REVENUE INTEGRITY TEAM

Transcription

1 REVENUE INTEGRITY TEAM Partnering Across Your Enterprise to Identify and Resolve Compliance Issues Sarah Couture, RN R. Brett Short, CHC, CHPC DISCOVERING WHO OWNS REVENUE INTEGRITY: Revenue Department, Compliance Office, Or both? Our story: Managing Growth in an Academic Medical Center; an opportunity to partner. 1

2 Road Map for Revenue Integrity 1. Discovering who owns Revenue Integrity 2. Finding the right players for the team 3. Creating a culture of excellence; managing change, education and process improvement 1. Discovering Who Owns Revenue Integrity It is amazing what you can accomplish if you do not care who gets the credit. Harry S. Truman Important things to remember: One organization, with common goal Goal for this activity is similar; Accuracy! Process should be inclusive, right stakeholders involved Define success or desired outcome of this activity 2

3 1. Discovering Who Owns Revenue Integrity Revenue Management Compliance Revenue Integrity Mutually beneficial journey Compliance Accuracy Institutional stability Risk reduction error rate Documented action plan for remediation Revenue Management Accuracy Institutional stability Increased challenges in reimbursement Payer pressure Changes in reimbursement models Traditional Revenue Integrity From a financial perspective: Decrease denials More accurate bills Reduced resources to work claims Avoid pay-backs Reduce audit risks 3

4 1. Discovering Who Owns Revenue Integrity. Considerations: Where should it land in your organization? Where does it fit best in your organizational culture? Can it be co-owned by Compliance and Revenue Management? QUESTIONS? FINDING THE RIGHT PLAYERS FOR THE TEAM Discovering the common goals and lines of communication. 4

5 2. Finding the Right Players for the Team Who cares? Revenue? Finance? Compliance? Government? Public? CEO/Board? 2. Finding the Right Players for the Team Where does your organization get love letters? Denials department? Patient Accounts? Legal? Compliance? HIM? Quality? 2. Finding the Right Players for the Team Z P I C OIG targeted audits Your Organization OIG Compliance Review OIG Workplan 5

6 2. Finding the Right Players for the Team Who owns these audits/processes? Assigned to the right department? Who has the power to affect change? Who has a stake in the activity or outcome? Who has the resources? 2. Finding the Right Players for the Team Success in Relationships compliance news/updates pertinent to specific departments Spend time getting to know what they do; ask them questions about their processes Monthly meetings with involved departments Have an open door for compliance concerns QUESTIONS? 6

7 MOVING TOWARD A CULTURE OF CHANGE Identifying ways to affect change in your organization Question: Do you change the culture through organic, grass-roots efforts or a top-down initiative? Answer: What time do you arrive at work? Tone at the top. Common goal identified and supported by management. : Issues Ownership Process Change Education Monitoring 7

8 Is there a group in your organization that is filtering all of the incoming audits and internal issues that are discovered? Example: RAC committee 2. Determine who owns the process and why it is not working? Example: 3. Formulate a plan to address the problem. Example: 8

9 4. Educate the appropriate parties to fix error. Example of communication: 5. Develop and implement a monitoring plan. Example: Question assessment: Is there an existing group that addresses these issues? (RAC) Who has the same goal of compliance (accuracy)? (RM, PA, CEO) Who will champion or be the executive sponsor? Who can cast the vision and promote the activity? (CEO, CFO?) Do you need a workgroup or a steering committee? How can you best communicate? Is your change management process robust? Is there someone in your organization that can get it done? (credit) How does this fit into your compliance plan? (Risk Assessment, etc) Is this an opportunity for you to be a leader? (Lead up) 9

10 Questions? Thank You! 10