Case Studies in Optimal Revenue Cycle Management Redesign. Craig Mandeville, Forcura Nick Seabrook, BlackTree Healthcare Consulting

Transcription

1 Case Studies in Optimal Revenue Cycle Management Redesign Craig Mandeville, Forcura Nick Seabrook, BlackTree Healthcare Consulting 1

2 Revenue Cycle Overview Revenue Cycle Obstacles Revenue Cycle Improvement Case Studies Summary 2

3 Intake Insurance Verification Authorization Scheduling Patient Management OASIS Completion Orders and F2F Tracking Document Management Billing and Collections 3

4 4

5 What Who Where When Why How How Many 5

6 What What is the task? Who Who is responsible for completing? Where Where (which department) is it completed? When When does the task get completed? Why Why is the task being completed? How How does it get completed? How Many How many people are needed? 6

7 1. Staffing 7

8 2. Structure 8

9 3. Duplication 9

10 4. Technology 10

11 5. Communication 11

12 6. Productivity 12

13 7. Accountability 13

14 8. Paper!!!! 14

15 9. Management 15

16 How do I know if I have an issue??? 16

17 Intake Low Conversion Percentage Incomplete/Incorrect Documentation Insurance Verification Denials for incorrect insurance Authorization Denials for lack of authorization Backlog in authorization requests Delays in start of care 17

18 Scheduling High number of missed visits High SOC/evaluation lag time High overtime Patient Management High LUPA % Low clinical visit productivity Inconsistent recertification percentage OASIS Completion High days to RAP Low case mix 18

19 Orders and F2F Tracking High number of unsigned orders/f2f Increased unbilled A/R Document Management Compliance High storage costs Billing and Collections High Accounts Receivable Low collectibility Inconsistent cash flow 19

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21 Implementation Plan Short Term Mid Term Long Term 21

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23 Service Lines Home Health Hospice Census HH 245 HO 50 PD State Maine Software Cerner 23

24 Challenges Identified Orders tracking Manual reporting, tracking, and follow-up processes Large outstanding A/R over 90 days Slow turnaround on MD Orders and F2F 24

25 Challenges Identified Intake Paper intensive processes Under-utilization of EMR for referral process Department staffed almost entirely with RN s Billing Department Under-staffed billing department led to a backlog of MaineCare billing Billing department lacked knowledge of claim submission on MaineCare portal 25

26 Accomplishments Outstanding A/R reduced by 50% Turnaround improvement of 25% for orders/f2f 30 days or less 100% paperless process for orders tracking and F2F 26

27 Accomplishments Implemented new processes that utilized the EMR for referral entry which streamlined information to scheduling and benefits/authorization Rearranged staffing to minimize clinical data entry elements of the referral entry process Hired and trained new billing office staff member on MaineCare billing Created in-depth training manual on Maine Care billing Resulted in a 66% decrease in MaineCare A/R 27

28 Service Lines Home Health Census 1,230 State New York Software Allscripts 28

29 Challenges Identified Intake and Authorization Distributed locations managing intake process Intake document gathering Timely approval of benefits and authorizations 29

30 Challenges Identified Intake Inaccurate referral information Manual workflow Insurance/Authorization Manually verifying eligibility by patient Timeliness in verifying insurance and patient benefits Timeliness in obtaining initial and additional authorization Productivity 30

31 Challenges Identified Billing Paper billing claims Manual cash posting Billing too frequently Low productivity Large volume of claims on hold 31

32 Accomplishments Intake and Authorization Centralized intake process with technology and FTE allocation FTE savings of 40% 32

33 Accomplishments Intake Created Standard Referral Assessment Form Automated document management system Insurance verification/authorizations Implemented payor portals and clearinghouse Communication Standardized communication methodology in software to more efficiently complete tasks Created weekly/bi-weekly meetings with all departments on challenges with referrals 33

34 Accomplishments Referral/Insurance Verification/Authorization Established productivity standards and staff goals Referral to completion of insurance verification and obtaining initial authorization turnaround for all insurances (days) Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 March Additional authorization turnaround times for all insurances 34

35 Accomplishments Billing Redesigned billing schedule to bill in monthly increments Implemented electronic billing and cash posting Established productivity goals Within the first six months, commercial cash collections increased by $93K a month and Medicare cash collections by $178K a month 35

36 Service Lines Home Health Census 1,000 State Maine Software Epic 36

37 Challenges Identified Orders tracking Slow turnaround on MD Orders & F2F Disparate processes with Epic and other systems 37

38 Challenges Identified Intake Correct physician signing the F2F was not confirmed at the time of referral Referral productivity was not tracked Staffing model comprised solely of nurses Insurance Verification/Authorization Lack of cross training Paper intensive process No standard template for inputting benefit and authorization information Inconsistent expiring authorization tracking process 38

39 Challenges Identified Orders Tracking No follow-up protocols Scheduling Visits scheduled in excel rather than Epic Lack of communication between clinicians and scheduling Lack of communication between referral department and scheduling Department regularly working overtime 39

40 Challenges Identified Clinical Management Clinicians not assigned geographic region SOCs, ROCs, Recerts completed by per diem nurses Quality Management Too much responsibility for department Three week backlog in coding/oasis reviews Unnecessary pre-coding of all referrals 40

41 Accomplishments Outstanding A/R reduced, 50% improvement Turnaround improvement: 30% Epic integration services deployed with minimal expense 41

42 Accomplishments Intake Implemented F2F physician follow-up calls Utilize Epic report to track referral productivity Introduced blended staffing model Insurance Verification/Authorization Provided training to all staff for cross training Created process to track expiring authorizations Developed standard template for entering benefit and authorization information into Epic Increased payor portal utilization 75% of all non-medicare payors completed electronically 42

43 Accomplishments Orders tracking Developed follow-up protocol & automation Built pending orders dashboard for escalation Scheduling Required all staff to utilize Epic s scheduling Held clinicians responsible for communicating visits that need to be covered Staggered department errors to reduce overtime 43

44 Accomplishments Clinical Management Assigned clinicians to specific geographic areas Quality Outsourced backlog of OASIS and coding reviews Eliminated pre-coding Overall $1.6M improvement to bottom line in one year 44

45 Craig Mandeville, Founder & CEO (800) ext Nick Seabrook, Managing Director (610) ext