Top 5 Things to Know for CE:

Transcription

1 Understanding And Reducing the Cost of Billing and Getting Paid Pete Tanguay, President Rock-Pond Solutions Top 5 Things to Know for CE: 1. Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance. 2. Carry the Evaluation Packet you received on registration with you to EVERY session. 3. If you re not applying for CE, we still want to hear from you! Your opinions about our conference are very valuable. 4. Pharmacists and Nurses need to track their hours on the Statement of Continuing Education Certificate form as they go. 5. FOR CE: At your last session, total the hours and sign your Statement of Continuing Education Certificate form. Keep the PINK copy for your records. Place the YELLOW and WHITE copies in your Evaluation packet Make sure an evaluation form from each session you attended is completed and in your Evaluation packet Put your name on the outside of the packet, seal it, and drop it in the drop boxes in the NHIA registration area at the convention center Introduction / Goals This course is not about the nuts and bolts of billing and collec3ons. It is about how to understand, manage and reduce the costs of this process.. It is designed for all home infusion professionals. 1

2 The Reimbursement Process Referral / Intake Revenue Qualifica3on Order Processing Distribu3on Billing Collec3ons Accoun3ng The Reimbursement Process Referral / Intake Revenue Qualification Order Processing Distribution Billing Collections Software Selection System configuration / setup Staff Training Data Standards Workflow Efficiencies Code definitions Contract / Pricing Setup Accounting The Reimbursement Process Referral / Intake Revenue Qualification Order Processing Distribution Billing Collections Accounting Software Selection System config / setup Staff Training Data Standards Workflow Efficiencies Code definitions Contract / Pricing Setup Contracts Competence Communication Controls Compliance Consequences Cash 2

3 The Reimbursement Process Referral / Intake Revenue Qualification Order Processing Distribution Billing Collections Accounting Software Selection System config / setup Staff Training Data Standards Workflow Efficiencies Code definitions Contract / Pricing Setup Contracts Competence Communication Controls Compliance Consequences Cash The Reimbursement Team Now that we understand that the entire company has an impact on the reimbursement process, we ll focus on: 4 major reimbursement costs 4 factors that increase these costs 4 strategies to reduce cost 3

4 Reimbursement Costs People / Training Time / Efficiency Cost of Money / Lost Opportunity Non- Compliance / Failure Reimbursement Costs: Staff How many home infusion billers does it take to... How are you training your staff? Direct and indirect costs of staffing Alternative staffing models Reimbursement Costs: Time Establish expectations / measure results Not all payers are created equal Not all claims are created equal Not all employees are equal Load balance to make the best use of time The longer it takes, the more it costs 4

5 Reimbursement Costs: Cost of $ DSO = (A/R / Sales ) / days Cost of $ = (Principal x Interest Rate x Term) Administrative Costs of Debt Reimbursement Costs: Non-Compliance Primarily with Medicare Claims Proper Qualification Accurate Billing Complete Documentation Timely filing Post-pay audits Beyond compliance accurate, clean claims Reimbursement Cost Factors Wrong Staffing Model / Wrong Staff System / Process Issues Lack of Good Informa3on Payer Incompetence 5

6 Cost Factors: Staffing Best biller is not always your best manager Qualities of a good billing manager (MBWA) Clear expectations Clear measurements Happy employees make good workers Cost Factors: Poor systems / processes System setup drives process Intake / Authorization Working unbilled / generating clean claims Learning from your errors / denials Technology and software is constantly changing so should you. Cost Factors: Lack of Good Information Authorization / Re-authorization status Unbilled reason codes Missing / incorrect data pre-billing Claims dropped, claims denied, calls made, cash collected by person. Tickets not billed, claims not paid. Trends by payer, therapy and employee 6

7 Cost Factors: Payer Incompetence You can not control it, but you can manage it. Stop being surprised by it. Incompetence can be predictable. Change your process and deal with it proactively. Costs Reduction Strategies Incen3ve Programs Financial & Produc3vity Metrics Nego3ate Leverage your DATA Strategies: Incentive Programs Individual, team and department goals Discretionary incentives Forces clear expectations Motivates through appreciation as well as financial rewards. Scoreboards 7

8 Strategies: Metrics Know the Score, Report the Score And the Score Will Improve (some things never change) Strategies: Negotiate / Leverage DATA You get what you negotiate Build your case with DATA Face to face interaction with the right people Persistence, same message over and over In Summary Staff Time Cost of Money Non-Compliance Staffing Model System / Processes Lack of Good Information Payer Incompetence Incentive Programs Financial & Productivity Metrics Negotiation Leverage Your DATA 8

9 Questions? Pete Tanguay, President Rock-Pond Solutions Thank You! 9