Microsoft PowerPoint - Best Practices in Rev Cycle Mgmt - SDCMS 2009

Presented by:

Ron Anderson, CHMB Solutions www.chmbsolutions.com

Founded in 1995, CHMB delivers Business, Clinical and Technology Solutions to Transform Physician Practices.

CHMB billing and revenue cycle management expertise includes a wide range of surgical, primary care, and internal medicine specialties for over 750 providers throughout California. www.chmbsolutions.com

Ron Anderson, CPEHR, CPHIT CHMB Director of Business Development a CHMB shareholder, has worked in healthcare since 1990. In addition to overseeing sales and marketing for CHMB, Mr. Anderson plays a key role in CHMB Client IT Projects and Internet based solutions.

Expertise

Certifications

Revenue Cycle Management Reimbursement Analytics Healthcare Information Systems (HIS)

CPHIT – Certified Professional Healthcare Information Technology CPEHR – Certified Professional Electronic Health Records

Healthcare Industry Participation:

Co-Chair MGMA Information Technology Advisory Panel (since 2002) CAMGMA liaison to the California Medical Association (since 2004) CAMGMA Webmaster (since 2005) Past President of the California MGMA – CAMGMA (2003-2004) Past President of San Diego MGMA (2001 & 2002)

Revenue Cycle Where does it start? Where does it end?

Front Office $

Back Office $

Reception and Scheduling

Billing and Collections

Reporting and Analytics $

Gather Data, Analyze, Take Action

Gathering & Verifying Quality Data Point of Service Collections Audit Revenue Capture Accounts Receivable Metrics Monitoring Cash Flow Denials/Underpayments Measuring Productivity Analyzing Payer Contracts

Eligibility – Does you practice verify eligibility and obtain pre-authorization/referral for all appropriate patient services?

Patient Registration – Does your practice have (and monitor) basic data which is captured, verified and entered prior to or at the time of service?

Are you incorporating verified eligibility info to front office check-in staff?

How often do you update patient demographic information?

What percentage of patient co-pays are collected at time of service?

When are patients with outstanding balances being informed and/or requested to pay?

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Family Family Practice Practice Associates Associates

That which gets measured‌ gets done

$10,000 $ 7,500 $ 5,000 $ 2,500 - 0 -

Contests / Challenges with incentives & rewards

Are you auditing the capture of all provided services?

Do you reconcile your days superbills against the appointment book?

Do you reconcile inputted charges against surgery logs (IP and OP)?

Average Charge per patient/encounter Average Gross Collections Rate Missing/Lost Superbills Annual Lost Revenue per provider* * Assuming 25 patients per day

$ 200 55 % 1% $6,600

When was the last time you updated your fee schedule and superbill?

Do you periodically audit coding to maximize revenue potential and ensure compliance?

Do you know which procedures provide the best and worst profitability?

Are you sending claims daily?

Date of Service Date of Entry Date of Billing Date of Payment

Can you diagnose where the delays are?

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Examples might include how many: - encounters per day - payments per day ($$ or count) - turnaround (DOS to Bill Date) - Use Days in AR to measure follow-up If you outsource, measure date of sending batch to date of entry and claim creation

Track denials by payer, reason, and financial consequence and then prioritize activities Have dedicated denials process in place Must include “tickler” system so they don’t go unresolved Must have access to contractual allowables

Are you tracking adjustments?

Do you compare EOB allowables or contractual write-offs against your actual contracts?

Create your key Payor/Procedure Matrix

Medicare

99211 99212 99213 99214 99215 20.78 37.65 60.86 92.16 124.40

Blue Cross

21.82

39.53

63.90

96.77 130.62

Blue Shield

20.34

36.98

59.74

91.15 123.15

Aetna

19.74

35.77

57.82

87.55 118.18

How much of your over 90 day receivables is actually collectible?

Do you have a process for dealing with it?

By 120 days patient due it should be resolved. That means either: • Paid in full

• Payment plan

• Adjusted off

• Sent to collections

Collection Policy A 3 statements (90- 120 days) 14 days letter #1 14 days phone 14 days letter #2 14 days request approval for outside collection TOTAL: 160-190 days

Collection Policy B 2 statements (25-50 days) Phone Call #1 (64 days) Statement #3 (75 days) - Phone Call #2 - Collection Letter #1 - Pre-approval Statement #4 (100 days) - Collection letter #2 TOTAL: 110 days

Revenue/Production

Benchmarking

Practice Dashboard

Charges, Payments, Adjustments and AR (by provider, payor and/or financial class) Cumulative Month and Year to date with last month/year comparison Identify and track key departments or high volume/$$ procedures (Surgeries, X-Ray, Deliveries)

Set benchmark based on month in which Your Net Collections was average or good Example: Gross FFS Charge = $100.00 Payment Total = $ 54.00 Formula = Payment Total divided by Gross Charge ($54 รท $100 = 54%) Gross Collections Percentage = 54% * Fee schedule, contracts and payor mix vary from practice to practice

Monthly Charges

$80,000

Current Net Collections

93 %

Improved Net Collections

95 %

Annual Increase in Revenue

$19,200

Do you measure and compare payors?

(PPO and HMO) 1st step is to insure you have negotiated best possible rates for your practice 2nd, insure you are being paid your negotiated rates ENFORCEMENT IS KEY! 3rd, keep the process going

Build a better “front-end” “Do it right the first time”

Automate wherever possible Technology is great but “Keep It Simple”

Analyze production and performance Measure, decide, take action

Consulting • •

Ability to provide outsiders view and bring alternative perspective to problem Any one can point out problems, key is to offer suggestions and plan to implement changes

Billing Services • • • •

100% focus on Revenue Cycle Management “TEAMWORK” approach with practice works best as some areas must be handled internally Concern over “Lack of Internal Control” Reputable, Stable, Service Oriented

DEFINING EXPECTATIONS IS KEY!