Epic Revenue Cycle Western User Group OHSU- Managing HB Claims Yvonne Vorderstrasse & Kelly Smith August 8, 2013

Transcription

1 Epic Revenue Cycle Western User Group OHSU- Managing HB Claims Yvonne Vorderstrasse & Kelly Smith August 8, 2013

2 Agenda 1. Revenue Cycle Structure 2. Epic HB Go-live 3. Charge Source 4. Billing Management 5. DNB Configuration 6. Stop Bills 7. Claim Definition Files 8. Claim Edits 9. Dashboard Management 10. Claims Submission 11. HB Clearinghouse 12. Claims Data Export 13. Lessons Learned 2

3 OHSU Revenue Cycle Structure Enterprise Revenue Cycle Patient Business Services (HB) University Medical Group (PB) Enterprise Coding 3

4 HB Revenue Cycle Structure Enterprise Coding Staffing: 5 DP, 2 ED, 9 IP Facility, 18 OP Facility, & 34 Pro Revenue Cycle Team Staffing: 3 Analysts (Inpatient, Outpatient, Ancillary/Interface), 1 CDM Builder & 1 Coder HB Billing Office Staffing:16 dedicated billers who also do follow-up Staff divided into 3 teams: Medicare, Medicaid, Commercial/Managed care 4

5 EPIC HB Golive OHSU HB Go-live April, 2008 Upgraded to 2012 version on May 11,2013 5

6 Charge Source Charges/Coding Manual Charge Entry in Department Enterprise Coding HB, PB and Integrated desks Auto Coding- ancillary only services HB Late Charges- after 3 Days 6

7 HB Billing Management OHSU Approach to Edits Fewest possible stops to hinder claims flow Everything defaults to Billing office, so nothing gets stuck too long in Workqueues Try to keep as many similarities to legacy system to aid learning curve 7

8 HB Billing Management Hold Days Outpatient claims- 7 days Inpatient claims- 5 days DNBs vs. Stop Bills Try not to have any hard stops and few stop bills 8

9 DNB Configuration 9

10 Stop bills Currently have 35 stop bills available for holding and tracking accounts. 10

11 Claim Definition Files We currently have 7 CDFs plus one used by non billing claim extracts: 1. Managed care 2. Commercial 3. Medicare 4. Medicare HMO 5. Medicaid 6. Tricare 7. Workers Comp 8. Self pay 11

12 Claim Edit Rules Majority of rules done at CDF level (most in Medicare and fewest in Workers Comp) Multiple sources for requests: New payer edits from Clearinghouse Denials from payers Bulletins from payers Biller identified issues 12

13 Claim Edits Code integration table built at high level without a lot of detail levels. Mostly ranges of cpt/hcpcs codes to ranges of revenue codes. 13

14 Claim Edits, Cont d Claim Edit Error Code Structure Registration/ADT Errors Epic HB Claim Errors - Biller Epic HB Claim Errors - Coding Masterfile Errors (HB/Claims) Masterfile Errors (Provider) APC Grouper Errors Coding APC Grouper Errors Revenue Cycle APC Grouper Errors Biller PBB MSP Error (pending payment) PBB MSP Error (ready to bill) HB Split Error Code APC Grouper Error to Queue Claims 14

15 Dashboard Management Review Epic Dashboard DNBs and Claim Edits 15

16 Dashboard Management, Cont d Monitor dollars, number of accounts in each DNB/edit and average age daily Drill down in detailed report to account/tx inquiry to research pending transactions 16

17 Claims Submission Claims Currently billing 83% of claims electronically Average 16,400 claims a week Try to bill as many payors electronically as possible 17

18 Claims Submission, Cont d Remainder on paper include: Claims needing special attachments/documents Worker s Compensation Smaller Payors without volume Some Transplant/Case Rate 18

19 HB Clearinghouse RelayHealth s (now Mckesson) Epremis application Utilize Error Reports from import to know if new edits needed 19

20 Claims Data Export Systems used in tandem with Epic: Work Management System (Huron/AEOS) JDA Customer Service/Collections (NCO) Compliance 360 Sentry Data 20

21 Lessons Learned Challenges Assigned resources Keeping up on continually changing billing requirements Reevaluating custom logic for standard logic available Late charges and charge corrections Struggle to separate ownership of DNBs Successes Days in A/R are at 36 Standardized WQ naming conventions 21

22 Contact Info Questions? Yvonne Vorderstrasse, Kelly Smith, 22