Introduction. Agenda 9/13/2013. Tools to Maximize Efficiency and Effectiveness in Your Billing Department

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1 Tools to Maximize Efficiency and Effectiveness in Your Billing Department Presented by: Charitie Horsley, CPC All Rights Reserved Introduction Who am I? Who are you? What are your goals for the session? Agenda What are my tools or resources? What are some of the best resources available? How to use all of your resources to maximize Efficiency and Effectiveness (E&E). 1

2 The Billing Department What does the typical Billing Department Look Like? What are your Resources? People Hardware Data Software Hardware / Office Equipment Office Equipment and Space Design Letter opener Letter stuffer/sealer Copy machine and printers Access Placement Computer Access & Speed Stall or slow speed Shared files 2

3 Software Automation Practice Management System Clearinghouse Internet Microsoft Office Suite Automation is Step 1 Don t underestimate the value of 1 minute. Time per Day Total Minutes Day Week Month Year Total Hours 1 minute minutes minutes Practice Management System Eligibility Claim Status Referrals Payment Posting Voice and Text Reminder Systems Appointments Account Balance Notifications (ABN s) 3

4 45 Days Old (DPR) 75 Days Old (DPR) 105 Days Old (DPR) 9/13/2013 The research shows 88% of patients want to receive digital reminders for preventive or follow up care. 85% of Patients said that E-Communications are more helpful than in-person or phone conversations. More than 35% of patients who don t follow treatment plans exactly said they would be more likely to do so if they received e- mail, voic , or text reminders. Source: An Ounce of Prevention: Automation and the Patient Protection and Affordable Care Act Article TeleVox Software found at Automated Patient Collections Process Automated Collection Letter ABN Call 15 Days Later Automated Collection Letter ABN Call 15 Days Later Review Ensure Letters & ABN Calls were successful Place Personal Call (Over $x.xx) Pre-List Account 90 Days Old (DPR) PAR Account Account Pre- Listed for Placement with an Agency Clearinghouse Denial Corrections Appeal Solutions Analysis Tools 4

5 Internet Freebies Google YouTube CMS Medlearn Channel Strengths Based Leadership Customer Service Microsoft Training Software Training World Health Organization ICD-10 Training American Medical Association CPT RVU Lookup CMS.gov Physician Fee Schedule Lookup Microsoft Office Suite Outlook Shared Calendars Task Lists and Assignments Word Labels Excel Pivotables Data Knowledge is power! What is measured improves! Distribution Prioritization Analytics 5

6 Knowledge is Power! Stay Up To Date! CMS AMA MGMA AAPC Specialty Association Coding Rules Payer Rules What is Measured Improves! Key Indicators Tracking Trending Setting Goals Using Graphics Benchmarking Sample Key Indicators 6

7 Using Graphics Benchmarking Why benchmark? How to create your own benchmarks Where to find other benchmarks MGMA Cost Survey = #1 Associations Government Charitie s Benchmarks 7

8 More Benchmarks Work function Per day Per hour Per transaction management codes n/a to 20 claims 3 to 4 minutes Coding of evaluation and 15 Coding of procedures and surgeries n/a 6 to 12 5 to 10 minutes Charge entry line items without registration Charge entry line items with registration Payment and adjustment transactions posted manually Insurance account follow-up, research and resolution by phone n/a 6-12 Insurance account follow-up, research and resolution by appeal n/a 3-4 Insurance account follow-up, claim-status verification and re-billing n/a Patient account follow-up Source: MGMA Book, The Physician Billing Process: 12 Potholes in the Road to Getting Paid MGMA Benchmarks Table 67.2: for All Orthopedic Surgery Practices Accounts Receivable Data, Collection Percentages, and Financial Ratios Practice Count Mean Stdev 25%tile Median 75%tile 90%tile 109 $331,797 $154,061 $212,123 $304,792 $435,761 $547,541 Total AR/physician Total AR/provider 89 $228,347 $112,881 $149,461 $206,839 $270,078 $377, days in AR % 15.44% 42.52% 55.84% 61.64% 69.47% days in AR % 4.97% 11.36% 13.83% 17.08% 21.23% days in AR % 3.65% 5.61% 6.84% 8.42% 10.75% days in AR % 3.42% 3.56% 4.77% 6.05% 8.76% 120+ days in AR % 15.62% 11.89% 16.82% 25.15% 36.59% Re-aged: 0-30 days in AR % 12.31% 49.00% 53.32% 60.80% 63.64% Re-aged: days in AR % 5.21% 10.55% 13.09% 16.97% 22.72% Re-aged: days in AR % 1.73% 5.92% 6.98% 8.21% 9.90% Re-aged: days in AR % 1.83% 3.84% 5.33% 6.20% 7.70% Re-aged: 120+ days in AR % 14.33% 13.06% 16.95% 23.73% 44.92% Not re-aged: 0-30 days in AR % 12.49% 48.71% 59.46% 65.23% 73.65% Not re-aged: days in AR % 4.08% 11.39% 13.86% 16.89% 19.95% Not re-aged: days in AR % 3.24% 5.31% 6.62% 8.00% 10.01% Not re-aged: days in AR % 3.28% 3.14% 4.19% 5.32% 8.08% Not re-aged: 120+ days in AR % 10.22% 9.31% 15.03% 21.15% 29.14% Months gross FFS charges in AR Days gross FFS charges in AR Gross FFS collection % % 10.44% 37.21% 41.35% 46.54% 53.05% Adjusted FFS collection % 17.81% 93.69% 97.22% % % % Gross FFS + cap collection 2 * * * * * * % Net cap rev % of gross cap 2 * * * * * * Medical Group Management Association All Rights Reserved Distribution of Work Billing Department Work Distribution Strength Based! When done right, strengths based A/R work models can greatly increase production and improve morale at the same time. 8

9 Data - Prioritization First By Strength and Skill Then by Workflow Claim Edits Claim Denials Correspondence Then by Aging Bucket ALWAYS by Dollar!!! 1 - $1,000 account or encounter worked in 20 minutes VS $100 accounts worked in 60 minutes Newer Industry All of your Key Financial Information at a glance. Data - Analytics TITAN- a real-time, web-based application that provides comparative healthcare analytics on reimbursement, utilization and productivity for practices, service providers and health systems. Dashboard Insight Board 9

10 Denial Management Instantaneous E&M Utilization with Analysis Clearinghouse Analysis 10

11 People # 1 MOST IMPORTANT RESOURCE!! Hire the Right People Pre-Employment Skills Assessments Writing Spelling Basic Math Keyboard ( 10-Key ( Special Skills Tests Patient Account Rep Coding Get the right people on the Bus! Know the benchmarks and appropriate staffing ratios! Strength Based Interviewing Networking 11

12 Sample Strengths Based Interview Questions What are you good at? What comes easily to you? What do you learn quickly? What things give you energy? How would a close friend/previous boss describe you? Describe a successful day you have had. When did you achieve something you are really proud of? What things are always left on your to-do list? Retain Good Staff Pay them Right Performance-Based Pay Production Quality Assurance Attendance Reward them for work done well Small rewards regularly Larger rewards when warranted Extrinsic rewards like association memberships and conferences Using All Your Resources People Hardware Data Software 12

13 Questions Charitie Horsley, CPC 13