Transcript Slide 1

Revenue Cycle Management
Industry Trends and Tips to Improve Efficiency
Bob Svendsen, Chief Executive Officer
February 7, 2013
CHMB – Who We Are
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Founded in 1995
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Privately Held
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500 + staff in 24/7 work-cycle
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Inc. 5000 Award Winner (2008-2011)
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Locations – San Diego, Irvine, Oakdale and Chicago
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Profitable and Well Funded for Growth
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Customers Located Across U.S.
Partners w/ Allscripts since 2007
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Remote Workforce – 15 Different States
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Star Reference Site
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Deeply Connected Across Multiple Disciplines
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Largest Install of Allscripts PM
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450 + Allscripts PM Databases Built, Deployed and Supported
Hosting, Implementation and Support
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30,000 + Implementation Hours Annually
RCM Services
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1,000 + physicians supported on EHR
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Enterprise EHR//PM and Professional EHR/PM
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HCLS Partner w/ Dell since 2003
Service
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3,500 + physicians (13,000 + end-users)
Physician Centric
Physician/Hospital Alignment
ACO
Technology
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Leading Technology
Leverages Staff Efforts and
Allows Repurposing of Staff
Results
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End-to-End Revenue Cycle
Solution Optimizes Results
Key Industry Trends
• Consolidation
• New Business Models
• Connectivity and Interoperability
• Reliance on Data
• Unfunded Mandates
Risk Factors
• Rate of Change Exceeds Capabilities
• Scalability of Infrastructure… Human/Tech
• Stuck in a Silo
• Business Intelligence
• Resource Constraints
Revenue Cycle Management Success
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Dedicated Revenue Cycle Team
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Team Model - Dedicated Team with Support Infrastructure to Enable Optimum Performance
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Workflows Complement Technology
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Auditing + Accountability = Performance
Claims
IT
Reporting/
Analytics
Reconciliation,
Tracking &
Auditing
Executive
Leadership
Rev Cycle Team
Account Manager
Data Entry
Payment Posting
Patient Calls
Appeals
Follow-Up
Information Services
•Conversions
•Interfaces
Advocacy
Compliance
Document
Imaging
Application
Support
Blocking and Tackling
RCM Basics
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Policies, Procedures and Processes – Documented
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Accuracy and Timeliness of Information – Clean Claims
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Time of Service Collections and Self-Pay Collection – Policy and Technology
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Productivity Measures – Clinical, Administrative and Financial Staff
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Claims Submission – Process, Process, Process…
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Work Aging Buckets Proactively and Consistently – Know your AR
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Review and Audit Coding – EHR Charge Capture Spotlights Physician Challenges
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Review and Enforce Contracts – 5% or More
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Application Expertise – New Products with Increasingly Enhanced Capabilities
10) Manage to Goals - That which gets measured gets done!
Noun blocking and tackling (idiomatic, US)
Basic tasks or skills in an undertaking or occupation.
Key Revenue Cycle Metrics
•Days in AR
•Net Collection %
•AR Over 90 Days %
•First Pass Clean Claims %
39.5
99.1
17.0
97.1
Other Benchmarks:
•Service Date to Receive Date
•Receive Date to Post Date
•Denial Rate
•Contract Performance
•Results will vary by practice as many factors contribute to overall revenue cycle success
Allscripts/CHMB RCM Services  Shifting the Responsibility
Allscripts/CHMB Responsibilities…
PM SYSTEM HOSTING
Provide for PM System Access for Authorized Users
Provide for System Failsafe, Backup, &
Redundancy
PM SYSTEM IMPLEMENTATION & TRAINING
Best Practice Based PM System Implementation &
Training
DATA ENTRY & POSTING
Posting Charges
Posting Payments (Patient & Insurance)
Client Staff Responsibilities…
PATIENT REGISTRATION
Patient Demographic Capture
Insurance Card Scanning & Documentation Capture
INSURANCE FOLLOW-UP
Claims Submissions / Patient Statements
Insurance Follow-Up/Correspondences
Filing appeals & follow-up and tracking status
Reporting denials & underpayments
PATIENT SCHEDULING & PRE-VISIT MANAGEMENT
Liaison with payers
Patient Appointment Scheduling
PATIENT COLLECTIONS
Batch & Real-Time Eligibility Processing
Patient account inquiries
Eligibility & Appointment Confirmation Exception Follow-up
Requests for correct/updated information
MISSING INORMATION FOLLOW-UP
Attend to Work Queue with Data Requests for Missing Information
Letters to delinquent/no-pay accounts
Phone calls to delinquent/no-pay accounts
Prepare accounts to send to collections
Resource Re-Allocation
A change to the status quo fosters opportunities to evaluate operational
resources and priorities… particularly at the staff level. New technology, new
business models and a changing marketplace all create new opportunities
for deploying staff resources in a new more effective model.
• Charge Entry Clerks = Charge Review Specialists
• Biller/Coders = Physician Educators
• Patient Registration Clerks = Patient Financial Services Reps
• IT Specialists = Business Intelligence Analysts
Summary
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Understand the Impact of Industry Trends – Financial, Technical and Human
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Assess Risk Factors to Your Organization – How Much Risk Can You Absorb?
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Find Alignment Balance – Are You Aligned with All Stakeholders?
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Evaluate Core Competencies – Policy, Procedure and Process
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Take Care of the Basics – Blocking and Tackling
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Measure and Manage to Goals