From Minors to Majors

Transcription

1 From Minors to Majors Revenue Cycle Best Practices to Take Your ASC to the Big League March 4, 2016

2 Contents Pre Game Warm-Ups - What Does a Winning Team Look Like? How Do You Define Optimum Revenue Cycle? Top of the 4 th Inning & Tied 1-1 Do You Know Where Your Revenue Cycle Is? Recommended Key Performance Indicators(KPI s) Bottom of the 8 th & You re Down by 5 Time to Outsource? Major League Partner or Minor League Partner Managing Team Stats Automate Through Technology Louisville Slugger & Business Office Audit Powerful Tools for success Superstitions and Myths Boston Red Sox to Business Partner Post Game: And The Game Ball Goes To - Success Stories in Action Post Game Press Conference Q&A Open Forum

3 From Minors to Majors Revenue Cycle Best Practices to Take Your ASC to the Big League March 4, 2016 Pre Game Warm-Ups What Does a Winning Team Look Like?

4 Milwaukee Brewers hire Craig Counsell as next Manager 5/4/15 "I believe his on-field success as a player and his awareness for preparation should resonate in the clubhouse

5 A different type of player manager

6 Creating The Optimal Revenue Cycle Program Dedicated Resources with Clearly Defined Responsibilities Culture of Engagement and Urgency ASC Specific Billing & Collections Expertise Leveraging Technology to Drive Competitive Advantage + Continuous Improvement Understanding Impact on Shareholders and Patients Performance Management - Standard Industry Benchmarks?!

7 From Minors to Majors Revenue Cycle Best Practices to Take Your ASC to the Big League March 4, 2016 Top of the 4th Inning & Tied 1-1 Do You Know Where Your Revenue Cycle Is?

8 Recommended KPI s Days Outstanding / Days in A/R Claim Lag / Charge Lag % of A/R Greater than 90 Days Net Collection Rate Denial % / Clean Claim % Business Office Staff per 1,000 Cases

9 Days Outstanding / Days in AR Definition: In its most basic form, Days Outstanding is essentially the time it takes to get a claim paid Calculation: Total AR / (total charges from last 3 months/90) Regent Standard: Less than 30 Days Uses: Determines the health of your AR. Wild swings from month-to-month may highlight a billing or collection problem

10 Claim Lag / Charge Lag Definition: The time it takes to get a claim entered and sent Calculation: Number of days from DOS to charge entry / submission Regent Standard: Less than 3 Days Uses: Determines how quickly charges are being sent. A high Claim/ Charge Lag has a negative impact on Days Outstanding

11 % of A/R Greater than 90 Days Definition: The amount of $$ as it relates to total AR greater than 90 days outstanding Calculation: Total AR greater than 90 days / Total AR Regent Standard: Less than 15% Uses: High % of AR greater than 90 days may emphasize an issue with patient collections or insurance denials

12 Net Collection Rate Definition: The % of eligible $$ the facility actually collected Calculation: Total payments / (total charge contractual bad debt + refunds) Regent Standard: Greater than 97% Uses: Determines how well business office staff are collecting on contracted accounts

13 Denial % and Clean Claim % Definition: % of claims that are rejected by payer and % of claims sent out without edits Calculation: Total claims / denied or clean claims Regent Standard: 98% Clean, Less than 5% Denial Rate Uses: A high denial rate could highlight issues with certain payers. A low clean claim % may pinpoint some issues with either your biller or front office

14 2010 Business Office FTEs per 1,000 Cases Regent Average = Total Cases (June '09 - May '10) FTE's per 1,000 Cases

15 2013 Business Office FTEs per 1,000 Cases Regent Average = Total Cases (August '12 - July '13) FTE's per 1,000 Cases

16 2014 Business Office FTEs per 1,000 Cases Regent Average = Total Cases 2014 FTE's per 1,000 Cases

17 The KPI In the list of hypothetical ASC s below, assuming charge masters are the same, which one is in the best financial position and why? a) Days in A/R 35.0; Net Collection Rate 97%; Percent A/R > 90 11%; Gross Collection Rate 69% b) Days in A/R 23.0; Net Collection Rate 99%; Percent A/R > 90 6%; Gross Collection Rate 63% c) Days in A/R 40.0; Net Collection Rate 92%; Percent A/R > 90 16%; Gross Collection Rate 74%

18 From Minors to Majors Revenue Cycle Best Practices to Take Your ASC to the Big League March 4, 2016 Bottom of the 8th & You re Down by 5 Time to Outsource?

19 Expertise High level of RCM experience bi-lingual capabilities a bonus! 100% US based operations with hands on leadership Clear competencies in managing denials as well as payer contracts Recurring audit cycles, internal and external Assist with the selection and implementation of technologies that address the individual needs and objectives of a Center, current state and desired future state Navigate the complexities of ongoing regulatory and compliance changes Keen understanding that billing process directly impacts patient satisfaction Prioritize and aggressively improve core financial competencies/metrics

20 Staffing Experience is critical to evolving complexity and accurate decision making How can I find ASC billing and collections expertise? Immediate contributor or extended training? Goal - Passionate employees that act as fully engaged partners, in fact extensions of the Centers themselves Dedicated specialists will create the right culture An organization s reputation in the marketplace is a strong indicator of candidate pipeline Leverage a rigorous hiring process, including skills assessment and cultural assessment Succession and contingency planning = continuity & predictability

21 Process Automation Automating RCM is as much about efficiency as it is analytics Customizing an integrated solution to the individual needs of each ASC becomes paramount Three core areas of technology form the foundation of ASC billing and collections: ASC Management Information System(MIS platform) Clearinghouse Reporting, Analytics, Dashboard Capabilities Staff expertise is essential to a smooth implementation as well as leveraging full functionality for ROI

22 Real Time Measurement & Reporting Standard ASC software platform capabilities ASC Custom software capabilities Next generation reporting and analytics Individualized v. generalized data Establish KPI s and benchmark against industry performance Real time dashboard(management console) Graphical and fully customizable Leverage expert analysis to drive decisions Actionable insight Trends Issues Continuous improvement

23 Real Time Dashboard - Financial

24 Real Time Dashboard Financial & Clinical

25 Revenue Cycle Audit A no cost Business Office Audit is a fundamental part of the outsourcing process to understand both qualitatively and quantitatively if an external partner can add value to a perspective Center Collaborative by design, it encompasses the active exchange of business office data in four core areas: Reimbursement Staffing Coding Workflow/Process Importantly, the audit toolset has been refined for 10+ years including a formal presentation of audit findings and recommendations at the conclusion of the process

26 Myth #1 Outsourcing RCM will be more expensive than handling internally Only with the wrong partner! Designed to be more cost effective Significant cost savings with industry partnerships Core elements driving cost effectiveness: 1. Reduction in salary and benefits 2. Reduction in recurring training 3. Reduction in office space(urban areas) 4. Reduction in succession planning/recruiting costs 5. Avoiding time and revenue lag associated with transitions 6. Increased net collections

27 More Expensive to Outsource? # of billing & collections staff 1 Annual revenue $ 2,000, Reduction in staff salary (based on nationwide average) $ 40, Reduction social security, Medicare & unemployment contributions $ 8, Reduction in employee healthcare costs $ 12, Reduction in overhead, IT costs, & training $ 2, Reduction in succession planning costs - Recruiting, Time and Revenue lag $ 8, In-house billing related cost reduction $ 70, Total cost of outsourced billing $ 70, Annual savings by outsourcing $ Average annual collections improvement $ 70, Total annual financial improvement $ 70,800.00

28 Myth #2 Outsourcing RCM can diminish an ASC s control Only with the wrong partner! Designed to increase a Center s control Core elements supporting enhanced control: 1. Dedicated, full time billing and collection specialist Eliminate shared duties and diminished results Deep experience driving analysis and decisions 2. Utilizing best-in-class technologies MIS - Workflow and process optimization Reporting and analytics Real time dashboard capabilities

29 From Minors to Majors Revenue Cycle Best Practices to Take Your ASC to the Big League March 4, 2016 Post Game: And The Game Ball Goes To Success Stories in Action

30 Southeast Surgery Center Center Profile Multi-Specialty Orthopedic, Pain 5,900 cases/year $19M annual revenue Challenge Underachieving monthly collections and unable to pin point specific causes Average monthly collections of $1.5M Results Outsourcing increased average monthly collections to $1.9M Method Relationship Claims Accuracy Reimbursement Appeals Timing/Efficiency

31 West Coast Surgery Center Center Profile Multi-Specialty Orthopedic, Pain, ENT, Spine, Gynecology 3,000 cases/year $5M annual revenue Challenge Incorrect coding and claims submission(including implants) Results Outsourcing increased average monthly collections by $105K Increased year over year collections by $1.25M Method Relationship Audited coding, errors and omissions Re-Billed claims Appeals Timing/Efficiency

32 From Minors to Majors Revenue Cycle Best Practices to Take Your ASC to the Big League March 4, 2016 Post Game Press Conference Q&A Open Forum

33 From Minors to Majors Revenue Cycle Best Practices to Take Your ASC to the Big League THANK YOU! March 4, 2016