Charles V. Wilson, MHA, MT (ASCP) Administrative Laboratory Director Robert Wood Johnson University Hospital DISCLOSURE

Transcription

1 Using Real-Time Dashboards to Maximize Hospital Laboratory Outreach Revenue: Simple and Effective Steps to Boost Net Collected Dollars While Reducing Lost Clients Charles V. Wilson, MHA, MT (ASCP) Administrative Laboratory Director Robert Wood Johnson University Hospital 1 DISCLOSURE Relevant Financial Relationship(s) None Off Label Usage None 2 RWJUH

2 Objectives Define challenges and barriers which inhibit effective financial performance of Laboratory Outreach Programs. Define key financial metrics and indices which should be monitored to assure financial integrity of a Laboratory Outreach Program. Review strategies for maximizing reimbursement and customer satisfaction. 3 RWJUH

3 Laboratory Outreach Program How it all Started 2008 Proposal presented to Senior Administration Dedicated I.T. systems Dedicated Billing systems Dedicated Staff Manager Business Development Liaison Field Service Coordinator Courier 5 Laboratory Outreach Program 2009 Building the Program Developed a strong foundation (5-year Business Plan) Exceptional support from Senior Administration Support from ancillary departments. Must sell as a hospital program. First client in September RWJUH

4 2010 First Full Year of the Program 2010 Total Gross Sales $13.6 million 7 Laboratory Outreach Program How did we Achieve This? Accurate Test Orders Electronic & Written Cost Analysis Charge Master Review An effective Real Time dashboard Prompt mechanisms for handling client and billing issues Client loyalty 8 RWJUH

5 Accurate Electronic Test Orders * Preference - bridge to physician Practice Management System * Required information fields must be completed to execute order * Repeat patients do not require re-entry of this information 9 Error-proof Manual Entry * Tube type for test * Provide LIS order codes * Physician names * Attempt to correct potential errors at point of entry 10 RWJUH

6 You Must Know Your Costs Do not assume that Finance knows about your test and procedural costs Perform Cost Analysis for every procedure in the department Educate staff using standard template CLSI GP11-A Basic Accounting for Clinical Laboratories Update as required 11 Full Understanding of Charges is Essential RWJUH conducted a full hospital CDM review by an external group. Schenck, Price, Smith & King, LLP Full review of revenue codes and charges Reviewed modifiers Provided recommendations and comments for many of our billed procedures 12 RWJUH

7 Reimbursements Are Predicated On Accurate Costs and Charges The relationship between costs and charges must be well understood by the Laboratory. Inefficiencies in regards to costs and charges result in net greater losses even when volumes increase. This information must be readily accessible. Laboratorians must have or develop fiscal understanding of terms and metrics that drive reimbursement. 13 Laboratory Outreach Dashboard An effective Financial Dashboard is essential to management and governance of the program. Must be readily accessible Must be real time in order to respond promptly to variances Should be able to drill down to individual client, patient and payor level 14 RWJUH

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9 17 - The system informs the user that there is a Medicare Limited Coverage test without an appropriate diagnosis code. - The user can either add the proper code (according to the patient s chart) or an ABN would be generated. 18 RWJUH

10 Centers for Medicare & Medicaid Services (CMS) Determinations CMS website for National Coverage Determinations: Check with your local Fiscal Intermediary (ie. Highmark, Humana, etc.) for the Local Coverage Determinations RWJUH

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13 2011 First Quarter 2011 Gross Sales To Date $4.9 million 25 The difficult we do immediately. The impossible takes a little longer. 26 RWJUH