Medline Webinar February 13, Presented By: Miriam Lieber

Transcription

1 Medline Webinar February 13, 2012 Presented By: Miriam Lieber

2 Objectives 2 Management theory is a top down matter Examine key departments for objective measures Trend performance and productivity Manage your operation via data

3 3 Strong performers are intrinsically motivated by performance. Good to Great, Jim Collins

4 Manage by Example 4 Demonstrate the behavior you want to see in your staff Perception is reality Communication is a common weakness Staff must know what is expected of them Accountability is key to productivity

5 Use Staff Input 5 Allow staff to help set goals Ownership works This exercise alone shows staff they are valued Train/teach towards goals Teach how one department s goals intertwine with the company s overall goals Bigger picture view a must!

6 Tinkering 6 A unit- based team identifies a challenge, taps the wisdom in the system to identify a potential solution, and then they try it out in a limited way. If it works, they spread it across the organization. If it doesn t, they try something else. Leadership Without Excuses, Jeff Grimshaw, Gregg Baron

7 Facilitate Productivity 7 Provide necessary resources Automate as much as possible Establish tools to measure progress Reward/thank staff as they reach goals People want to think their work makes a difference Treat your staff like you would like to be treated Stroking is key Remember: Tone comes from the top

8 The Little Things 8 Successful businesses do the things that others know they should do but generally don t. Building a Great Business, Ari Weinzweig

9 9 Turning Theory Into Practice

10 Front End Operational Measures 10 Front end/intake New orders By product and payer By zip code By rep By receipt method fax, phone, , walk-in, rep Reoccurring sales/replenishment orders By product and payer By zip code By frequency dispensed

11 Front End Operational Measures 11 Intake Revenue Net revenue percentages by Product Payer Patient/customer Order Rep How long does it take to process an order? Segregate by supply and new orders What is average revenue per patient?

12 Front End Operational Measures 12 Insurance verification Measure quantity handled on-line versus fax and/or phone Measured against payment/denial Track average length of time to verify per insurance Time per call Track number verified by rep Create template for easy access to major plan requirements

13 Front End Operational Measures 13 Authorizations Pre-authorizations measured for length of time from submission to receipt of auth Length of authorization Number approved, pending and denied auths Number electronic versus fax auths, etc. Segregate by payers Assign re-auths to specific person/team Monitor number reauthorized, to be reauthorized, average length of time Often gets neglected

14 Front End Operational 14 Measures Intake Documentation Pros and cons to gathering documentation up front Prior to dispensing equipment Referral source vulnerability Ensuring proper ABN employment Knowledge based decision making Accepting a viable order Minimize documentation hassles and post pay audit risk Chart note requests

15 Front End Operational 15 Measures Documentation Tracking Establish documentation protocol E.g. 2, 4, 6 day return repeat process Segregate by document type Written order versus CMN Measure items in each process Track number of requests per doctor Number of outstanding documents per doctor Automate process and tracking

16 Front End Operational 16 Measures Documentation Reporting Unbilled - Track dollars, age, product type pending per doctor Set goals to reduce held billing days Status checks Follow-through is key Last action taken, next step, tickle date Engage patients as last resort Office visit

17 Front End Operational 17 Measures Open Orders Quantity, date and dollars Track and trend by reason Still in hospital/facility Segregate after hours/weekend orders Set goal to reduce number of outstanding open orders Must be worked daily

18 Front End Operational 18 Measures Confirmation Confirmation goal aim for confirmation within hours of delivery Dependent upon number of hands involved Inventory inaccuracies may cause delays Insist on paperwork completion Train delivery technicians of importance POD Automation helps improve timeliness Should ease paperwork chase

19 Front End Operational 19 Measures Deliveries Measure deliveries by Item, payer, referral, rep Sort by delivery method Constantly measure cost of each method Number of deliveries, pickups, exchanges per driver POD/GPS routing systems to tally results Mileage, stops, etc. Gas usage

20 Front End Operational 20 Measures Delivery Nuances Exchanges - $0 dollar orders Special orders Repairs Supply replenishment copay first Loaners Items requiring extra documentation WOPDs, lab results, etc.

21 Front End Operational 21 Measures Product Costs Look for ways to maintain lean inventory Hone in on costs leverage vendor preference Requires constant evaluation and reevaluation Consider formulary for some products Automate purchasing Min/Max adherence Track items on repair and out of service Designate responsible person

22 Back End Measures 22 Billing Billing edit report review Length of time to work edit report Error tracking Segregate by payer, product Electronic versus paper submissions Front end denials Denial management Segregate by reason, HCPCS, rep, dollars Staying on top of denials now to help minimize A/R issues later

23 Back End Measures 23 Cash Receipts Auto-posting for Medicare Auto-posting for other insurance Imposes perfect allowables Minimize miscellaneous account postings Resolve unapplied cash immediately Measure daily cash collected by Payer Product category Old versus new A/R cash Cash as a percentage of billed (lag time)

24 Back End Measures 24 Adjustments Number bad debt adjustments Dollars adjusted for bad debt Number of free services provided Dollars in free service provided Dollars in contractual allowance adjustments Track adjustments by dollar, reason, rep, adjustment to collection ratio Summary by reason code

25 Back End Measures 25 Collections Track number and dollar of accounts worked Denials and outstanding receivables No automatic resubmissions Examine medical necessity justification Payer segregation Top 50 per payer Descending balance Private pay vs Medicare/3 rd party payers

26 Back End Measures 26 Collections Segregate old from new Overlapping may cause duplication Top 5 payers percentage of A/R 30, 60, 90, 120 day buckets Percentage in each bucket Elongate A/R buckets as necessary Timely filing measures Payer segregation customary DSO Year to date and yearly comparisons Seasonal fluctuations

27 Staffing Ratio 27 From $8+ million, add audit/compliance staff/dept (2+), HR, IT, clerical/scanners, etc.

28 Sample Productivity Goals 28 Reduce A/R over 120 days by 10% in 3 months Collect 85% of copays up front (private pay) Confirm 90% open orders within 2 days of delivery date Held billing DSO to 5-8 days Percentage cash to billing to 90% 85% of all insurance verifications performed on-line

29 Data Analysis 29 Determine revenue per product and payer Look for payer diversification Combine nonreimbursables with reimbursable products Evaluate diseases for possible companion products E.g. COPD or diabetic patients who might need enteral nutrition

30 Summary 30 Manage and lead by example Know key operational measures for frontend process Work back end of business via reports Track and monitor performance via software Keep a pulse on operation to meet today s challenges

31 Speaker Information 31 President, Lieber Consulting Ventura Blvd., Suite 786 Sherman Oaks, California Fax Website: Facebook: miriamlieberconsulting