HBMA 2016: THE HEALTHCARE REVENUE CYCLE CONFERENCE

Transcription

1 HBMA 2016: THE HEALTHCARE REVENUE CYCLE CONFERENCE Keys to Managing a Successful Offshore Management Company Amy Redmond, Vice President of Revenue Integrity, CHBME About the Author VP of Revenue Integrity, Innovative Healthcare Solutions, Inc. Chair of Commercial Payer Relations Committee CHBME Resides in Chicago, Illinois Getting to know one another Who does not currently utilize an offshore vendor? Current estimations? Client based? Departmentalized? Examples 1

2 Few Concepts for the Presentation Fake Names: Managers Name = Susan Dedicated Employee = Debbie Director/VP = Amy Experience = (mine and yours) Five Key Metrics + Plus One Five Key Metrics that you should use when making the need to expand your current offshore vendor or start utilization. Control Cost Salaries, benefits, supplies, space, TRAINING. Manage Workflow Providers working 7 days a week hospital based, eliminate vacations, weekend, holidays. Yes offshore does have holidays too, but it s different. Control the Labor Hiring, training, managing staff, turnover, vacations, sick days, etc. Visibility Gain control of the visibility of your claims. Become 100% transparent in your claim adjudication. Data Intelligence Vendors have systems to monitor the AR, production numbers, FTE ratios, and dashboards. Five Key Metrics + Plus One How many currently get these metrics from your current vendor? How do you start? START OVER How? 2

3 + Plus One The Unnecessary Metric FEELING and ASSUMPTIONS Uneasy - get a BA, review your contract, do your research. Fear -losing control Sad letting staff go Nervous upsetting Debbie or losing Susan Anxious effective/ efficient + Plus One Bottom Line Remove your feelings, Get a Grip on what you can and cannot control. Work faster and MOVE PRODUCTION! Declining payer reimbursements Higher deductibles Higher volumes more patients covered Lower profit margins Need I say more? UTILIZE your VENDOR to MAX Potential! 3

4 What makes the most sense? Utilize the vendor for your repetitive tasks. Verification, eligibility, charge capture, coding, payment posting, follow up, denial review. MOST LABOR INTENSIVE Easily measured Start SIMPLE get COMPLEX! One, Two, Three? Multiple vendors is a high recommendation. Competitive market Too much work? For who? No not the case. It s not IF a vendor will experience system issues it s WHEN. Be ready. One, Two, or Three Gain control, establish security Few things to review with your vendor (s) if you have not already. Do you have numerous locations disaster relief? Manager to client ratio? Staff to FTE ratio Audit techniques Is the auditor included in FTE fee? How does that slow production? What is audited? How often? Utilize the free 30 days to get a project done, monitor performance. 4

5 Stop Overcomplicating Seriously STOP! It s that SIMPLE! Plan - what needs to be completed offshore Develop - tools they need to use to get the job done. Monitor - the work Evaluate -AUDIT! So why do we still struggle? GET CONTROL Claim ratio. YOU HAVE TO SET PACE. Don t let the vendor advise you how long it is taking them to get a job done. Time your staff or yourself then set expectations by the week, day, hour, and EVERY MINUTE. Every minute is MONEY. Ask Vendor to provide this to you weekly. WARNING be very careful of tasks you cannot measure. 5

6 AUDIT, AUDIT, AUDIT Data Management Be cautions of systems The Data Feed Are they getting everything? How do they prioritize? What are they working? How is the data being manipulated? DON T LOSE Control of your AR that is in fact your inventory. Audit, Audit, Audit Spot Audit each project or batch. DON T Audit everything, you did hire them after all, use it as a training tool. Its okay to reject an entire project if there are more than a few errors. Work with your vendor about reworking projects with multiple errors as to not add an added expense. Medical Coding Expectations What the vendor should be providing to you. Charts per hour, per FTE Level Of Service ratio, RVU expectations, procedure code count. Internal staff audits Coding guidelines and continue education What you should be providing Chart per hour expectations Level of service, RVU expectations Guidelines for each client Physician information detail 6

7 Coding Expectations and Audit Techniques You must audit internally and consistently and constantly. Debbie is now your internal auditor and Susan sets the audit rotation quarterly and Amy monitors the acuity weekly. If you hit month end, it s too late. Is this an added cost? Yes, but is it? Continuing Education This is your job. Why, they are the experts? Because Time is money and so is accuracy. How? there is so much to learn and train. Remember don t overcomplicate 5 steps. Continuing Education 5 steps Guidelines must be written Department guidelines and client guidelines Tip Sheets Websites, eligibility, claim status, provider portals, Payer strategies Shared Portal Reconsideration Templates, Appeals templates, patient letter templates, guidelines keep them up to date. Dedicate an internal employee for maintaining the updates. Audits, let the audits drive the continued education. Document each training, create a continued education training manual. The Vendor should document each training session and provide it to you, save time. Meetings, make meetings mandatory. 7

8 Continuing Education 5 steps Meetings Who: Vendor Manager and Auditor When: At start of new client daily, then weekly, then biweekly. Never anything less. Where: phone (obviously) and Always use a WebEx, share screens and view same documents and note taking. What: An Agenda should be produced by the vendor and internal team 48 hours prior to meeting. Why: This is your team, treat them as equal as you treat the internal team, give them the same tools to get the job done and respect. Continue Educations 5 Steps Get to know your Manager and or team lead. They are an extended part of your team and company. They may be thousands of miles away, but they have family too. Utilize your camera on the WebEx.. smiles are contagious. The Agenda Rules The Agenda Set the Rules Try NOT to review claim or accounts on a call. Written clarification on accounts is key to maintaining your continued education manual. Claim by claim discussions take up TOO much valuable time. Do not extend one hour. Anything not covered on the call will need to be covered one on one or other method. If you must review account details, they must be reviewed prior to the call and in the agenda so that all parties have understanding of the issue. Steer clear of multiple account issues, one is enough and move on. Always have vendor document notes and return the notes within 24 hours. Review the notes with corrections within 24 hours. Save the agenda and notes and share with internal team so everyone is aware of the discussions taking place. 8

9 The Meeting Auditor must always be present on the call both parties. Review most recent audit results. Review new procedure and policies. Always send new policies or procedures prior to the call in writing and review again verbally. Review prior production report. NEVER MISS a Call. Reschedule for the next day. Treat these meetings as BLOCKED out time. Maintain same staff on each call, do not rotate staff be consistent. Tips and Tricks Create a monthly meeting for a Tips and Tricks meeting. Include all offshore vendors and internal staff. Make it fun, learn from one another. Ideas to include Payer Website tools, forms to use Policy number recognitions easy eligibility understanding Modifiers usage or need on particular procedure codes Diagnosis codes that are not accepted, codes that are bundled Offshore Call Etiquette There is a language barrier in most cases, avoid being rude and kindly ask them to repeat and or slow down. Use a web base system for the call and use the chat feature for clarification. Use a camera -ENGAGE We do use a lot of acronyms in this industry so be careful when using terms such as the ACO with the PPO due to the HMO, because of the DX and LOS. Really. Common etiquette: Avoid typing on the keyboard Being in the car or on the move (wind) Mute your phone when not speaking Talking to colleagues in the same office Using social media, not paying attention Taking other calls or questions Sleeping Eating Going to the bathroom 9

10 Everything Must be Black & White Largest Obstacle is maintaining an up to date manual of process and policy. Do it. Make the effort, start with chapters and do what you can weekly, set goals. Training will be created by the vendor you maintain. Continued Education will be created by the vendor, you maintain. Its that easy. Everything must be documented Common Quote I hear I have no time to do anything, I have to document the new procedure I just trained offshore on, never mind I ll just call them again tomorrow. TRY AGAIN Susan would often be on a call for hours everyday just speaking with the offshore team never really wrote anything down. Result inconsistency. KPIs What would indicate in our industry a vendor is not performing to expectations? 10

11 KPI Denials increasing Eligibility Invalid DX Procedure code not valid RVU/LOS decrease Aged Receivable continue to increase Its that simple KPI KPI Some things you cannot measure but need to monitor. (something that is easily discussed in an office that can no longer happen). Example: Susan would state we really need to meet with Dr. Redmond she has terrible HPI in her charting. Now you have a decreased LOS for Dr. Redmond. Example: Susan would state we have over 50 missing signatures for date of service Now you have an increased incomplete chart list. Example: Susan would walk into the office and say we did not get date of service 9.22 complete only had 100 of 300 charts. Now you have an increased missing chart list. 11

12 Checks and Balances Data import errors, watch your census volumes Physician inaccuracy, monitor your internal missing, incomplete listing. Registration changes at the hospital, increased denials for a particular time period Checks and Balances Move away from the day to day. Start monitoring your dashboards. Many vendors offer dashboard controls if you do not have one of your own. You still have work to do, just at a higher level. Common Misconceptions Reviews I have read I have seen first hand what offshoring is all about, loss in reimbursement to providers and facilities. The vendor never understood what I was saying to them, they cannot grasp the healthcare complexity. All of the above are examples of inconsistent management and vendor partnership. 12

13 Common Misconceptions Reviews I have read I reviewed the vendor website and I don t see how they can handle the volume or what we need to do. The website told you that? It s not that complex. THIS IS A PARTNERSHIP not a STRUGGLE Engage your staff Change the structure and mentality. Stop allowing for internal staff to state offshore is making more mistakes. Put the work on your internal staff to send the vendor an to retrain them. Tell staff, if they are making mistakes it is our job to NOT correct the accounts, but to alert the vendor of the problem so it can stop occurring. Remind the staff it is now there job to retrain, not correct and complain. Engage Staff Frequently Remind your staff. 13

14 Change the structure Utilize your offshore an internal teams wisely Do not have offshore sending medical records, too time sensitive. Post all correspondence, avoid missed documents Separate your denials from your correspondence and AR team. Denials are time sensitive move them appropriately. Keep your vendor on task oriented and escalate internally for higher review and involvement. Change the Mindset Change not only the structure of your staffing but the mindset. Frequently engage both teams at all times. Create a partnership! The End For Some a New Beginning? 14

15 Hope you enjoyed your time! Questions? Amy Redmond, Vice President of Revenue Integrity, CHBME 15