Presentation on theme: "Treatment Planning Accurate Scheduling Patient Check- in/Out Coding and documentation Claims Processing Denial Management Payment Posting AR Management."— Presentation transcript:
Treatment Planning Accurate Scheduling Patient Check- in/Out Coding and documentation Claims Processing Denial Management Payment Posting AR Management Tracking Progress Presented By Suzanne Adolphson, MSW, MHA
Located in Pomona, California 1 st class graduates in 2013 Use a paperless system
Define the revenue cycle Use the EHR to improve your revenue cycle Use the EHR to track improvements
Improve your revenue cycle rather than relying on cutting expenses. ‘…find the holes in your revenue cycle and then plug them...’
More than just billing and collecting Includes all processes and procedures that have potential to impact the revenue Ex: treatment planning, scheduling, accounts, patient check-in/out, all things AR, etc.
O RGANIZING Y OUR T HOUGHTS : S YSTEMS T HEORY : Treatment Planning Accurate Scheduling Patient Check- in/Out Coding and documentation Claims Processing Denial Management Payment Posting AR Management Tracking Progress R EVENUE C YCLE EHR
U SING THE EHR W HAT IS THE EHR? EHR = Electronic Health Record Fully integrated EHR = all functions are interconnected and do not stand alone.
T REATMENT P LAN Lack of treatment plan=lack of communication Communicates cost of treatment to patient A sequenced treatment plan facilitates scheduling Tracks potential revenue
S CHEDULING Need to know clinic activity. Using the Treatment Plan = staff knows what to collect Track patients who habitual fail or cancel = stable patient base Tracks chair utilization Digital format allows for use of outside vendor for confirmation of appointments
P ATIENT C HECK - IN Treatment plan and accurate scheduling = patient check-in process Ensures collection or verification of patient demographics Allows for collection of payment before treatment Do you want to manage credit or debt?
C ODING AND D OCUMENTATION Treatment Plan = accurate coding Inaccurate coding = slower reimbursement from 3 rd party payers No codes = missing charges and/or reduced productivity/revenue Use EHR to track missing charges (codes) daily
C LAIMS P ROCESSING Treatment Plan = accurate coding = accurate claims Accurate claims = faster reimbursement Electronic Claims and electronic attachments = faster reimbursement Real time processing information
D ENIAL M ANAGEMENT EHR flags incomplete claims. Electronic claims allows for real time management. Real time management = faster claim correction = faster reimbursement Reduces the amount of time staff spends on the phone with 3 rd party payers
A/R M ANAGEMENT Accurate demographics = fewer returned statements Digital format provides for sending file to 3 rd party vendors for statement processing. Allows staff to use time in more productive manner Reports that assist staff in claims and outstanding balance follow-up
P AYMENT P OSTING Tracks the amount of time from check posting in the system to allocation to individual claim Future: 3 rd party payers will send electronic files that download payments automatically Staff will only have to look at the payments with exceptions
P ATIENT C OLLECTIONS Report generation for outstanding claims/patient balances Ease of working with collection agencies Collection agency can access files and download information into their system. Streamlines process and reduce staff involvement
T RACKING I MPROVEMENTS Determine which benchmarks to use to gauge improvement Apply a simple pre-test/post-test method to determine improvement Use the data your EHR collects to determine improvements Determine which intervals to check for improvements
C ERTAIN B ENCHMARKS CAN BE USED TO TRACK PROGRESS : Average days in A/R <50 days % of A/R over 90 day <20% % of A/R over 120 days<10% Billing turn-aroundwithin 5 days of treatment Payer turn-around Electronic claims10-15 days Paper claims <45 days Bad debt expense (% of net revenue) <2%
Q UESTIONS ?
R EFERENCES Quist, Jim & Robertson, Brian. (2004). Key Revenue Cycle Metrics. Healthcare Financial Management, 58 (9), Palmer, Diane. (2004). Key Tools For Turning Receivables Into Cash. Healthcare Financial Management, 58 (2), Hammer, David. (2007). The Next Generation Of Revenue Cycle Management. Healthcare Financial Management, 61 (7), Amatayakul, Margaret. (2005). Are You Using The EHR-Really?. Healthcare Financial Management, 59 (11),