CHIEF REIMBURSEMENT AND INFORMATION TECHNOLOGY OFFICER

Transcription

1 CHIEF REIMBURSEMENT AND INFORMATION TECHNOLOGY OFFICER ROLE The role of the Chief Reimbursement and Information Technology Officer is to ensure the practice s billing and collection processes are completed in a timely, accurate, effective and efficient manner and that they comply with all regulatory guidelines. This includes providing billing and collection services as well as developing, implementing and maintaining policies and procedures that establish the effective and efficient entry, storage and reporting of patient and financial data. This also includes providing education and training to all staff on the procedures for the collection and entry of patient and medical information and the use of the EMR and PMS systems. The Chief Reimbursement and Information Technology Officer also serves as the practice s IT and EMR subject matter expert and in that capacity is responsible for ensuring the practice has appropriate technology in place, in all locations, that facilitates the secure, effective and efficient entry, storage, and monitoring of patient and financial data in compliance with all regulatory guidelines. The Chief Reimbursement and Information Technology Officer is also responsible for ensuring the EMR and Practice Management Systems remain in synch. The Chief Reimbursement and Information Technology Officer also serves as the practice s Quality Control Officer to ensure the establishment and implementation of quality control standards and measures for all aspects of the practice. BILLING AND COLLECTION SERVICES Posting KEY FUNCTIONS 1. Downloads ERAs, reviews, and completes all posting Insurance Direct Deposits (IDDs). Applies insurance payments and appropriate adjustments, including Void and Correct Adjustments, to the appropriate line number only, that come from GatewayEDI ERAs to Nextech Insurance and patient receivables in a timely and accurate manner. Researches IDDs when necessary to ensure accurate posting of payments, including conducting follow up with insurance companies if necessary. 2. Makes appropriate notations to patient accounts for patient balances due, denial reasons, or refunds due to patients or insurance companies. All notations will include initials. 3. Creates necessary notes in General 2 alerting front desk to request a from patient a copay, percentage of visit, or a recurring charge amount, including copays and all deductibles, as well as all other notations requiring staff to be alerted to a patient account. All notations will include initials. 4. Sends s to the Operations Specialist and Front Desk on a daily basis: regarding particular accounts which may require Copay Assistance due to the amount of the patient copay; to determine possible reasons why the staff did not collect from patients where a notation to collect was added to the system, or to address any and all other items which arise from the posting of IDDs on a daily basis. 5. Posts insurance checks and appropriate adjustments, to the appropriate line number only, in a timely 07/17 1

2 and accurate manner. Researches payments when necessary to ensure accurate posting of payments, including conducting follow up with insurance companies if necessary. 6. Posts refunds to the appropriate line number only, in a timely and accurate manner. Research overpayments when necessary to ensure accurate notes are in PMS. 7. Maintains a thorough understanding of accounting practices and ensure the posting of charges, payments, adjustments and write offs are done in keeping with these. General Billing And Collection Services 1. Audits billing accuracy as needed to determine if the posting of charges are equivalent to the EMNs created during patient encounters. Makes sure all elements of the encounter have been fulfilled including: Referral Doctor letters have been sent, PQRS measures have been added, and Meaningful Use has been met. Cleans up EMNs when necessary. 2. Works with the Chief Medical Officer and Chief Administrative Officer, to identify the need for and create education and training material for Lunch and Learns for staff as a way to ensure consistency in processing practices, streamline patient flow operations, and strengthen the working relationship between the front desk and technicians. 3. Works with Operations Specialist to process denials from insurance companies and identify trends in denials to determine if issues related to claims coding and/or processing need to be escalated to the physicians, insurance companies, Chief Financial Control Officer, Administrative staff, and/or clinical staff. 4. Maintains an up-to-date knowledge of procedure coding guidelines, insurance claims processing policies and procedures, Medicare and Medicaid rules and regulations and other information related to authorizations, billing and collection. Shares updates with all team members. 5. Maintains a current understanding of Medicare, Medicaid and commercial insurance companies policies and procedures, especially Medicare Updates. Share updates with all team members. 6. Provides assistance with implementation of new billing and collections-related services provided by Retina Associates of Florida. 7. Provides support and/or assistance for the implementation of ICD-10 codes. 8. Works with Operations Specialist in helping coordinate any questions regarding Medicare Policy, PQRI s, and other billing and collections-related services impacting the practice. 9. Works with Front Desk to help implement any changes needed to follow Medicare Policy, Practice Policy, or any other billing and collections-related services impacting the practice. 10. Works with the Chief Medical Officer to implement any policies or procedures regarding the billing and collections-related processing of patient flow through the office regarding any printed material from Nextech for use in technical operations. 11. Works with Operations Specialist to determine if follow up is needed for No Show encounters. Determines if a discharge letter is necessary if an established patient, or a No Show Referral letter to 07/17 2

3 the Referring physician. 12. Maintains the recall system and works with the Front Desk to ensure they have a thorough understanding of the recall system and are able to complete all tasks necessary to implement the process in a timely manner. Front Desk Education and Training 1. Develops, implements and maintains policies and procedures related to the operation of the Front Desk and provides education and training to front desk staff to ensure they have a thorough understanding of the processes necessary to implement same. 2. Maintains and participates in the implementation of the Front Desk Orientation program for training of new hires. 3. Provides comprehensive education and training to new hires on billing and coding practices, use of PQRS measures, Meaningful Use, and general use of the Nextech system. 4. Maintains a working knowledge of Nextech webinars, printed materials for the Front Desk Orientation program, and policies and procedures corresponding to front desk duties. IT SERVICES 1. Provides support to the practice to implement all necessary PMS-related and EMR-related technologies, maintain current installed architecture, and assist in necessary expansion of current system. 2. Maintains the practice s infrastructure of Network Server, PMS/EMR Server, all PCs and medical equipment, including all peripherals, used in day-to-day business operations including satellite locations. 3. Maintains the practice s local area network and virtual private networks ensuring both uptime and security between all locations. 4. Maintains the practice s backup procedure and restore policies: works with Operations Specialist to ensure they are being upheld. Performs a system restore once a month in coordination with Operations Specialist. 5. Assists technical staff with the maintenance and back up of medical equipment databases. 6. Provides user education and training for the operation of computer system and use of all hardware and peripherals. 7. Coordinates installation, maintenance and relocation of equipment, including peripherals. 8. Troubleshoots end-user errors which includes: analyzing errors to determine how they can be fixed, and fixing errors not related to the functioning of the software. 9. Provides Remote Desktop service to be used in solving problems. 07/17 3

4 10. Provides IT support to the Front Desk, Operations Specialist, and technicians in implementing procedures related to the processing of patient flow through the office, specifically related to the creation, revision and maintenance of printed material from Nextech PMS/EMR. 11. On a daily basis, creates file necessary to upload appointment reminders into Televox. Maintains a working knowledge of Televox appointment reminder system, and works with Front Desk Specialist II to ensure calls were placed. EMR SERVICES 1. Acts as the liaison between Nextech and Retina Associates of Florida, LLC in regard to updates, changes, edits, or re-designs of EMR templates, dictation, or other needs associated with the continued use of EMR. 2. Maintains a working knowledge of the EMR system and all updates made by Nextech. Use this knowledge to brainstorm with doctors and staff to create new EMR topics, forms, and/or edits to current EMR forms. 3. Serves as a sounding board to the doctors and staff in relation to EMR-related policies, procedures and operational matters. 4. Maintains an up-to-date knowledge of procedure coding guidelines, insurance claims processing policies and procedures, Medicare and Medicaid rules and regulations and other information related to EMR-related forms. 5. Provides the practice with Meaningful Use Analytics each month and work with the Front Desk, Operations Specialist and Senior Technical Operations Specialist and Clinical Research Coordinator to ensure the practice is within required measurements. Complete the attestation process with CMS. 6. Provides user education for the operation of EMR System and use of all hardware and peripherals. 7. Coordinates and maintains the integration of medical camera equipment with EMR system ensuring a timely transfer rate and upload of images to EMR. 8. Provides EMR support to the Front Desk, Operations Specialist, and technicians in implementing procedures related to the processing of patient flow through the office, specifically related to the creation, revision and maintenance of printed material from Nextech PMS/EMR. FISCAL INTEGRITY 1. Works with the Chief Financial Control Officer to monitor the billing and collection process and ensure the timely and accurate billing and collection of all amounts due to the practice. 2. Works with the Chief Executive Officer and Chief Medical Officer, Chief Administrative Officer and Chief Financial Control Officer to determine the timing of expenditures to allow for effective and efficient of the practice s financial resources. 3. Maintains the practice s privacy plan. Conduct regular audits of the plan to ensure continued 07/17 4

5 compliance. Serve as the Privacy Officer. 4. Maintains the practice s HIPAA Disaster Recovery Plan. Conducts regular audits of the plan to ensure continued compliance. 5. Maintains the practice s Meaningful Use Core Menu 9 requirements for Electronic Protected Health Information. Serve as the Security Officer. 6. Represents the practice as necessary to third party payers. 7. Supports the identification and pursuit of new business opportunities. 8. Ensures the implementation of the Compliance Plan. QUALITY CONTROL 1. At the direction of the Doctors, works with the staff to establish Quality Control Standards and Measurement Metrics for all aspects of the practice which includes but is not limited to: a. Technology: 1) Compliance with established guidelines for the use of all computer systems, including proper use and protection of user credentials. 2) Proper use of all equipment, including completion of appropriate maintenance as assigned. 3) Troubleshooting of hardware issues as appropriate. b. Data Entry: 1) Timely and accurate entry of information into all modules. 2) Compliance with established protocols concerning compatibility of patient treatment coding to ensure accurate billing of claims. c. Administration: 1) Compliance with established procedures and deadlines for the completion and submission of timesheets which includes the accurate reporting of mileage, Paid Time Off usage. 2) Completion and submission of performance evaluation forms within established timeframes. 3) Compliance with established policies regarding maintenance of documentation and accurate ordering and handling of medical and administrative supplies, and equipment. 4) Appropriate allocation and use of resources to ensure all work stations and patient treatment areas are appropriately stocked, clean and well organized. 2. Provides education, as needed, to staff to ensure there is a clear understanding of the Quality Control Standards and Measures. Provides education and training to new staff for same. 3. Works with the Doctors and staff to implement and monitor compliance with Quality Control Standards and Metrics. 4. When appropriate, works with individual staff and work groups to ensure Quality Control Standards are implemented correctly and in a timely manner. ACCOUNTABILITY 07/17 5

6 The individual holding this position is accountable to himself, the Chief Executive Officer and Chief Medical Officer, the Chief Administrative Officer and the Chief Financial Control Officer. 07/17 6