Paperwork /Processes

Transcription

1 The Future of Revenue Cycle Management Presented By: Melinda A. Gaboury, CEO Healthcare Provider Solutions, Inc. healthcareprovidersolutions.com Paperwork /Processes Paperwork Flow: Intake to Discharge Paper or Electronic CASH POSTING Physician s Order Tracking Physician s Signature 1

2 Payroll/Travel Time Productivity Monitoring Electronic Deposit vs. Hard Checks Salaried vs. Hourly or Per Visit Full Time vs. Part Time Benefits Packages Vacation Time Insurance Retirement Plans Match clinicians and patients that are in the same geographic area Schedule visits for patients in the same area efficiently Technology/Overhead Point-of-Care systems Telehealth Current billing software Scheduling Physician Order Tracking Reduce Unnecessary Office Space Control Administrative FTEs Consider Alternative Wound Care Supplies Don t Underestimate Value of Billing Department 2

3 Monitor Overhead Set default on printers Double-sided (less paper) Black and white (color more expensive) Think before you print Ask yourself if you really need the document in hard copy format (training material, brochures, procedures, reports, etc.) Place this note at the bottom of your s for others to consider Documented Processes Processes should be reviewed to ensure they match what is actually happening Duplication of work? Is the process changing with the times? Is what is happening now the most efficient way or are we doing that way because We have always done it that way!? If someone is no longer there, can someone else pick up the processes documentation and continue the job? Is everything we do on a daily basis necessary? 3

4 Job Descriptions Job Descriptions: Do they exist for all positions? Do Employees have a copy? Do Employees truly understand what they are responsible for? Are positions over/under-staffed? Revenue Cycle Intake/Referral Eligibility/Verification & authorization Care Provided Documentation & orders Pre-billing audit File Claims Tracking & collections Payment posting & reconciliation Reporting 4

5 Revenue Cycle Structure Level one Level two Revenue Cycle Manager Level three Billers Collectors Cash Posters Who Does What? Managers/Supervisors Hold to your title Must be able to DELEGATE Require reports at specific time intervals that monitor progress Never take a Verbal everything is fine in place of concrete reports 5

6 Who Does What? Billers Collectors Cash Posters Managers/Supervisors Do you have separate designations or does one person wear all four hats? Does each employee understand his/her responsibilities? Who is the leader/manager/supervisor? Is there required reporting in place to monitor progress? Cash Posting Medicare Cash Receipts Should be Posted on a Daily Basis: If payments are less than the original HIPPS recorded, research reason for difference in DDE/Pricer Differentiate the various types of PPS adjustments in your billing system to obtain statistical data. Make sure adjustments are appropriate. Don t assume anything! 6

7 Collector s Performance Traits of a Collector: Tenacious Determined Relentless Charming - Hard Core Knowledgeable - Assertive Avoid typical Collection problems Inadequate time for collections Lack of adequate supervision/management Unorganized billing/collection tracking Incorrectly paid claims for lack of researching balances Collector s Performance Accurate Receivable Reports Access to all Contracts w/rates Timely Copies of EOBs & Remit Accurate Recording of Authorizations and Verifications in system Adequate time to perform duties NOT other assignments Effective tracking system for follow-up work done 7

8 Billing Department Performance Develop measures to monitor staff performance Review measures in team meetings Set reasonable expectations/goals Require staff to be accountable Deal with low performance Set limits for time allowed to perform at these levels Reward high performance Allow staff to express concerns & act on issues in a timely manner Billing Department Performance Avoid typical billing problems Inadequate time for collections Lack of adequate supervision/management Unorganized billing/collection tracking Incorrectly paid claims for lack of researching balances 8

9 Billing Department Performance Avoid typical billing problems Excessive RAP takebacks/takebacks not being rekeyed Inadequate cash posting reconciliation Inadequate or inefficient pre-billing audits Limited billing training Inadequate knowledge of software/tools What to Review? How many claims are over 150 days on my Accounts Receivable? Require Billers/Collectors give you a detail explanation of each claim that is 150+ days on the A/R as part of your month end close process What is my Average Days in A/R? A/R Balance/(Total Revenues/Total Days) $333,000/($1,850,000/365) = 66 Days in A/R 9

10 What to Review! Admissions & Recerts vs. RAPs filed - Review reports to ensure that all admitted and recertified patients have had RAPs created/revenue recorded by month end # of days to transmit a RAP & Final How many days from date of admission before RAP is transmitted How many days from end of episode or discharge date before Final is transmitted Some effect will be felt from clinical issues QUESTIONS! 10

11 Speaker Information Melinda A. Gaboury, COS-C Chief Executive Officer Healthcare Provider Solutions, Inc. 810 Royal Parkway, Suite 200 Nashville, TN healthcareprovidersolutions.com 11