Accelerating your Revenue Cycle: From Patient Encounter Through Account

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

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

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

Characteristics of Best Performers Technology Systems HIE

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

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

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

Characteristics of Best Performers Payers Set-up Rules Options Changes Reference: AMA 2012 National Health Insurer Report Card http://www.ama-assn.org/ama/pub/physician-resources/practice-managementcenter/health-insurer-payer-relations/payer-specific-information.page?

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

EFFICIENT ENCOUNTERS = REVENUE CYCLE SUCCESS

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

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, email Insurance details Guarantor Ms. Smith, details I see you have a past due amount of $50.00. How would you like to take care of that Employer today? We information accept Visa, MasterCard, or do you have an FSA?

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. 2012 Note: These estimates include workers enrolled in HDHP/SO and other plan types. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006-2010.

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

Efficient Encounters = Revenue Cycle Success Eligibility & benefits verification Increase time with patients Faster payments Increased efficiency Reference: http://www.aetna.com/provider/medical/service_med/electronic_med/edi_calculator/edi_savings_calc.html

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

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

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.

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 2010. TOS Collection % for Providers Reason the provider did not collect Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012

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

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?

Efficient Encounters = Revenue Cycle Success Utilize a clearinghouse 997 claim rejection report Submit charges within 24-48 hours 277u claim status report Initial follow-up 24 hours Level 1 rejections

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

Efficient Encounters = Revenue Cycle Success Payment processing PPACA Changed to 10/1/2014! Reference: www.cms.gov/.../hipaa-administrative-simplification/.../deadlines-and...

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 www.wpc-edi.com/reference/codelists/healthcare/

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 www.wpc-edi.com/reference/codelists/healthcare/

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

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. $34,584.03 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

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 2011-2012 2012 E-statements save providers approximately 42% compared to paper statements. In paying their medical receiving bills electronically % of patients medical bills via email It is estimated that consumers in the U.S. will spend more than $300 billion online in 2016. Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012 Reference: Gartner Group, HFMA, and HH&N Research

Efficient Encounters = Revenue Cycle Success Account resolution Automate when possible 277/997 reports 24 hours after submission 14-21 days clearinghouse 31+ days payer website/phone Universal note area Appropriate reports Review notes & tasks Payer High $$$ Down DOS Group by Patient

Efficient Encounters = Revenue Cycle Success

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% = 132 132 X $100.00 (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

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

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

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.

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: http://caqh.org/eft_enrollment.php

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

MEASURING REVENUE CYCLE PERFORMANCE

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

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

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

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

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

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

Measuring Revenue Cycle Performance

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

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

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

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

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

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

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

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

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

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

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

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%

Measuring Revenue Cycle Performance

Measuring Revenue Cycle Performance Month Charges Adjustments Payments Feb-12 $ 52,055.00 00 $31,614.00 $47,339.00 Mar-12 $ 86,907.00 $37,568.00 $48,464.00 Apr-12 $105,678.00 $39,273.00 $54,717.00 $140,000.00 May-12 $ 98,696.00 $46,484.00 $60,494.00 $120,000.00 Jun-12 $ 96,436.00 $36,220.00 $47,903.00 $100,000.00 Jul-12 $ 98,920.00 $51,498.00 $68,210.00 $80,000.00 Aug-12 $ 99,147.00 $38,574.00 $53,583.00 $60,000.00 Sep-12 $114,955.00 $31,091.00 $46,277.00 Oct-12 $120,458.00 $63,241.00 $78,275.00 $40,000.00 Nov-12 $ 85,598.00 $41,123.00 $55,719.00 $20,000.00 Dec-12 $ 99,943.00 $47,073.00 $60,816.00 $- Jan-13 $117,800.00 $47,919.00 $64,025.00 Feb-13 $ 84,708.00 $35,377.00 $47,559.00 Decrease in charges one month means decrease in payments succeeding month! Charges Adjustments Payments Analyze charges, adjustments & payments monthly. Correlate with practice/provider production.

Measuring Revenue Cycle Performance Payment Analysis Payer Name Encounter Chg Amt Count Adj Amt Allowed Amount Fee Schedule Variance 99204 Anthem Blue Choice PPO 15302 $225.00 1 $105.00 $120.00 $125.93 $5.93 99204 Anthem Blue Choice PPO 15536 $225.00 1 $102.00 $123.00 $125.93 $2.93 99204 Anthem Blue Choice PPO 16075 $225.00 1 $102.00 $123.00 $125.93 $2.93 99204 Anthem Blue Choice PPO 16077 $225.00 1 $102.00 $123.00 $125.93 $2.93 99204 Anthem Blue Choice PPO 16078 $225.00 1 $102.00 $123.00 $125.93 $2.93 99204 Anthem Blue Choice PPO 17630 $225.00 1 $185.00 $40.00 $125.93 $85.93 99204 Anthem Blue Choice PPO 17631 $225.00 1 $185.00 $40.00 $125.93 $85.93 99204 Anthem Blue Choice PPO 17721 $225.00 1 $139.07 $85.93 $125.93 $40.0000 99204 Anthem Blue Choice PPO 17722 $225.00 1 $139.07 $85.93 $125.93 $40.00 99204 Anthem Blue Choice PPO 18002 $225.00 1 $205.00 $20.00 $125.93 $105.93 99204 Anthem Blue Choice PPO 18121 $225.00 1 $100.42 $124.58 $125.93 $1.35 99204 Anthem Blue Choice PPO 18179 $225.00 1 $99.07 $125.93 $125.93 $0.00 99204 Anthem Blue Choice PPO 18203 $225.00 1 $99.07 $125.93 $125.93 $0.00 99204 Anthem Blue Choice PPO 18363 $225.00 1 $100.42 $124.58 $125.93 $1.35 99204 Anthem Blue Choice PPO 18715 $225.00 1 $99.07 $125.93 $125.93 $0.00 99204 Anthem Blue Choice PPO 18821 $225.00 1 $99.07Compare $125.93 allowed $125.93 $0.00 99204 Anthem Blue Choice PPO 18862 $225.00 1 $139.07 $85.93 $125.93 $40.00 99204 Anthem Blue Choice PPO 19051 $225.00 1 $99.07 amount $125.93 not paid $125.93 $0.00 99204 Anthem Blue Choice PPO 19605 $225.00 1 $100.42 $124.58 $125.93 $1.35 amount 99204 Anthem Blue Choice PPO 19734 $225.00 1 $99.07 $125.93 $125.93 $0.0000 99204 Anthem Blue Choice PPO 19755 $225.00 1 $99.07 $125.93 $125.93 $0.00 99204 Anthem Blue Choice PPO 19867 $225.00 1 $99.07 $125.93 $125.93 $0.00 99204 Anthem Blue Choice PPO 20213 $225.00 1 $99.07 $125.93 $125.93 $0.00

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

IDENTIFYING YOUR OPPORTUNITIES

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

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

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

Identifying Your Opportunities Patient Name (L, F) Payer DOS Code(s) Charges DCE DCF 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Legend: DCE Date Charge Entered DCF Date Claim Filed Date Paid Paid Adj. Balance Activity Status Rating Total Average

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

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

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!

Accelerating your Revenue Cycle From Patient Encounter Through Account Resolution

www.anderscpa.com/webinar-series 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

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.

Anders Health Care Services Jerrie K. Weith, FHFMA, CMPE 314-655-5558 jweith@anderscpa.com Chastity D. Werner, RHIT, CMPE, NCP 314-655-5561 5561 cwerner@anderscpa.com

Anders Health Care Services Jessica Johnson Brian McCook John McGuire Brian Meyers jjohnson@anderscpa.com bmccook@anderscpa.com jmcguire@anderscpa.com bmeyers@anderscpa.com 314-655-5500 www.andershealthcare.com