Enhancing Reimbursement Productivity and Results through the Effective Use of Measurements and Benchmarks

Transcription

1 Enhancing Reimbursement Productivity and Results through the Effective Use of Measurements and Benchmarks Cynde Derryberry, Vice President Reimbursement Advisory Services and Maeve McConville, Managing Director MCG Resources

2 CE Credit in Four Easy Steps! 1. Scan your badge as you enter each session. 2. Carry your Evaluation Packet to every session so you can add session evaluation forms to it. 3. Track your hours on the Statement of Session Attendance Form as you go. 4. At your last session, total the hours and sign both pages of your Statement of Session Attendance Form. Keep the PINK copy for your records. Put the YELLOW and WHITE copies in your CE Envelope. Make sure an Evaluation Form is in your CE Envelope for each session you attended. Miss one? Extras are in a file near Registration. Fill out the information on the outside of the CE Packet envelope, seal it, and drop it in the box near Registration. Applying for Pharmacy CPE? If you have not yet registered for an NABP e-profile ID, please visit to do so before submitting your packet. You must enter your NABP e-profile ID in order to receive CE credit this year! 3/27/2013 2

3 Speaker Disclosures Maeve McConville and Cynde Derryberry are members of MCG Resources, LLC and provide reimbursement advisory services to home infusion providers. This conflict of interest was resolved by peer review of slide content. Clinical trials and off label/investigational uses will not be discussed during this presentation. 3/27/2013 3

4 Agenda Metrics what s the point? Key Reimbursement Measurements Standardization and Process Mix and Measurement Staff Development 3/27/2013 4

5 METRICS WHAT S THE POINT? 3/27/2013 5

6 Metrics What s the Point? What productivity measures don t do: Serve as a replacement for effective leadership Tell you why a number isn t trending as expected Help you put a square peg through a round hole 3/27/2013 6

7 KEY REIMBURSEMENT MEASUREMENTS 3/27/2013 7

8 Key Reimbursement Measurements CASH! Processes you are likely measuring now Intake, Insurance Verification & Authorization Billing Collections Denials We ll dig deeper on these a little later 3/27/2013 8

9 Key Reimbursement Measurements Are you also tracking Cash Posting/Adjustments Delivery Ticket Confirmation Time from delivery to confirmation Part D/NCPDP AR Follow Ups Your organization s pain points 3/27/2013 9

10 Project Scoping for Process Metrics Take Control of Your System Define what counts High Value Activity Process Standardization STANDARDIZATION AND PROCESS 3/27/

11 Project Scoping for Process Metrics Plan Ahead Limit the number of new measures at any one time Plan for the worst Resistance is natural Understand data collection will have errors Assume innocence.at first Plan to revisit Train team once, train team again, invite questions Prepare to act Build in time and plans to follow through on unacceptable numbers 3/27/

12 Project Scoping for Process Metrics Be realistic about the effort it takes to launch a new measure Avoid false starts (!) Set yourself up for success System reporting is critical Excel skills will almost certainly be required for ongoing process Know there is a multiplier effect for time invested now 3/27/

13 Take Control of Your System Billing Hold Status Reasons (Unbilled) Pending Claim Hold Status Reasons Collection Note Subject Headings Adjustment Reason Codes Payor Groups Lock it down! 3/27/

14 Define What Counts Determine what actions equal Productivity (Billing, Collections, Intake) Most systems track user activity, however not all activity counts as productivity System Generated A user will likely get credit twice for one action Drop down/manual Entry Define what a collection Action is 3/27/

15 High Value Activities Your staff is busy all day every day they are constantly working or pulling overtime Do you know for sure what they are working? Does your staff know what NOT to work? Even experienced collectors need direction 3/27/

16 High Value Activities Target Account Concept Targets patient accounts that are >60 or 90 days aged and > certain dollar threshold Measure whether the account has been worked by a collector in the last 30 days Caution for systems that give you the last follow up Follow Up and Follow Through ERN/EOB Incorporation Payer Projects 3/27/

17 MIX AND MEASUREMENT 3/27/

18 Mix and Measurement The Age Old Questions Mix How should you split the workload for billing, collections, cash posting & adjustments? Measurement How can you measure someone s productivity if they are doing both billing & collections? 3/27/

19 Mix Billing How many invoices should a biller be able to do? How do I determine how many billers I need? Collections Should I look at invoices, accounts, dollar amount? How do I determine how many collectors I need? Cash Posting and Adjustments How can I determine how many posters I need and will they really have time to also post adjustments? Insurance Verification/Authorization A tough subject 3/27/

20 Measurement Setting Productivity Goals for: Collection Actions Billing Actions Cash Posting Actions Intake Accountability should be enforced 3/27/

21 Trending Productivity Measures Allows you to clearly see underperformers Very High and Very Low should be a flag Percentage of Accounts by Worked Overall By Collector By Payor Cash by Payor (top 10 25) Adjustments by Payor and Type 3/27/

22 Delivery Confirmation Trending Part D/NCPDP claims > 30 days Past Due Follow Ups Credit Balances 3/27/

23 Develop Payor Experts Note Audits Billing Audits Take an hour Give staff the Information they Need STAFF DEVELOPMENT 3/27/

24 Develop Payor Experts Assign specific payors to billers and collectors Work with them on fully understanding the contract and payor guidelines and then. Test them do they really know it? Once they do Involve them in trend identification, payor projects and meetings (as appropriate) with the payor 3/27/

25 Note Audits Ensure the collectors know you are auditing notes Send an with a copy of the audited note Comment or coach as needed in the Follow up verbally as needed It only takes 2 or 3 a week 3/27/

26 Billing Audits New billers 100% for 30 days or until claims are accurate Existing billers % of claims each month or quarter High Dollar Claims Dollar Amount is relative to your business Medicare Claims Centered more around supporting documentation 3/27/

27 Give Them What they Need Take new staff through your processes from Intake to Collection let them see it in real time Provide access to: The fee schedule portion of your contracts Payor websites Informational sites like Share expectations around productivity 3/27/

28 Give Them What They Need Let collectors know what a note should consist of Create templates in or out of your system if necessary Provide appeal templates for your collectors System training usually increases productivity Train the trainer if funds are limited Share cash goals and how they are calculated Let me them know daily where you stand 3/27/

29 Take An Hour There is no substitute for Ride Alongs (i.e., sitting with Biller, Collector or Intake) You will be surprised what you ll learn Review your Cash Aging Assess your credit balances Review an Adjustment report 3/27/

30 The Right Report An Aging is invaluable but wouldn t it be great if it had which accounts were worked by a collector Your CFO wants to know the amount and percent by payer that you adjusted off last month May not be available as a canned report Can t be obtained due to IT limitations or costs around outside systems 3/27/

31 Excel knowledge is key Pivot Tables The Right Report Great for those 5,000+ line spreadsheets V Lookup Pulls in data from one spreadsheet into another Basic formulas 3/27/