Change Action & Resource Exchange (CARE) Network

Transcription

1 Change Action & Resource Exchange (CARE) Network Webinar for Billing and Collections: Developing Best Practices and Procedures 1/30/14 This webinar is being recorded and will be posted on For technical issues, please chat Q&A to Evelyn Kleinbardt For questions about content, please chat Q&A to Justine Lai

2 Dewey Howard CFO Institute for Community Living INTRODUCTION

3 Agenda Introduction Key Billing & Collections Developing Best Practices Department Responsibilities Department Structure Communication Systems Regular Monitoring Addressing Billing Errors Benchmarking Success Wrapping Up

4 Goals for Today! Review the ideal structure for a billing & collections department Core responsibilities Reporting structure Key data sources Key functions What Will Not Be Covered Today: In-depth details on strategy implementation Your problem-solving calls are intended to provide a forum where you can brainstorm these details with your fellow clinics We want your feedback! Please use the chat to the right of your screen to answer the following question: Is there anything missing from the above goals that you would like to discuss in this webinar?

5 Who s on the Line? Upstate Billing & Collections - Developing BP Cohort Madison County Mental Health Cayuga County Mental Health Clinton County Community Services Board The Dale Association Columbia County Department of Human Services Occupations, Inc Orleans County Mental Health Downstate Billing & Collections - Developing BP Cohort Transitional Living Services Fedcap ICL The Child Center of NY Central Nassau Guidance & Counseling Services, Inc. Other CARE clinics who are interested in this topic

6 Cohort Composition 7 clinics Upstate, 5 clinics Downstate Your Upstate calls facilitator will be Donna Peri, COO at CCSI Your Downstate calls facilitator will be David Wawryznek, CFO at Spectrum Human Services The emphasis is on YOUR ideas and collective brain-trust Donna & David will serve as an expert resource to help identify further ways that CTAC can help you

7 Chat Question # 1 As we progress through this 90 minute WebEx we want your feedback via chat and polling questions! Please use the chat box to the right of your screen to answer the following question: Is there anything missing from the above goals that you would like to discuss in this webinar? or Post a different question if you like!

8 We want to hear from you! Polling Question #1: Is your entire core team in attendance for this webinar? A. Yes B. No Polling Question #2: How many people are in the room viewing this webinar? A. 1 B. 2-3 C. 4-5 D. 6 or more Thank you! Your feedback and participation in this workshop is important to us.

9 Polling Question #3: Who is on the line?* A. Finance B. Clinic Leadership C. Executive Leadership D. Clinician E. Professional Staff *You may select more than one answer.

10 Dewey Howard CFO Institute for Community Living Billing and Collections: Developing Best Practices and Procedures

11 Key Topics Covered Today Billing Department Responsibilities To bill for all services delivered in the clinic. Billing Department Structure What are the core responsibilities of the billing director and billers? Who is responsible to whom? Key Communication Strategies What controls are in place to ensure the clinic and billing staff communicate properly? Regular Monitoring Procedures What gets billed vs. what doesn t, how do you track what is billed and what isn t? Addressing Billing Errors Continually fine-tuning your system to make sure its working! Benchmarking Indicators What is success? What are the pitfalls? Do you use data dashboards?

12 What Do We Mean by Billing & Collections? The lifeblood of the agency When you provide services your survival is not possible unless you are receiving payment for what you provide Billing The process of submitting correct and timely claims for services provided Collections The process of timely collecting correct payments for services provided

13 Billing Responsibilities, Step by Step Step 1: Implement Method of Capturing Services An Appointment module should be in place to record detailed information from client visits and their needs. Once the conclusion final note is entered the appointment is closed and ready for billing. Step 2: Track Where Bills Are Sent Will be sent mostly to third parties, Medicaid, Medicaid Managed Care, Medicare and Medicare Managed Care Over time, this tracking will provide you with a historical picture of your payer mix

14 Billing Responsibilities, Step by Step (cont) Step 3: Ensuring Payer Requirements are Met One person should be responsible for reviewing through the whole process (billing, rejections, collections and denials) Be knowledgeable on payers detailed requirements Consistent monitoring should be in place to ensure all crossovers are processed appropriately and timely! Double check to ensure the rates are set up correctly in the system for all services and payers (CPTs/APGs/etc.). Step 4: Up to Date Insurance Eligibility Who enters the insurance plan into the system? Insurance coverage should be checked on every visit! The clinics must always be updated on clients eligibility under different insurance plans.

15 Billing Responsibilities, Step by Step (cont) Step 5: Billing Reconciliation Clear designated responsibility for reconciling details of billing to general ledger Understand why you are claiming said amount and provide support for claims Step 6: Reviewing Non-Billable/Collectible Services & Bad Debts Clear designated responsibility to write off non-collectible services Audited on a regular basis Identified point person who accounts for bad debts in the billing records and the CFR

16 What Do You Think? Chat/Speaking Question # 2: Do you do these steps in your clinic? Do you think there were any steps we left out? Take a moment and discuss amongst yourselves then use either click the raise your hand button to speak or use the chat box to your right to send us your thoughts! 16

17 Billing Department Structure One individual should be 100% responsible for the billing. Suggested: report to Director of Finance or individual responsible for all revenue within clinic/agency The expectations of the department and each individual within the department should be clear! Make sure you have the proper staffing in place Have the requisite skills and knowledge of their function Understand clearly their responsibilities from billing to collection Clear point person for every billing function

18 COMMUNICATION FINANCE DEPARTMENT SOFTWARE EMEDNY BILLING DEPARTMENT CLINICS INTERMEDIARY (EMDEON)

19 Key Communication Strategies for an Effective Billing System A strong ability to communicate with other departments is critical to an effective billing system Certain other functions in the agency like the clinic front desk or the therapist providers will impact the billing error rate Collaborating with your colleagues will help to identify specific issues Consistent communication mechanism (e.g. alert, , etc.) that lets billing department know when the claims are ready to go out Quality control check put in place by clinic supervisory staff before billing department receives the data Setting a regular time that billing gets delivered and reviewed E.g. All claims from the previous day is reviewed every morning and clinic staff notified of any irregular claims

20 Regular Monitoring Procedures Its critical to have a clear understanding of what the billing department does and functions are performed. Help to identify what is working, and when it s off course Does the department bill weekly? It should! Does the department create the following lists? Weekly billed list: List of all invoices sent out Weekly write off list: List of services that cannot be billed and must be written off Weekly accepted list: List of claims that were accepted and will be reimbursed Weekly rejected list: List of claims that were denied and cannot be reimbursed Weekly denied list: List of claims that were denied but can be resubmitted Do the department staff know the location and function of these lists to use for their day to day responsibilities?

21 QUESTIONS?? We will take a few minutes to answer any questions thus far. Please use the chat to the right of your screen to ask any questions you might have thus far. Feel free to continue chatting in questions as we continue on in the webinar! 21

22 Addressing Billing Errors Billing systems always require fine tuning! Is my current system working? Are billings being lost? Unpaid? When viewing your denials, ask yourself: Why is this happening? What can be done to correct /prevent this error in the future? What are the clinic s major denial codes? Someone should be responsible for reviewing denials» Closely familiar with denial codes» Correcting/rebilling the denials within mandatory time frames (i.e. 60 days)» Critical to catching errors early» Identifying ways to correct problem in future

23 Benchmarking Indicators Use data dashboards to track key indicators of billing success Per pay period and year to date (YTD) Critical indicators to consider Amount billed Amount collected Amount billed by payer Average rate billed Amount not accepted by insurance companies Amount to write off Amount paid Amount denied Amount of denials per payer Denial reasons Keep in mind - dashboards are not helpful unless they are easy to read and understand

24 Lets Catch Our Breath Polling Question #4: Have you ever heard of or been exposed to a change initiative on improving your billing & collections practices in your current agency? A. Yes B. No C. Unsure Polling Question #5: If yes, in your opinion, did it result in improved revenue or improved client outcome? A. Yes B. No C. Unsure of results D. Not applicable

25 Follow-Up Question If you answered yes to Polling Question #4 on the previous slide, please take a few minutes to let us know what the experience was like for you when you were exposed to this change initiative. Please either click the hand button to speak on the line or use the chat to the right of your screen to answer. Thank you for your feedback and patience!

26 What Are Things You Can Do Tomorrow? If you don t have them in place already Clear organization chart with job responsibilities Properly trained and evaluated staffing Clear inventory of reports generated each week, month, quarter and for the audit. A clear set of dashboard indicators System for identifying and capturing the many changes to the system(s). A system to recognize barriers to collections and eliminating these barriers.

27 Organizational Change Tips Frame in the context of organizational change Organizational change is inevitable and necessary for survival Do not attempt more than one change at a time prioritize! Once you arrive at consensus on the overall goals, form a change team to lead the charge The change team ( within CARE, your CARE Team) maps out a logical implementation progression Plan is shared with others to get buy-in Plan is implemented Research methods, pilot, and iterate! Don t forget to collect metrics that track progress and outcomes! 27

28 Questions?? Do you have any questions? Either click the hand button and we will unmute you to talk, or chat us! Both can be found in the control panel to your right.

29 Justine Lai Project Manager, ICL Next Steps

30 First Call What To Expect Each clinic will be asked to re-introduce themselves again Explain briefly why everyone has chosen to address their billing & collections Clarify group ground rules and call schedule going forward Discuss this webinar and the strategies that you plan to implement Be prepared with data What is your current collections rate by payer mix? What do you want to change about these numbers?

31 Remaining Calls What To Expect Each clinic will be given an opportunity to present the key problem/implementation process they are going through Take advantage of other clinics expertise to brainstorm solutions The presentation schedule will be set before the first call Will be given a format to structure presentation Since it s a small group, its really important everyone attends & contributes! Impact on wealth of ideas and available resources

32 Cohort Communication Setting up a Wiggio list-serve that all members of the cohort can use to communicate with the group Need to click a link to join Will use to coordinate available times for calls and send out the call schedule in advance Primary resource for all content/implementation questions For content questions the list-serve can t answer, Lauren Jensen at ljensen@ccsi.org is your contact! Will help identify further resources

33 Data Collection The Payer Mix cohort will collect: Collections rate by payer class (% of cash received vs. revenue billed) Will be collected at midpoint & end of CARE Collected via a Qualtrics link Rapid feedback will be presented back within quick cycle

34 Questions?? We encourage questions and appreciate all of your feedback!

35 Other Upcoming CARE Webinars Topic Date Presenter Payer Mix 1/27/14, 11:30 1 PM Peter Campanelli & Chris Copeland Billing & Collections Developing Best Practices 1/30/14, 11:30 1 PM Dewey Howard No Show Management & Engagement 2/5/14, 12:00 1:30 Kara Dean-Assael & Yvette Kelly Effective Strategies for Staff Communication & Accountability 2/7/14, 12:00 1:30 David Wawryznek & Julie Gutowski Open Access 2/11/14, 2:14 3:45 Joy Fruth, MTM Services Centralized Scheduling 2/12/14, 3:15 4:45 Scott Lloyd, MTM Services 35

36 Contact Us Justine Lai CTAC Business Practices Project Manager Phone: x * Preferred

37 Thank you!! Your feedback is appreciated Please fill out the survey afterwards