AR MANAGEMENT FOR THE LTC PROFESSIONAL

Transcription

1 1 AR MANAGEMENT FOR THE LTC PROFESSIONAL LEADINGAGE MICHIGAN 2015 LEADERSHIP INSTITUTE Carolyn Lookabill

2 Notice of Disclosure 2 Richter Healthcare Consultants has produced this material as an informational reference. Richter Healthcare Consultants employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the healthcare environment is constantly changing, and it is the responsibility of each individual to remain abreast of the regulatory and reimbursement compliance. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice.

3 Objectives for the Day 3 Participants will be able to: List and describe at least three performance indicators to help ascertain the monthly efficiency of the SNF Business Office Participants will be able to describe how DSO is calculated and used as a measurement for performance Describe key Revenue Cycle standards that will help to ensure that billing for care provided will not be delayed due to errors in the billing process at the facility level Understand the Triple Check Process and why it is fundamental to the Revenue Cycle process

4 AR Management for LTC Professional 4 Revenue Cycle standards Oversight and monitoring Compliance Personnel management Change management

5 Revenue Cycle Standards 5 Admission/Intake Best Practice Verification Paperwork Contracts Communication E-Referral/Integrations Costing

6 Revenue Cycle Standards 6 Software and Technical Resources Software system should meet all regulatory standards Set up and ongoing maintenance Staff should attend software vendor training/webinars Utilize software support, call the vendor for updates and new information EDI solutions Utilize online resources provided by payers

7 Revenue Cycle Standards 7 Technical Knowledge Timely and appropriate follow-up on claims Proper denial management Lost revenue charge capture Know your contracts with payers

8 Revenue Cycle Standards 8 Accuracy Checks and Balances Triple Check Process Remittance reconciliation Revenue test/month-end reconciliation Segregation of duties Effective denial management & collection practices

9 Oversight & Monitoring 9 Aging reviews Performance indicators Internal auditing Process review

10 Oversight & Monitoring 10 Aging Reviews Monthly scheduled AR Reviews with the Business Office Review by Payer Identify red flags : resources unpaid for 30 days, payer denials, collection issues Assist with next steps, escalation points Compare collection efforts to Policy & Procedure standards Document results Include in performance reviews

11 Oversight & Monitoring 11 Performance Indicators: Days Sales Outstanding (DSO) Average Daily Revenue (ADR)=3 months revenue divided by days DSO= Total A/R divided by ADR Trend analysis rolling three month comparison of AR in total and by payer Percentage of AR older than 90 days Percentage of revenue collected Percentage of bad debt Should be less than 1% of revenue

12 Oversight & Monitoring 12 Process Review Model on logical process flow Document responses and findings Plan of Correction Implement corrective action Include in compliance plan/policy and procedure manual Monitor progress Include findings in performance evaluation process

13 Oversight & Monitoring 13 Safeguarding AR and Cash Loss Prevention Know payer timeframes for payment Scrutinize revenue adjustments and bad debt write offs Utilize lockbox

14 Oversight & Monitoring 14 Safeguarding AR and Cash Loss Prevention Electronic funds transfer (EFT) and electronic remittance advice (ERA) Signature control Require two signers on Resident Trust Fund (RTF) checks Segregation of duties

15 Oversight & Monitoring Safeguarding A/R and Cash Loss Prevention Audit/reconcile Resident Trust Fund (RTF) monthly Daily deposits If not feasible, lock un-deposited funds in a safe Compare revenue to collections

16 Compliance 16 Understand Provider Rules and Regulations CMS Provider Manuals, National/Local Coverage Determination (NCD/LCD), other Federal and State regulations Monitor and understand the OIG work plan Collection Laws (Fair Debt Collection Act, Fair Credit Billing Act)

17 Compliance 17 Understand Provider Rules and Regulations False Claims Act HIPAA standards Privacy protection Electronic Data Interchange (EDI) Cyber-Compliance

18 Compliance 18 Preparedness Keep current on the latest integrity program information and findings via government websites, trade and professional associations Confer with legal counsel to schedule integrity compliance audits conducted by an independent consulting firm

19 Compliance 19 Preparedness Develop compliance strategy Designate Compliance Officer and team Build into Policy & Procedure manual integrating regulatory guidelines. Incorporate all revenue cycle functions and detail at task level Empower the people and the process Educate, and then hold staff accountable

20 Personnel Management 20 Smart hiring practices Job descriptions and performance measurements Monitoring Sufficient training and ongoing education Staffing levels based on facility size and type

21 Change Management 21 Medicaid Managed Care Medicare advantage claim requirements Bundled reimbursement (ACO s) Increasing scrutiny by OIG and other Federal oversight agencies

22 Change Management 22 ICD-10 Interoperability: is the ability of making systems and organizations to work together

23 Objectives for the Day 23 Participants will be able to: List and describe at least three performance indicators to help ascertain the monthly efficiency of the SNF Business Office Participants will be able to describe how DSO is calculated and used as a measurement for performance Describe key Revenue Cycle standards that will help to ensure that billing for care provided will not be delayed due to errors in the billing process at the facility level Understand the Triple Check Process and why it is fundamental to the Revenue Cycle process

24 Resources 24 Centers for Medicare & Medicaid Services (CMS) Office of the Inspector General (OIG) American Health Information Management Association Health Care Compliance Association Healthcare Financial Management Association (HFMA)

25 Carolyn Lookabill 25 Phone: (216) Toll Free: Connect: LinkedIn and Facebook Web:

26 Contact Richter Healthcare Consultants 26 Phone: (216) Toll Free: Fax: (216) Connect: LinkedIn and Facebook Web: Visit: 8948 Canyon Falls Blvd. Suite 400 Twinsburg, OH 44087