Understanding Best Practices in Revenue Cycle Management Speaker: Deena Wojtkowski, CPC, CEMC, CCP-P April 18, 2013

One of the best ways to increase revenue is to ensure that you don’t ignore income sources already in place. “The lifeblood of a practice is how it captures, obtains and submits billing information” We see a lot of practices leave money on the table because of incomplete billing practices” Where do you start?

Pre-Planning the Office Visit Determine prior account balance Verify insurance Determine co-payment Determine co-insurance and deductible Learn pre-authorization requirements Make demographic/insurance updates Learn patient’s no-show history

Pre-planning the Office Visit What about patient’s financial responsibility with insurance coverage? Areas to consider: Co-payment: pay before or after service Co-insurance: pre-pay or payment plans Deductibles: pre-pay or payment plans Supplemental Insurance

Pre-planning the Office Visit What if patient doesn’t have insurance coverage? Areas to consider: Pre-service financial counseling/arrangements Payment plan Charity care Sliding scale based on ability to pay Interest on past-due balances Pass-through on the collection agency fee

Patient Check-in Collect co-pays/co-insurance/deductibles/outstanding balance - Merchant services - Electronic fund transfer scanner Collect past-due balances/no show penalties/etc. Obtain copy of insurance card – front and back Obtain/verify demographics Obtain HIPAA signature, waiver forms

Charge Capture and Charge Entry Surgical / Office Procedures Fee Schedule Practice Management System - Claim scrubber - Claim edit Encounter Form - Update procedure and diagnostic codes annually - Track when provider turns in - Track when submitted to payer (lag time)

Charge Capture and Charge Entry Inpatient Procedures Fee Schedule Encounter Form - Verify charge capture against documentation, such as operative reports, discharge summaries, etc. - Timely dictation and reports - May realize as much as 20% charge increase with reconciliation process

Charge Capture and Charge Entry Conduct Quality Control Processes Coding Audit Charge Entry Audit Lag Time Analysis

Claims Submission Clearinghouse Conduct a Quality Review of Claims Hold Claims Until Documentation is Completed Submit Claims on a Daily Basis Submit E-Claims

Claims Submission E-Claims Checklist Keep Updated on Claim Formats Review and Work Your Claim Edits Work Error Reports Daily Monitor Claim Filing Deadlines Know Your States Regulations about a Clean Claim Use Scrubbing Software

Claims Submission Clean Claims Checklist Institute an Edit Function for Paper Claims Review Your Clearinghouse Costs Work Suspended Claims Be Efficient in Processing Claims

Payment Posting Payment Variance Determine if you are being paid what you are due Payment Posting Performance Checklist - Cash Batching employee - Cash Posting employee - Multiple layers for auditing efforts

Payment Posting Payment Posting Audit Tool Institute Electronic Payment Posting Establish Appropriate and Effective Internal Controls Safeguard Checks and Credit/Debit Card Receipts Make Sure Payers Have Updated Information about Your Practice Actively Manage Unidentified Payments Implement Non-Contractual Adjustment Codes

Payment Posting Verifying Reimbursement Level by Payer Resolve Credit Balances Within 60 Days Develop a Streamlined Refund Process Develop a Streamlined Process for Billing Secondary Claims and EOB’s That Need Follow-Up

Payment Posting Contractual Adjustments - “Allowable” Non-Contractual Adjustments - Reduction of payment, or non-payment, for a particular reason Lockbox Services

Account Follow-up Prioritize Account Follow-Up Ensure Timely Account Follow-up Follow up on All Open Claims Do NOT Automatically Re-bill Accounts Clean Up Your Accounts Receivables Identify a Small Balance Adjustment - 30% of claims submitted for the first time get denied -50% of those claims are not followed up on - Denials Management

Account Follow-up Ways to Prioritize Your A/R Efforts - Educate Staff to Follow a Systematic Process - Develop a Systematic Follow-up Process with a Payer Payer Collection Checklist - Use the Internet to Check for Payer Updates - Transfer the Account to Patient Responsibility - Resolve “Information Requested from Patient”

Denials Management Measure Denial Data and Take Action Insurance Rejection Log Graph of Denial Trends Understand the Payer’s Reimbursement Policies Decide if a Denial is Inevitable Rework Appealable Claims Organize Denial Follow-up Activity Use denial Data to Redesign Billing Processes Calculate the Cost of Rework

Denials Minimization Appeal Denials Escalate Denials or Other Payer Issues if Necessary Schedule Routine Meetings with Top Payers Maintain Records of Inappropriate Denials Use Denial Data to Compare Payers

Patient Collection Establish a Collections Cycle That Works for your Practice and its Patients Set Protocols for Patient Follow-up Establish Protocols for Payment Plans Budget Plan and Payment Plan Agreement Collect When the Patient is in the Office Follow Up on All Patient Correspondence

Patient Collection Process Returned Mail Within 48 Hours Get the Patient Involved to Help You Track the Volume of Statements the Practice is Sending to Patients Show Patients How to Read the Patient Statement Maximize the Use of Statement Notes to Communicate with Patients Offer Online Patient Bill Paying

Patient Collection Establish a Billing for the Practice Collect Cellular Telephone Numbers from Patients Research Coverage for Self-Pay Patients Report Bad Debt to the Credit Bureau(s) Develop and Use a Charity Care Policy

Patient Collection Charge Billing Fees to Patients Who Don’t Pay in a Timely Manner Make it Easy for Patient to Pay You Include Billing Service Questions on Patient Satisfaction Instruments Maintain a Record of Patient Inquiries and Disposition - Use a Billing Inquiry Call Log - Have Dedicated Staff for Patient Inquiries

Patient Collection Be Aggressive Patient balance options The Industry in general says to “hit harder and faster on patient balances” - Statements every 15, 30, 45 days - Traditional 30, 60, 90 days - Total of three statements then to collections

Patient Collection Use a Collection Agency Obtain Physician Approval to Send an Account to Collections (if required) Without Delaying Its Move to the Collection Agency Establish Contracts with Two Collection Agencies Establish Appropriate Internal Controls for Collection Agency Funds

Rightsizing the Office Do we have the right number of staff? Are they doing the right things? Are they able to devote sufficient time to their major tasks? Are staff members completing the full revenue cycle each month? Is your current philosophy, “Just add one more person to fix the problem?”

Rightsizing the Office Allocate appropriate resources to diagnose and treat the disease, not the symptom You need the right number of staff who are performing the right tasks and processes to enable a streamlined revenue cycle Do you have the right people doing the right things to get the job done? Are account resolution staff cross trained?

Rightsizing the Office Determine how your staff spend their time Compare overall staffing with available benchmarks Determine benchmark measure of choice and identify specific full-time equivalent (FTE) levels required for tasks Identify performance workload ranges and compare these with suggested ranges to determine if there is opportunity for change/improvement

Rightsizing the Office If the performance is substandard, rather than have more staff involved in checking and rechecking work, train staff and provide them with additional tools and resources so they can perform at a high quality Train or trade mentality

Collect what is due on behalf of the physicians and other providers who provide medical care. Reduce your errors, increase your automation and increase your productivity – don't leave money that is due your practice uncollected. Rightsizing the Office

QUESTIONS?