SHELLY GUFFEY MAKING THE MOST OF YOUR REVENUE CYCLE MANAGEMENT TECHNOLOGY

Identify key questions Prepare your staff to fully leverage technology Create written policies OBJECTIVES 2

Declining Medicare reimbursements Growing patient responsibility for payments Industry transitions will impact revenue flow STATE OF THE HEALTH CARE INDUSTRY 3 Source: American Health Information Management Association

MANAGING YOUR REVENUE CYCLE 4 Source: MGMA’s Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid, 2 nd ed. Many medical practices report a gross collection rate of 60% or less – For every $1.00 billed, physicians are only reimbursed $0.60

IMPACT OF USING TECHNOLOGY Practices who use revenue cycle management technology consistently outperform their peers – Cost – Revenue REVENUE CYCLE MANAGEMENT TECHNOLOGY 5 Source: LarsonAllen study, 2010

IMPACT OF RCM TECHNOLOGY Technology adopters collected more than 50% of outstanding receivables in 15 days or less – Providers who did not use technology efficiently collected only 9% 6 REVENUE CYCLE MANAGEMENT TECHNOLOGY Source: LarsonAllen study, 2010

REVENUE CYCLE MANAGEMENT TECHNOLOGY 7 How can you make the most of your revenue cycle management technology?

INTEGRATE TECHNOLOGY SEAMLESSLY Minimize disruptions to staff during integration Break integration into phases Consider how tools will fit within other systems MAKING THE MOST OF YOUR TECHNOLOGY 8 FIT WITHIN YOUR EXISTING WORKFLOW

ENSURE VENDOR OFFERS SUPPORT How will they provide support? How often are their tools updated to keep current? How will the tool work within your existing systems? How will they train your staff? Do they offer user group meetings or webcasts? Can you call client references? MAKING THE MOST OF YOUR TECHNOLOGY 9 QUESTIONS TO ASK VENDORS ABOUT THEIR SUPPORT

TEST TECHNOLOGY TOOLS WITH STAFF Involve several staff members in testing Take staff feedback into consideration when selecting a tool MAKING THE MOST OF YOUR TECHNOLOGY 10 TEST OPTIONS

PREPARE YOUR STAFF TO USE TOOLS Determine who needs to interact with new system Hold training sessions Inform clinical staff how their work may impact the practice’s revenue cycle Involve staff in continued education and professional organizations MAKING THE MOST OF YOUR TECHNOLOGY 11 TRAIN STAFF TO USE NEW TECHNOLOGY

CREATE POLICIES FOR TECHNOLOGY USE Create standards for billing processes Record policies in writing MAKING THE MOST OF YOUR TECHNOLOGY 12 ESTABLISH POLICIES TO IMPROVE EFFICIENCY

UTILIZE REPORTING FEATURES Track how quickly claims are submitted Analyze frequent errors and denials Monitor days in A/R Benchmark to improve performance MAKING THE MOST OF YOUR TECHNOLOGY 13 UTILIZE REPORTS

CORRECT CLAIMS REJECTIONS On average, it costs practices $40 in staff time to rework a denied claim Correct claims rejections within 48 hours of submitting the claim Develop a process to identify and address common rejections MAKING THE MOST OF YOUR TECHNOLOGY 14 CORRECT CLAIMS REJECTIONS

IDENTIFY FREQUENT REJECTIONS Identify the top rejection for your practice Educate your staff on correct coding for that rejection Continue to eliminate common rejections that have the most impact on your practice MAKING THE MOST OF YOUR TECHNOLOGY 15 IDENTIFY FREQUENT REJECTIONS

CHECK PATIENT ELIGIBILITY Only 79% of practices check patient eligibility Only 24% of practices check patient eligibility at every visit Use eligibility tools to quickly verify patient eligibility prior to the appointment MAKING THE MOST OF YOUR TECHNOLOGY 16 CHECK PATIENT ELIGIBILITY

EDUCATE PATIENTS ABOUT PAYMENTS Talk with patients in advance about expected payment owed Collect patient payment at time of service Offer financing options MAKING THE MOST OF YOUR TECHNOLOGY 17 EDUCATE YOUR PATIENTS ABOUT PAYMENTS OWED

COLLECT PATIENT PAYMENTS Patient eligibility checks and other tools can help you calculate patient payment Enable multiple payment options (cash, checks, credit cards) to collect at time of service Create installment plan payment options MAKING THE MOST OF YOUR TECHNOLOGY 18 COLLECT PATIENT PAYMENTS

OFFER ELECTRONIC PAYMENT OPTIONS Enable off-hours patient payments Create online payment portal for easy access MAKING THE MOST OF YOUR TECHNOLOGY 19 OFFER ELECTRONIC PAYMENT OPTIONS

SELECT TECHNOLOGY THAT CAN GROW Choose products that allow for expansion and upgrades For example, Epic and Gateway EDI are always adding features and upgrades to keep up with industry changes MAKING THE MOST OF YOUR TECHNOLOGY 20 SELECT TECHNOLOGY THAT GROWS WITH YOU

TO MANAGE YOUR REVENUE CYCLE, ALWAYS: 21 Identify one staff member to review insurance payments for accuracy Review EOBs and ERAs to address delays, denials and reductions Analyze reason and remark codes on payment adjustments Verify patient insurance eligibility prior to each visit

TO MANAGE YOUR REVENUE CYCLE, ALWAYS: 22 Keep copies of fee schedules and health insurer contracts Create a plan to upgrade electronic transactions for ICD-10 Meet with your claims processing team regularly to evaluate workflow for ways to improve efficiency

TO MANAGE YOUR REVENUE CYCLE, DAILY: 23 Submit claims and statements Receive remittance advice files and reports Balance claims files against totals from your Practice Management System Manage primary and secondary rejections Post remits in your Practice Management System

TO MANAGE YOUR REVENUE CYCLE, WEEKLY: 24 Verify that rejected claims have been corrected and resubmitted Analyze claims rejections to spot and correct common errors Ensure all claims have reached appropriate payers

TO MANAGE YOUR REVENUE CYCLE, MONTHLY: 25 Balance claims statistics to create a snapshot of your office’s performance Compare your office’s performance to industry benchmarks Share news on industry trends and changes with your staff

KEY TAKEAWAYS 26 Practices who use revenue cycle management technology see positive results Training staff to utilize technology helps you collect more revenue and reduce staff time Establishing clear policies for posting claims and collecting patient payments helps manage your revenue cycle more efficiently

Q + A 27

SHELLY GUFFEY EXT

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