CHALLENGES IN PROFESSIONAL REVENUE CYCLE PRACTICE MANAGEMENT

Transcription

1 CHALLENGES IN PROFESSIONAL REVENUE CYCLE PRACTICE MANAGEMENT

2 Agenda Organizational Overview Analytics The CBO Story CBO PM Blank Measure it, Manage it Communication

3 ORLANDO HEALTH Healthcare Leader in Central FL People 5 th largest employer in Central FL 3.5M Central FL residents annually in seven counties 7,000 International patients annually $353 million in uncompensated care in 2012 Team members: 14,310 1,780 beds Physicians: 2,206+; of which 425 are employed Medical Education Faculty: 88 Residents: 194 Residency programs: 8 Orlando Regional Medical Center UF Cancer Center Orlando Arnold Palmer Hospital for Children Winnie Palmer Hospital for Women & Babies South Seminole Hospital Dr. P. Philips Hospital South Lake Hospital Fellowship programs: 12 Health Central

4 ORLANDO HEALTH Patients Total admissions: (with newborns) 107,405 Total births: 14,705 Total surgeries: 62,154 Total outpatient visits: 631,764 Total emergency visits: 290,275 Total trauma cases: 4,786 Financial Net revenue: $1.6 billion Total payroll: $620 million Total purchasing power: $1.4 billion Community Benefit Cost of charity care provided: $91.6 million Total uncompensated care provided: $214 million

5 ORLANDO HEALTH REVENUE MANAGEMENT Patient Business Patient Accounting HIM Application & Training Revenue Integrity Professional Services

6 ORLANDO HEALTH PHYSICIAN ENTERPRISE LINES OF SERVICE UF Cancer Center Orlando Outpatient Medicine & Primary Care Inpatient Medicine Orlando Health heart Institute Women s Health Institute Pediatrics Graduate medical Education Surgery & Orthopedics 6

7 PROFESSIONAL SERVICES, CBO 7 Corporate Director Manager Coding/Charge Mgmt (2047) Manager, Billing & Cash Application Manager, Accounts Receivable Managed Care Manager, Accounts Receivable Self Pay & Governmental Manager, Business Analytics Supervisor, Charge Mgmt Supervisor, Billing Edits Supervisor, Managed Care Supervisor, Accounts Receivable Governmental Departmental Liaison Supervisor, Coding (E&M) Supervisor, Cash Application Supervisor, Commercial Supervisor, Accounts Receivable Self Pay Home Health Supervisor, Coding (Surgical) Supervisor, Credit Balances/Refunds Supervisor, Coding Efficiency Supervisor, Coding Liaison

8 PROFESSIONAL SERVICES, CBO 8

9 PROFESSIONAL SERVICES, CBO Charge Mgmt Coding Billing Accounts Receivable Cash Receipts Business Analytics Visit creation Charge Capture TES edits Coding efficiency team Coding liaisons Assigned by Division Claims Transmission Statement Generation Charge Editing Assigned by Payor Payor Invoice Follow Up Customer Service Call Center Payor Relations Liaison Assigned by Lockbox & 835 Remit Refund Processing Credit Balance Review EOB Document Imaging Assigned by Division Denial Analysis First Pass Claims Ratio Practice Communication 9

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11 COMMUNICATION 11 Executive R&R Business Review Meetings Collection Improvement Quarterly Managerial Updates Administration Bi-Weekly Dept. Heads Monthly Practice Mgrs/Supervisors Monthly Administration Managers Supervisors

12 COMMUNICATION Insurance Follow Up Front Office Manager View Self Pay Collections Views ETM Task Stage Driven Views Rejection Views Claim Edit Views

13 COMMUNICATION - ANALYTICS

14 COMMUNICATION - ANALYTICS

15 COMMUNICATION - ANALYTICS

16 COMMUNICATION - ANALYTICS

17 COMMUNICATION - ANALYTICS

18 COMMUNICATION - ANALYTICS

19 [Near] Future - Team Member Performance Insights

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21 ORLANDO HEALTH FUTURE STATE Lumedix Provation SIS Enterprise Scheduling Hospitals, Practices, Diagnostics, Radiology, Nuc med, Rad Onc, Chemo, Rehadh, OHPG, MDACCO, and more Community Master Population Index Revenue Cycle Solution Hospital Patient Accounting and Practice Management GEMMS Cardiology EMR Hospitals Billing and Follow-Up Central Business office 837I Combined Call Center Scheduling, Auth, Pre-Cert Hospitals & Physicians One call does it all! Combined Call Center Hospital & Physicians Self-Pay Follow-Up Billing Questions Phone Payment Charity Application Physician & Professional Services Billing and Follow-Up Central Business Office 837P