QUORUM HEALTH RESOURCES REVENUE CYCLE STEERING COMMITTEE START-UP KIT, V5. Contents:

Transcription

1 Cntents: 1. Sample Team Charter Outline: Page #2 2. Sample Agenda: Page #3 3. Sample Rle and Respnsibilities : Page #5 4. Suggested Scre Card : Page #7 5. Sample Management Actin Plan : Page #9 6. Sample RCSC Status Reprt: Page #11 Page 1 f 13

2 Sample Charter Outline The gal is t increase net revenue The purpse f the Revenue Cycle Team is t have equal representatin frm cmpnent prcess t meet and discuss: Prblem Awareness, Actin Plans and Mnitring Idea Sharing and Generatin Benchmark Tracking and Mnitring Gal Setting & Timely Review Practive revenue cycle peratinal and technlgy planning fr new and/r revised services and/r systems The Team shall cnsist f the fllwing cre team members List names and titles frm Rles and Respnsibilities Adhc Subcmmittees may be created with ther Hspital Managers The Team shall meet at least mnthly The Team Shuld: Have Equal Representatin frm each Department Establish a Revenue Cycle Champin Have a Dedicated Revenue Cycle Team Meeting Be Metric, Benchmark and Actin riented Fcused Page 2 f 13

3 Sample Agenda (with Sample Cntent) I. Overview f Revenue Cycle Prject Status II. Outline f Next Steps III. Overview f Revenue Cycle Team a. Purpse, Visin, Participants, etc. IV. Overview f Key Perfrmance Indicatrs and Revenue Cycle Weekly (Mnthly) Reprting Package a. Updates frm: Administratin Facility Benchmark/Scre Card review; On barding f new Physicians, Services and/r Physician Practices and ther rganizatinal issues which impact AR Patient Access Denials and ther issues which impact AR and actin plans Case Management High Dllar In-Huse Reprt and ther issues which impact AR and actin plans HIM DNFB reprt, issues and actin plans and ther peratinal/technical issues which impact AR PFS Clean claims rate, billing edits, payr issues, denial management and ther issues impact AR and actin plans and reasns IT Status f the autmatin f tracking tls, system upgrade, new systems and ther IT upgrades which impact AR b. Future data pints: Patient Access Quality, Pre-Cert rates, Pre-reg rates, etc. Case Management Avidable Days/Delays Discharged Nt Final Billed Rt Cause Analysis Billing Edit Analysis Denial Management and rt cause analysis Cmmunity Needs (? Dan shuld we add a bullet fr this requirement) V. Facility r Regulatry requirements (within 6-9 mnths) Page 3 f 13

4 VI. Success Stries VII. Outstanding Questins Des unbilled reprt include in-huse accunts? Des billing exceptin reprt include in-huse accunts? VIII. Prjects IX. Other a. Patient Access and registratin including Emergency Rm Department i. Wrkflw ptimizatin 1. Centralized Scheduling/Pre-Registratin 2. Insurance Verificatin and medical necessity screening ii. Patient Status and crdinatin with Case Management b. Health Infrmatin Management i. Wrkflw ptimizatin ii. Cding prductivity iii. Discharge nt final billed slutins iv. Physician cmmunicatins and Queries c. Patient Financial Services i. Separatin f Billing and Cllectins ii. Centralized Scheduling/Pre-registratin iii. Denial Cdes / Denial Management Prcess iv. Prper Dcumentatin fr Write-Offs d. Infrmatin Technlgy i. System upgrades and/r nbarding 1. Testing scripts 2. Testing timeline 3. Staff educatin Page 4 f 13

5 SAMPLE ROLES AND RESPONSIBILITIES Patient Access Services: Discuss the insurance verificatin r payment arrangement status f high dllar in-huse accunts. Track and trend registratin quality and reprt prgress t team each week (mnth). Prvide update n pint f service cllectins status cmpared t gals. Update n successes t bst centralized scheduling and preregistering. Case Management: Discuss the status f all in-huse high dllar accunts; ensure that all patients meet inpatient criteria; ensure that all extended authrizatins have been btained; ensure that discharge planning has been initiated n all accunts; discuss barriers t efficient discharge planning HIM and Cding: Discuss the status f all unbilled buckets (i.e. # and $ f charts held due t charge validatins, medical necessity screening and/r physician query delays, # and $ f accunts held due t missing dcumentatin, etc.). Identify rt causes fr each categry and develp actin plans fr reslutin. Identify clinical dcumentatin trends by physician and/r clinical service. Review plan fr wrking thrugh any existing backlgs and update team weekly n the prgress. Patient Accunts (Business Office): Discuss key revenue cycle statistics (such as A/R days, average daily revenue, cash cllectins fr the week, etc) and discuss key prcess issues that may impact thse statistics; review A/R aging; discuss fllw-up status f all third party accunts ver 90 days, ver $10,000; review prductivity fr fllw-up staff and billing staff; review plan fr wrking thrugh ld accunts and new accunts; discuss errrs related t cding and registratin; reprt accunts being transferred t bad debt. Managed Care: Listen fr trends with respect t prblem payers and practively seek slutins t reslve unpaid and/r underpaid accunts. Practively seek input frm Patient Access, Case Management, and Business Office staff regarding cntract negtiatins. Infrmatin Systems: Listen fr ways that IT may be leveraged t assist with Revenue Cycle prcess issues. Ensure that super users are kept up t date n new features/upgrades t system. Ensure that there is rutine cmmunicatin between IT analyst and department super users Page 5 f 13

6 Chargemaster: Reprt educatinal needs t the team such as physician dcumentatin errrs; wrk with case management t review accunts with targeted DRGs fr dcumentatin; track, trend, and reprt late charges by department; review key Medicare edits that may have a majr impact n reimbursement Finance and Reimbursement: Prvide analysis t team n the impact f Chargemaster changes t reimbursement Senir Management: CEO r CFO will lead Revenue Cycle Team meetings; hld each team member accuntable fr last week's "t d" items; listen fr trends/issues that require executive level supprt and practively address at the end f each meeting; reprt utcmes t team at next meeting Facilitatr: Prepares meeting dcuments and facilitates meetings. Can be ne f the team members and respnsibility can rtate Page 6 f 13

7 Revenue Cycle Scre Card Each rganizatin will develp a unique scre card fr tracking revenue cycle indicatrs. There are prcess r perfrmance indicatrs effecting the verall revenue cycle. These wuld nrmally nt be indicatrs unique t individual department perfrmance. It will be best t set up yur versin in MS Excel (Sample Excel file may have been included in Kit). Revenue Cycle Screcard Sample Perfrmance Area: REVENUE PERFORMANCE Target Status Indicatr Bad Debt Transfers as % f Grss Revenue Charity Care as % f Grss Revenue In huse Days DNFB Days Billed Days Ttal AR Days 06/30/14 AVOIDABLE ADJUSTMENTS (Ttal)> $0 Denial Write Off Eligibility Nn Cvered Self Administered Drugs Untimely Filing Medical Necessity CHARGE TIMLINESS AND ACCURACY $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Late Charges % f Grss Revenue <2.0% 0.0% Charge Errrs <2.0% 0.0% Page 7 f 13

8 PATIENT ACCESS SERVICES Mnthly POS Cash Cllectins $0 Pre Registratin Rate (Nn Emergent Pt's nly) >90% 0% Centralized Scheduled 90% 0% Registratin Accuracy >98% 0% CASE MANAGEMENT Admissins reviewed w/in 1 bus. day 100% 0% Medicare Average LOS 0.00 Medicare CMI 0.00 Observatin ALOS (in hurs) 0 CLAIM PERFORMANCE Clean Claim Rate (pre claim transmissin) > 95% 0.0% MEDICARE REMIT REJECTIONS CATEGORIES* Duplicate Nn Cvered COB Eligibility Infrmatin Requested Cding Medical Necessity "Prvider Type" Issue Untimely Filing $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Percent Rejectins: <2% 0% *Denial Surce: Medicare 835 Remit Files Line item denial data Page 8 f 13

9 SAMPLE MANAGEMENT ACTION PLAN (if nt using Status Reprt belw) Management Actin Plan The Management Actin Plan (MAP) prvides the Revenue Cycle Team with a tl fr change management. The MAP further serves t dcument management decisins and t prvide a frum fr assigning respnsibility fr varius tasks and prjects. The MAP includes Clumns as fllws: Item #: Numeric tracking identificatin fr main tasks and sub-tasks. I.E: 1.0 main task, 1.1 sub-task Pririty: High, Medium r Lw based n ptential impact, barriers r ther pririties Task: Brief descriptin f the actin step Respnsibility: Title f Primary and secndary wner f this task, culd be a sub-cmmittee Start Date (actual r Helpful t make the distinctin frm actual and expected): expected. Mnth and year are nrmally fine. Actual Cmpleted Mnth and year are nrmally fine Date: Cmments: Parking spt fr ntes abut delays, cautins r reasns t table task Page 9 f 13

10 Item Pririty Task Cmments # Respnsibility Start Date (actual r expected) Actual Cmpleted Date Page 10 f 13

11 SAMPLE STATUS REPORT (If nt using MAP) Revenue Cycle Team Weekly (Mnthly) Status Reprt Revenue Cycle Team Chair Status Reprt Date: Reprting Perid: Overall Prject Status Prject Respnsible Department/Leader Status Cmments Status Key: Cmplete: On Target / In Prcess Delayed Nt Started Page 11 f 13

12 Discussin Pints Discussin Pint Cnsideratins Decisin(s) Significant Accmplishments fr this Reprting Perid Wrk Planned fr Next Reprting Perid Deliverables Deliverables Status Status Key: Cmplete: On Target / In Prcess Delayed Nt Started Page 12 f 13

13 Other Discussin Tpics: Next Meeting (Date/Time) Page 13 f 13