Insurance date and claim run number. prior to presenting A/R report to Insurance Balance Type = Insurance physicians for write-off approval. Owed Amt > 0 2. Provide physicians with a Move any possible to open A/R if breakdown report of accounts > match found. 365 days from date of service for write-off approval. HMO Primary-(540+ days from date of service) (Top six local carriers in which possible recovery of funds could occur) 1. GEMMA 2. HPUB 3. CDMM 4. ALTIMA PLAN 5. PRO HEALTH 6. BLUE CROSS BLUE SHIELD MEDICAID- (540+ days from date of service) MEDICARE (540+ days from date of service) BLUE CROSS BLUE SHIELD (540+ days from date of service) 1. Write-off 1. Check for unidentified credit balances on Medicaid accounts. Move any possible to open A/R if match found. 2. Write-off 1. Write-off 1. Check for unidentified credit balances on Medicare accounts. Move any possible to open A/R if match found 1. Send detailed report to payer for last chance of adjudication. The detailed report should include claim date and claim run number. 2. Provide physicians with a breakdown report of accounts > 365 days from date of service for write-off approval 2. Write-off 1. Move forward with option 1 2. Work unidentified credit balances prior to presenting A/R report to physicians for write-off approval. Move any possible to open A/R if match found. Primary Insurance Type = Medicaid Charge 540 days+ since DOS Current Insurance = Primary Insurance Insurance Balance Type = Insurance Owed Amt > 0 Primary Insurance Type = Medicare Charge 540 days+ since DOS Current Insurance = Primary Insurance Insurance Balance Type = Insurance Owed Amt > 0 Primary Insurance Type = BCBS Charge 540 days+ since DOS Current Insurance = Primary Insurance Insurance Balance Type = Insurance Owed Amt > 0

19 Once the Analysis is Completed Research Line item interaction with payer Detailed steps to realize payment Comprehensive, regular interval reporting on progress and success Follow-Up MedSynergies can update and utilize Groupcast for next steps One-time or continuous project Comprehensive, regular interval reporting on progress and success

20 Research Reporting Examples The service includes weekly and monthly status reports with specialty and/or regionally-specific benchmarks.

21 Research Reporting Examples Remaining Accounts AR Researched Write Offs/Adjust/Transfers Aged AR AR Project Yield to Date Date Accounts Units Revenue Accounts Units Revenue Accounts Units Revenue Accounts Units Payments Adjustments Owed Amount Total Aged AR 15,185 40,612 $6,099, /7/2008 1,203 1,889 $281, ,723 $5,818, $1, $3, $ /14/2008 1,274 2,456 $367, $153, ,426 $5,297, $17, $16, $2, /21/2008 1,092 1,998 $225, $24, ,381 $5,047, $10, $20, $4, /28/2008 1,366 2,590 $301, ,640 2,458 $397, ,333 $4,348, $59, $54, $4, /4/2008 1,095 2,490 $237, $ ,843 $4,111, $99, $101, $16, /11/2008 1,304 3,440 $362, $4, ,385 $3,744, $58, $54, $3, /18/2008 1,391 2,404 $389, ,324 2,368 $123, ,613 $3,231, $28, $46, $7, /25/ $0.00 9/1/ $0.00 9/8/ $0.00 9/15/ $0.00 9/22/ $0.00 9/29/ $ /6/ $0.00 Totals 8,726 17,267 $2,165, ,547 5,732 $703, ,543 2,450 $275, $297, $39, Transfers to next payers $123, Re-filed to 2 ND /3 rd Insurance; 1,993 units for $58, Transferred to patient; 263 units for $56,085 Transferred to next payer: 112 units for $9, Old AR ROI Calculation Project Yield for the week of August 18, accounts, 500 units, $28, Paid Amount $28, Contractual Adjustments $46, Per Account Fee $ 6.00 $73, Owed Amount $7, Analysis Fee $10, Total Investment $83, Balance of $7, units with $0 balance Cash Collected TD $275, units with a balance of $9, with a P balance of $7, Return 330% 35 with an I balance of $1, units with a P credit balance of ($1,823.41)

22 Research Reporting Examples 8/11/2008 Actions/Updates Write Offs for this week: CO55 SVC DEEMED EXPER/INVESTIGATIONAL These charge were first tagged as out of scope of the project All were researched by CBO and the uncollectable open AR is reflected below 17 accounts, 18 units, for $4, All Out Of Scope charge messages codes have been reviewed/researched This portion of the project has been completed All transfers, write offs, and adjustments have been completed from this portion of the AR project Per the direction of CBO, we have excluded the AR for the Neurology and Diagnostic Imaging for DOS prior to January 1, The impact of this omission is reflected in the following breakout 3,608 accounts $634, AR 6,072 units The base of the new project total can be reflected in cells K4, L4, and M4 Project yield for the week of August11, accounts, 414 units; $58, Paid amount $58, Contractual adjustments $54, Owed amount $3, Balance of $3, units at $0 balance 32 units for $3, sitting at Self-Pay 32 units for $ sitting at Insurance balance

23 The Process High Level Initiation Analysis Research Follow-up Ongoing Follow-up Reporting

24 Investment Analysis $10,000 one-time investment Research $6.00 per account Follow-up $2.00 per account

25 Next Steps 1. Meet with your representative to review the process and agreement 2. Sign agreement 3. Data extract 4. Start analysis 5. Show results

26 Questions?