Revenue Cycle Academy. Strategic Management Service

Transcription

1 Revenue Cycle Academy Strategic Management Service

2 Strategic Management Services! - Membership Principles - Life Cycle - Control Testing - Encounter-Level Findings

3 Strategic Management Membership Principles Real Results in Week 1 Our focus is revenue opportunities, not gradual deployment of our methodology Put the Burden on Us No heavy lifting by your team or implementations No Additional Investment Required Optimize the people, processes, and technology you ve decided upon don t purchase more Drive Sustained Improvement Encounter-level reviews enlighten your team and create future success 3

4 How Can You Make Certain Your Revenue Cycle is Doing What You Intended? One emerging strategy is Control Testing processes - Based on conducting encounter-level reviews - Compares actions taken on accounts with your revenue cycle policies and procedures: are the right actions being taken at the right time on the right accounts? This approach helps to drive accountability while pinpointing specific opportunities in areas like DNFB, follow-up timeframes, working denials, and more 4

5 Life Cycle of Strategic Management With high-dollar collections, what can we do to determine if all policies and procedures are being adhered to 100% of the time by your collectors? 1. Analyze A/R Data 72! 58! 54! 60! 50! 52! 60! 48! Analyze outstanding A/R data to recognize reimbursement trends and the efficiency of overall collection activity. 2. Recognize areas within collection processes that appear to offer the greatest opportunity for improvement based on influences such as payer, account age, and dollar amount. Target Payers, Aging, etc. 3. Identify Follow-up Timeframes Review collection policies and procedures to identify expected follow-up activity and timeframes for high-dollar encounters. 4. Define controls that test encounters within collection work queues for specific actions and their associated completion timeframes. Define Controls Within Work Queues 5. Perform Control Testing Remotely in ADT System Determine the best process for navigating your ADT system to test each control. 6. Provide detailed reporting on our control testing findings to display current collection performance and help prioritize your improvement strategies. Provide Control Testing Results 7. Improve Collection Timeframes Total Number of Encounters! 15! 25! 35! 0-30 days! days! days! days! >120 days! No Follow-up! Review collection policies and procedures to identify expected follow-up activity and timeframes for high-dollar encounters. 45! 35! 20! 5

6 What Has Control Testing Consistently Found? Our testing of encounters in the business office has identified several trends and opportunities across providers of all sizes and demographics and these may be worth further exploring at your organization: Unbilled charges leading to billing delays of several weeks or months Follow-up timeframes being infrequently adhered to, resulting in lost reimbursement Documentation of account follow-up activity being incomplete or absent Balances improperly transferred to patients when insurers deny 6

7 The Challenge Our Solution Control Testing: Illustrative Example Our member expressed a need to assess and improve the performance of Billing and Collection staff, processes, systems, and vendors, with a focus on the quality of actions taken on accounts. Top Priorities Improve high-dollar collections and reduce A/R days Enhance billing and follow-up accuracy to increase clean claim rates, reduce DNFB days, and reduce bad debt Resolve denials and improve appeal processes and timeframes Reviewed policies & procedures, process flows, and current performance with key stakeholders Audited 150+ encounters monthly based on needs of the organization Documented & reported findings, process opportunities, encounters flagged for follow-up, and the financial impact 7

8 Encounter-Level Findings: Illustrative Example Control Testing Review Customized KPI Analysis Identification and reporting of specific encounters not worked in adherence to policies & procedures often representing a high level of return ($) Monthly control testing reports provide summaries of findings and considerations going forward Customized Key Performance Indicators reviews 8

9 Healthcare Delivery Systems We Test Within Our team of subject matter experts is experienced in the following systems, so we can begin testing on Day 1 Patient Access Epic Systems Cadence ADT Prelude ASAP (ED) Meditech GE-IDX Web 4.0 (ADT) Siemens Soarian Financials Invision McKesson Paragon Financials Pathway Healthcare Scheduling (PHS) Pathway Compliance Advisor (PCA) Eligibility & Benefits Systems McKesson RelayHealth (RevRunner) Siemens HDX (EDI) Midas + Cerner Powerchart HIM / Imaging McKesson Horizon Patient Folder Webstation Document Imaging Systems Precision Activity Monitor Siemens EDM Imaging Chartmaxx (MedPlus, Inc.) Billing & Collections Epic Systems Resolute Hospital Billing (RHB) Resolute Professional Billing (RPB) Meditech GE-IDX Web 4.0 (HPA) Siemens Soarian Financials Invision McKesson Paragon Financials HIS_NET (TPA) Optum efr epremis (Per-Sé Technologies) Clearinghouse Systems MedAssets (i.e., XactiMed) Rycan

10 Why Leaders Continue to Choose The Academy Lori Davis Director of Patient Financial Services Suzie Bryan Associate Patient Financial Services Director Chris Frankovich Director of Patient Financial Services The [control testing] report layout is great because it clearly illustrates save opportunities and tells me exactly what encounters I will want to resolve first. I can use it to go into Epic and immediately work through encounters to collect revenue. We are always looking for ways to bring more money in, so this is awesome! We realize that improvements need to be made within our departments, but this audit process validated to us what our teams need to execute on. Because of the control testing report findings, our leadership team now knows what staff training and education opportunities exist. After reviewing the Academy s results, we also recognized additional process improvement opportunities between departments. Our objective is to design and implement effective processes and then remove variability. We utilize the Strategic Management team s control testing process as a measurement to see how well we re progressing, and we re going to be better-off as an organization as a result. Without developing controls and performing encounter-level testing, we would have never discovered these accounts or been able to identify that our vendor was not adhering to our contract. 10