Transcript Practical Information for Your Revenue Cycle

HFMA Website
Practical Information for Your
Revenue Cycle
Objectives
• Discover HFMA Website’s Information
• Demonstrate Practical Application of the
information
• Challenge - Do!
Discover
Site Layout
• The Site Layout Includes the following:
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Knowledge Center *
Education & Events *
Publications *
HFMA Initiatives &*
Career Center *
New & Opinion *
Marketplace *
Communities *
About HFMA
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Knowledge Center
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Knowledge Center
• The Knowledge Center has a plethora of
information in the following categories:
– Accounting and Financial Reporting
– Finance and Business Strategy
– Legal and Regulatory Compliance
– Operations Management
– Payment, Reimbursement, and Managed Care *
– Revenue Cycle *
– Technology *
Discover
• There are areas that relate to Revenue Cycle
in Knowledge Center, but the the HOT ones
are:
– Legal and Regulatory Compliance
– Payment, Reimbursement, and Managed Care
– Technology
Discover
• The Area of Greatest Interest for Revenue
Cycle Leaders?
The Revenue Cycle
Category!!!
Discover – Knowledge Center
Revenue Cycle *
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Bad Debt
Billings and Collections
Charity Care and Financial Counseling
CDM, Charge Capture and Coding
Consumer-Directed Health Care
Denials Management
Patient Access
Self-Payment Collection
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Education &Events
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Education &Events
• Key pieces to this part of the site:
• There are virtual conference trainings that
are free.
• Certification information is available
• Credentialing for your Revenue Cycle Staff is
available
• Training Products (Mastering Customer
Service and Revenue Cycle)
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Publications
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Publications
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HFM Magazine *
Healthcare Cost Containment Newsletter
Revenue Cycle Strategist Newsletter *
Strategic Financial Planning Newsletter
Leadership
Healthcare Finance Strategies E-Bulletin
Career Opportunities E-Bulletin
Patient Friendly Billing E-Bulletin
Business of Caring Archives
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HFMA Initiatives
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HFMA Initiatives
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HFMA’s MAP *
The Value Project
Principles and Practices Board
Healthcare Reform
Patient Friendly Billing *
Healthcare Financial Pulse
Research and Trends
Financing the Future
Coalitions
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Career Center
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Career Center
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Job Bank *
Careers at HFMA
Certification
Subscribe to Career Opportunities
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News & Opinion
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News & Opinion
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It has Healthcare Finance News
From the Chair and President
HFMA News
My favorite is the News Roundup (News
from various sources talking about things
that can impact Revenue Cycle)
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Marketplace
Discover
Communities
Discovering
Communities
• Revenue Cycle Forum *
– More Article Access
– More Tool Access
– Ask Experts Questions
– Participate in List Serve and Message Board
Discover
About HFMA
Demonstrate?!?!
• Your Revenue Cycle is a Mess
• You can’t fix it RESISTANCE IS FUTILE!!!
MAP Keys
First Set
Net Days in A/R
Aged A/R as a Percentage of billed A/R
Point-of-Service Collections
Cost to Collect
Cash Collections as a Percentage of Adjusted
Patient Net Service Revenue
• Bad Debt
• Charity Care
• Days in Total Discharged Not Final Billed (DNFB)
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MAP Keys
2nd Set
• Aged A/R as a % of Billed A/R by Payer
Group
• Day in Final Billed Not Submitted to Payer
• Days in Total Discharged Not Submitted to
Payer
• Late Charges as % of Total Charges
• Initial Denial Rate – Zero Pay
• Initial Denial Rate – Partial Pay
MAP Keys
2nd Set
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Denial Overturned by Appeal
Net Days Revenue in Credit Balance
Pre-Registration Rate
Insurance Verification Rate
Service Authorization Rate
MAP Application
Home Page
MAP Application
Dashboard
MAP Application
KEY Briefs
MAP Keys
• Effective 12/01/10 MAP Application was
made available.
• Cost is based on size
– Solo Facility
– System
• Not Necessary to Participate in MAP Award
• MAP Keys bring standard definitions and
purpose to enable providers to compare with
like facilities
MAP Keys
• New KPI’s
• Days in Final Billed Not Submitted to Payer
(FBNS) tracks claims held by edits in claims
processing system or secondary bills not
sent out
• Days in Total Discharged Not Submitted to
Payer (DNSP) – Includes FBNS and DNFB
KPI’s
Revenue Cycle Questions
Demonstrate
HFMA Usefulness
• Ecclesiastes 1:9 NIV
“What has been will be again,
what has been done will be done again;
there is nothing new under the sun.”
Jason’s Translation: Don’t recreate the
wheel…Steal !!!
Demonstrate
KPI’s – Patient Access
• Average Registration Time – unknown, but
patient’s are complaining
• Average Patient Wait Time – unknown. But
patients and departments complaining
• Average patient registrations per shift –
Unknown
• Registration Data Quality – Unknown but a
lot of patient and business office complaints
• MSPQs obtained – Accidentally eliminated
Demonstrate
Using KPI’s Access/Registration
• Average registration interview duration < 10
minutes
• Average patient Wait time < 10 Minutes
• Average Registrations per shift (Varies by
department and system - 35 inpatient 40
outpatient is Hammer’s KPI)
• Data Quality 99% or better
• ABN and MSPQ when Required 100%
Demonstrate
Wait time KPI’s
• Requested Productivity Reports with
Detailed Registration Start and Stop Times
– The times seemed reasonable 80% of the time
– 20% of the time there were significant waits
• Worked with Staff and found that Incomplete Orders
shut the process down
• Designated an office individual to handle those
situations with patient, physician and department
• Increased percentage to 98%
Demonstrate
Wait Time KPI’s
• Still had complaints
– Volume of Accounts didn’t work due to rush periods and
lulls after doing a traffic study. It wasn’t a productivity
issue
– Implemented a inexpensive check-in system
• Patients were waiting a long time for lab services and surgical
services
– Implemented direct lab registration process
– Implemented Quick-Registration for Surgical Patients
• Significant improvement (except for lab patients at peak times)
• Patient Access Perception Improved (Press Ganey)
Demonstrate
Data Quality
• Complaints from Patient and Business Office
– Implemented Individual Auditing
– Scanned Cards and IDs for Identity Protection
and to Audit Accuracy
Demonstrate
Date Quality
Expect Staff
to “Bomb” the
first audits.
They need to
fully
understand
expectations.
Scores will
improve over
time as staff
see that
quality is
being
monitored
seriously
Demonstrate
Data Quality
Demonstrate
Compliance
• If you don’t ask the question, you don’t know
what is going on.
• MSPQ’s were accidentally discontinued
when an eligibility verification was
implemented a year before.
• Training occurred and the MSPQ was
initiated immediately following.
Demonstrate
KPI - HIM
• Hospital Scenario
–Cash flow diminishing
–HIM days at 10
–Coder productivity unknown
–Un-coded charts > 30 unknown
Demonstrate
Using KPI’s HIM
• All coding done is in descending balance order, not first in/first out.
• Consistently monitor and control Discharged-Not-Final-Billed A/R due to
HIM.
• HIM “DRG development” D-N-F-B A/R days greater than the late charge
hold ≤ 2 A/R days
• Inpatient charts coded, per coder per day
• 23 - 26
• Outpatient charts coded, per coder per day
• 150 - 230
• Emergency room charts coded, per coder per day
• 190 - 250
• All coding is done by employees who report to the HIM director.
Demonstrate
Using HIM KPI’s
• Discovered that completed coding was being
tracked by a paper report generated weekly.
• Employee manually noted issues on paper.
• High Balances were worked like low
balances (No Pareto Principle gains)
– Discovered a software add-on not used by
hospital and created queues for each coder
– Productivity Reports created
– Coding Days began to drop except for outpatient
Demonstrate
Using HIM KPI’s
• Discovered that Facility-Based Urgent Care
coding happened on-site
• Coder position was vacant and lead was coding
when had time
• Coding was 6 months behind
– Used Scanning Technology to scan charts at site
daily
– Urgent Care coding position moved under HIM
– Coding caught up
– Increase Revenue due to coder put in charge for
E/M codes
Demonstrate
Charge Entry/Revenue Protection
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Bill hold 6 days
CDM duplicates - Unknown
Incorrect CDM items – Unknown
Item price less than HOPPS APC rate –
Unknown
Demonstrate
Using CDM KPI’s
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Late Charge Hold Period 2-4 days
CDM Duplicate 0
CDM Codes Incorrect/Missing CPT HCPCS 0
CDM item price less than HOPPS APC rate
Demonstrate
Using CDM KPI’s
• Worked with Departments and taught department
directors how to review rejected charge reports,
revenue reports, and enforced late charge policy
– Increase revenue and reduced late charges for many
departments other lost their revenue already not being
billed
• Discovered duplicate and incorrect CDM codes and
prices below APC rate –Some rates hadn’t been
updated since going on the system 2 years prior
– Updated CDM and improved revenue, payment, and
billing compliance
Demonstrate
KPI’s Business Office
• Discharge Not Final Billed (DNFB) 11.1
• A/R Days 58.5 Gross (67 Net)
• Days in Total Discharge Not Submitted to
Payer (DNSP) – Not Tracked
• Days Final Billed Not Submitted to Payer
(FBNS)
• Insurance A/R aged more than 90 days from
service/discharge 31% (w/o Self-Pay 19%)
Demonstrate
Using Business Office KPI’s
• DNFB A/R days - 4-6 A/R days
• Net A/R days - 55 A/R days
• Insurance A/R aged more than 90 days from
service/discharge 15-20%
Demonstrate
Using Business Office KPI’s
Demonstrate
Using Business Office KPI’s
• Focused on reducing HIM unbilled days
• Started Tracking Unbilled in Electronic
Claims System
– Discovered Electronic Claims were not counted
in unbilled numbers
– Discovered Secondary and printed claims not
mailed were not counted in any numbers
– Months of paper billing had been backlogged
and some reaching filing limits
Demonstrate
Using Business Office KPI’s
• HIM Days Started Going Down with HIM Focus and
Tools
• All Paper Claims starting going through Electronic
Claims system for Tracking
– Initially DNFB Days in PFS went up because of the new
tracking
– Additional Biller Training occurred to ensure billers knew
how to get claims out the door.
– OCR Remit scanning for paper remits began to assist
with secondary billing
– Cash increased due to bills starting to go out that were
not going out previously
– Instituted Collection Tool, Auditing, and Productivity
Demonstrate
Using Business Office KPI’s
Demonstrate
Using Business Office KPI’s
• Over 90 Aging is now below 20% including
Self-Pay
• Over 90 excluding self-pay is below 6%
• Total DNFB averages under 5 days
• FBNS is under 1 day
• DNSP is under 6 days on average
• 7% Cash increase in FY 2009
Demonstrate
Using Business Office KPI’s
Physician Practices
• 1. Visits without charges as % of total visits
0%
• 2. Co-pay collections as % of total copay
office visits $ 95%
• 3. EDI claims as % of total claims $ 90%
• 4. Charge-entry lag period - 1 business day
• 5. Claims passing claim edits as % of total
claims $ 98%
Physician Practices
• 6. Appointment no-show rate - 2-3%
• 7. Appointment bumped rate - 2-3%
• 8. Net A/R days (non-specialty practices) 40 days
• 9. Collections as % of net revenue $100%
• 10. Collections as % of gross revenue (nonspecialty practices) $ 60%
Physician Practices
• 11. Third-party A/R aging 90 days from service
date - 10%
• 12. Denials as % of net revenue (including
“incidental to” services) - 2%
• 13. Claims with no activity 90 days from last
activity date 0%
• 14. Credit balances - 2 A/R days
• 15.Average patient wait time after office arrival
- 15 minutes
Certified Revenue Cycle
Representatives
• Received a Grant in 2010 to do LEAN
Training and CRCR
• 50% of staff that took the test certified
• 90% of Patient Financial Services
• Staff are more involved in fixing problems
Challenge !! DO!!!
• Choose a topic to research on HFMA site or take
the MAP journey
• Prioritize Issues Discovered
(Compliance/Care/Cost Savings)
• Study the topic or MAP Keys
• Implement Changes
– Set SMART Goals
– Involve Staff (Devil is in the details)
• Teach others (Leaders and staff)
• Celebrate your success and tell your story
Questions??