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Best Practices in Revenue Cycle Management San Diego County Medical Society

Presented by:

Ron Anderson, CHMB Solutions www.chmbsolutions.com


CHMB Solutions Founded in 1995, CHMB provides physicians, clinics, and multi-specialty organizations with outsourced business services including billing and revenue cycle management consulting. CHMB expertise includes a wide range of surgical, primary care, and internal medicine specialties for over 500 providers throughout California. www.chmbsolutions.com


Ron Anderson 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 is responsible for client information system connectivity, and Internet based solutions.

Expertise – Revenue Cycle Management – Reimbursement Analytics – Healthcare Information Systems (HIS)

Certifications – 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 $ Reception and Scheduling

Back Office $ Billing and Collections

Reporting and Analytics $ Gather Data, Analyze, Take Action


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

Front Office $ Reception and Scheduling

Back Office $ Billing and Collections

Reporting and Analytics $ Gather Data, Analyze, Take Action


Revenue Cycle Key Areas of Concern • • • • • • • •

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


Front Office Patient Eligibility & Insurance Verification • 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?


Front Office Data Quality & Time of Service Collections • 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?


Simple Solutions……Great Results Notice Notice to to Our Our Patients Patients Please Pleasebe beprepared preparedto topay payfor forall allpatient patientdue dueamounts amountsatattime timeof of service. service.This Thisincludes: includes:  Co-Payments Co-Payments  Deductibles Deductibles  Outstanding OutstandingBalances Balances For Foryour yourconvenience conveniencewe weaccept acceptcash, cash,checks, checks,credit creditand anddebit debitcards. cards. IfIfyou youare areunable unableto topay payatattime timeof ofservice servicethere therewill willbe beaa $15.00 $15.00fee feeadded addedto toyour youraccount accountto tocover coverour ourcosts costsassociated associatedwith with preparing, preparing,sending sendingand andprocessing processingpatient patientstatements. statements. Thank Thankyou youfor foryour yourcooperation cooperationand andhelping helpingus usto tokeep keepour ourcosts coststo to patients patientsatataaminimum. minimum.

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


Front Office to Back Office Transfer Charge Capture Verification • 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)?


The Cost of Missing Superbills‌ A leak in your revenue cycle! Average Charge per patient/encounter Average Collections Rate Missing/Lost Superbills Annual Lost Revenue per provider* * Assuming 25 patient encounters per day

$ 200 55 % 1% $5,280

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– Revenue Cycle Management – Reimbursement Analytics – Healthcare Information Systems (HIS) • What percentage of patient co­pays are collec...

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