revenue cycle management medical office economics · revenue cycle management & medical office...

© 2016 Aprima Medical Software, Inc. All rights reserved. Aprima is a registered trademark of Aprima Medical Software. All other trademarks are the property of their respective owners.

Revenue Cycle Management&

Medical Office Economics

Amy MillsImelda Morales

Omid Ebrahimi-SohiCristen Sistrunk

© 2015 Aprima Medical Software, Inc. All rights reserved. Aprima is a registered trademark of Aprima Medical Software. All other trademarks are the property of their respective owners.

Today’s Topics

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• Aprima RCM-Implementation• Medical Office Economics Front Office Efficiency – Best Practices A/R Management Practice Assessment

• Enhanced Reporting dashboardMD

Aprima RCM - Implementation Batches

• Timely Completion Balancing

• Daily• Hard Close

Fee Schedule• Missing Fees

Amount Allowed Schedule• Underpayment

Insurance Payer/Plan Setup• Claim Formats

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Front Office Efficiency-Best Practices

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• Appointment Scheduling • Check-In & Check-Out• Insurance Verification

Best Practice - Appointment Scheduling

Staff responsible for scheduling are the first line of defense when it comes to preventing loss of revenue, and the first opportunity to collect accurate patient information. Accurate demographics and insurance information are essential to verifying patient financial responsibility and filing clean claims.

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Best Practice - Appointment Scheduling

• Plan Participation Matrix Utilized• Scheduling Protocols per Provider Available • Triage Process • Patient Demographics Obtained• Subscriber Information Obtained• Populate Meaningful Use Fields • Patient Remarks Addressed • Patient Balances Reviewed and Addressed• Referral/Authorization Requirements Communicated• Non-covered Services or Exclusions Communicated

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Best Practice - Check-In

Staff working Check-In have a direct financial impact on the company. Policies and Procedures must be designed in order to be efficient, reduce denials and maximize the collection rate

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Best Practice - Check-In• Insurance Cards and Patient Identification Obtained

and Scanned• Payment Policies Available to Patients (i.e. payments

due at the time of service)• Obtain Annual Required Forms• Confirm Patient Information and Demographics • Confirm all Meaningful Use fields are populated• Confirm Referral/Authorization Requirements• Collect Copays at Time of Service • Patient Notified Deductibles are collected at check-out • Collect Old Patient Balances • Cross Trained Staff

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Best Practice - Check-Out

• When the patient’s portion is not collected at checkout, there is a greater possibility the money will never be collected.

• Collecting after the time of service results in higher overhead costs.

• Scheduling follow-up appointments at the time of check-out increases patient retention.

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Best Practice - Check-Out

• Collect Deductible, Co-insurance, Outstanding Balances and Co-pays not collected at check-in

• Collect Pre-Payment for Procedures/Ancillary Services

• Follow-up Appointments Scheduled• Confirm and/or Schedule Internal Referral

Appointments• Required Signed ABN Waivers Obtained

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Best Practice - Insurance Verification

Insurance expertise gives employees an opportunity to provide excellent customer service and maximize revenue. Insurance coverage must be verified prior to the appointment in order to communicate the patient’s financial responsibility and secure payment at the time of service.

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Best Practice - Insurance Verification

• Insurance Expertise (i.e. Plan Types, Medicare Advantage clean claim requirements, etc.)

• Patient Eligibility & Benefits Tools Available• Referral/Authorization Requirements Communicated• Non-covered Services or Exclusion Communicated• Patient Financial Responsibilities Communicated

Prior to Appointment• Next Day Prep Benefits verified Patients with HDHP Patient Balances Required Forms

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The Insurance Card: What is it trying to tell us?

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Plan type: this one is a POS:Point Of Service

PRODUCT NAMEHelps you select payer/plan code

ID number, group numberand Coverage Effective date will be needed for Insurance Verification

Subscriber and patientdemographics will be needed for registration and scheduling

Copay Information for primary care & specialist: This information will be entered in the system and we’ll need to remind patient to bring the copay

Claims AddressProvider Number

Medicare Replacement Plans

• View the benefit details for all patients with Medicare

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Medicaid Managed Care

• View the benefit details for all patients with Medicaid

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Accounts Receivable Management

• File Claims Regularly• Manage rejections• Timely Follow-Up on Claims• Automate Insurance Information ERAs/EFTs

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Practice Assessment

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• Reports & Practice Metrics Financial Summary

• Days in AR• Gross Collection Rate• Net Collection Rate• Average Charges• Average Collections

Insurance Productivity• Payer Mix

Patient Aging Summary Adjustment Summary Procedure Productivity Summary

• Assess salaried provider’s production• Analyze ROI on ancillary services

Financial Summary

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Important Practice Metrics• Days in AR: average number of days it takes

for a claim to pay after the charge is posted.Ending A/R ÷ Average Charges X 30

• Gross Collection Rate: percentage received in revenue for every dollar charged.

Receipts ÷ Charges• Net Collection Rate: percentage collected

(receipts and adjustments) for every dollar charged.

(Payments + Adjustments) ÷ Charges

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Insurance Productivity

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Monitor your payer mix.

Patient Aging Summary

• Collect Patient Portion at the Time of Service Utilize eligibility and Aprima to estimate the

patient balance for the visit.• Patient Payment Plans• In-House Collections• Refer to a Collection Agency

***Payments can be made on the Patient Portal***

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Adjustment Summary

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Procedure Productivity Summary

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Procedure Productivity Summary

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Manually? …with Excel?

How Does Your Office Manage The Revenue Cycle?

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Enhanced Reporting

Better Tools, Better Results, Best Practices

How dashboardMD can Help You dashboardMD automatically generates ready to use

information for the entire revenue cycle. dashboardMD reports are pre-calculated and deliver

information in an “at a glance” format. Simply by checking their dashboards for a few minutes

each day, everyone in your practice has the information they need, on-line, anytime.

Managers can track monthly goals Executives can monitor the progress of initiatives practice-

wide and drill through to detail Physicians can receive automatic email reports for

performance initiatives

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Enhanced Reporting Solutions

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• Ad Hoc Analysis

• Scheduled Reports

• Daily Dashboards

• Scorecards

• User Defined Alerts

• Predictive Analytics

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Daily Dashboards - Enterprise Scorecard

Practice Manager Dashboard

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Practice Manager Dashboard

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Practice Manager Dashboard

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Ad Hoc Analysis – Payments for Top Payers by CPT Section YTD

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Ad Hoc Analysis – Top Provider Shifts in Patient E&M Visit Counts YoY

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Push Reports via Email-E&M Provider Dashboards

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Request a Demo

For more information regarding dashboardMD please contact your Aprima Sales Executive.

Aprima RCM

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• We file the claims Electronic & Paper

• We work the rejections where we can• We post the payments, adjustments and transfer

patient liability Appeal inappropriate denials Review Medical Policies & provide to clinician

• Mail monthly statements• Month End Close Schedule conference call and provide financial reports

Aprima RCM

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Customers 136 Practices

Providers 558 Providers

Specialties 35 Specialties

Localities 36 States

Annual Client Revenue $200,000,000.00

Amy MillsExecutive Director of RCM Implementation214-675-6851amills@aprima.com