DUHS Revenue Cycle Management & Clinical Integration Program

Transcription

1 DUHS Revenue Cycle Management & Clinical Integration Program Garland Goins, Director Revenue and Documentation Integrity Michael Bernas, Program Manager Revenue Management

2 Duke Health At A Glance City of Medicine, USA Durham is known as the City of Medicine, USA, with healthcare as a major industry including more than 300 medical and health-related companies and medical practices with a combined payroll that exceeds $1.2 billion annually. The Duke University Health System (DUHS) Fully Integrated 3 Hospital Health System Intricate Primary Care, HomeCare and Hospice, Patient Revenue Management Organization, Research Institute and numerous Joint Ventures Annual Operating Revenues Over $3.6B, Medical Center campus size: 99 buildings located on 210 acres. Gross square feet: 8 Million Annual Visits: IP over 66K, OP over 2.4M and 60K in ED

3 Program Overview Purpose/Strategy: Leadership guided and grass-roots driven effort to encourage communication and coordination among all stakeholders Drive transparency, align revenue cycle priorities, efficiently manage resources, and create a system that is responsive to internal and external forces Vision of Success: Open dialogue, information sharing, data driven, partnership Vertical and horizontal alignment of priorities Sustainable framework for intra-departmental and interdepartmental collaboration Tactics: Making meeting time/places available to enhance relationships, and discuss, educate, and address revenue topics Revenue Governance meetings (COO, CFOs, VPs, and PRMO Leadership) include topics like Late Charges, Authorizations, Duke Health Access Services (DHAS), and Central Financial Services are covered; VPs share priorities and activities that are impactful to other areas Revenue Integrity Committee (RIC) meetings (VPs/Ops, Physician Champions, Finance, Compliance, PRMO and Revenue Managers) hold discussions about service level priorities; process improvement projects are monitored Revenue Workgroups meetings at the service line level focused on subtopics such as (1) coding, (2) service access, payer relations, & billing collections, (3) information systems, (4) research/clinical trials, (5) outreach and development

4 Aligning Priorities 3-Year Plan (est. August 2012) Heading in the Same Direction 1. MISSION To be recognized for best practices in Revenue Cycle Management 2. VISION Understand PDC, Hospital, and PRMO Streamline PDC, Hospital, and PRMO Develop strategic & models Enhance partnerships with payors & regulatory agencies 3. VALUES A. Align with organizational priorities B. Plan comprehensively C. Change with an understanding of your people and

5 Meeting Topics & RIC Roll-Out Revenue Governance Meetings Program Expansion Date Meeting Topic 07/27/17 Health Info. Management Rev. Gov. 05/25/17 Clinical Doc. Improvement FY2013 FY2015 FY2016 FY2017 FY /26/17 Duke Health Access Services 10/20/16 Clinical Research Billing Radiology Cancer Center Behav. Hlth Ambulatory 07/28/16 Central Financial Services 05/19/16 Rev. Cycle Pt Responsibility Heart Center Rad. Onc Emergency Medicine 03/24/16 Authorization Overview 01/28/16 ICD-10 Implementation Neurology Orthopaedics 10/23/15 CCA.net 08/27/15 FY15 Year-End Highlights Pathology / Labs Periop Svc 07/09/15 Program Intro. & Overview 08/22/12 RIC Initiation Pharmacy Women s & Children s

6 Service Line Revenue Integrity Committees Fundamentals What is the big picture? Aligning priorities, Coordinating efforts, Translating strategy into action Why is it important? Building on existing successes Communication and collaboration Revenue and compliance education Patient satisfaction and partnership What will success look like? Strategic planning, Open dialogue, Process improvement Who is involved? Department Chief, Service Line VP, Clinical Ops, Compliance, Finance, Performance Services, Revenue Cycle Operations How are the meetings conducted? Standing Hospital Billing and Professional Billing performance updates Rotating Meeting Topics: Service Access, Revenue Management, Billing & Collections performance, Operational Initiatives, Special Topics, Workgroup Report-Outs Keys to Success Personnel: DUHS & PDC Leadership driven; PDC, DUH, & PRMO Change agents Stakeholder awareness, and vested interest in long term solutions Environmental: Focus on not people, Commitment to framework, Organizational alignment Structural: Reporting & data, Communication channels, Project management platform Expected Challenges Uniqueness among clinical service line business Identifying resources and proper skill mix Foundational revenue cycle awareness and knowledge

7 Results Transformative and Comprehensive cultural change towards collaboration Reduction in Radiology authorization writeoffs by 30%, increase in standard reporting Increase in Lab Coding efficiency and quality Improvement in Neurology documentation Improvement in patient education regarding out of network services in Heart Center procedural areas