Back Office Controls. Paperwork /Processes. Achieving Efficiencies in Back Office Staffing & Structure

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1 Achieving Efficiencies in Back Office Staffing & Structure Presented By: Melinda A. Gaboury, CEO Healthcare Provider Solutions, Inc Back Office Controls Paperwork Flow Technology Efficiencies Processes Job Descriptions Paperwork /Processes Paperwork Flow: Intake to Discharge Paper or Electronic CASH POSTING Physician s Order Tracking Physician s Signature 1

2 Paperwork /Technology Reduce Redundant Paperwork Point-of-Care Systems Consider Telemedicine Assessment Nurses New OASIS - C Data Sets Job Descriptions Job Descriptions: Do they exist for all positions? Do Employees have a copy? Do Employees truly understand what they are responsible for? Are positions over/under-staffed? Monitor Overhead Reduce Unnecessary Office Space Control Administrative FTEs Consider Alternative Wound Care Supplies Don t Underestimate Value of Billing Department 2

3 Develop measures to monitor staff performance Review measures in team meetings Set reasonable expectations/goals Require staff to be accountable Deal with low performance Set limits for time allowed to perform at these levels Reward high performance Require reports to support low performance issues Require monthly details from staff on all claims older than 120/150 days Require weekly reports to monitor progress of billing and cash receipts Allow staff to express concerns & act on issues in a timely manner Avoid typical billing problems Inadequate time for collections Lack of adequate supervision/management Unorganized billing/collection tracking Incorrectly paid claims for lack of researching balances 3

4 Avoid typical billing problems Excessive RAP takebacks/takebacks not being rekeyed Inadequate cash posting reconciliation Inadequate or inefficient pre-billing audits Limited billing training Inadequate knowledge of software/tools What to Review? What is my Average Days in A/R? A/R Balance/(Total Revenues/Total Days) $333,000/($1,850,000/365) = 66 Days in A/R Admissions & Recerts vs. RAPs filed - Review reports to ensure that all admitted and recertified patients have had RAPs created and preferably actually billed by month end What to Review? # of days to transmit a RAP & Final How many days from date of admission before RAP is transmitted How many days from end of episode or discharge date before Final is transmitted Some effect will be felt from clinical issues 4

5 What to Review? Monitoring Reports on a weekly/biweekly basis such as: Management Summary see attachments RAPs & Finals transmitted vs. averages Cash Flow Unbilled Medicare Final Claim Status Claims that are ON HOLD and why Corrections needed Audits required, etc. Prebilling Audit Audit 100% of Charts Catch Compliance Issues Catch Issues Associated w/pps Avoid unnecessary denials Who should conduct these audits? Billing or Clerical Staff are sufficient it is not a clinical audit Prebilling Audit When do we conduct these audits? End of episode no need to audit prior to end of episode or discharge What do you need for audit? Patient Chart Audit Tool Trial Bill (Pre-bill) 5

6 Questions Please complete evaluation forms! Healthcare Provider Solutions, Inc. 555 Marriott Drive, Suite 225 Nashville, TN