building clean lab test claims the right way the first time · building clean lab test claims the...

Building Clean Lab Test Claims the Right Way the First Time

Combining the Lean Mindset with New Tools to Boost Collected Revenue

The Lean Mindset

Lean thinking is shifting away from a static mindset and shifting to continuous improvement and continuous problem solving.

© 2017 Confidential and proprietary to TELCOR Inc. All rights reserved.

Is About Growth

What the Experts Say

“Lean is described in terms of three systems: an Operating System for scalable, transparent and effective execution, an Organizational Learning System for evolving better products and processes, and a People System that helps everyone learn and grow.”

- Frode Odegard, CEO Lean Systems Institute

And Results

Laboratory 1

25% NET

COLLECTIONS INCREASE

8% GROWTH INCREASE

Laboratory 2

Integration standards established

(over 25 interfaces)

$1M NET

COLLECTIONS INCREASE IN YEAR 1

30+ DAY DSO

REDUCTION Manual routines to revenue cycle automation

Migration to a lab-specific solution

Consolidation of processes into single solution


Strategies to Apply Lean Mindset


Vision To make air travel on Southwest Airlines less expensive than driving between two points

Objectives

Strategy

• Generate more revenue • Lower unit costs per flight • Operate with reduced number of personnel

• Enter markets at rates that allow the airline to be profitable on the basis of lean operations and high aircraft use

• Operate only short haul, high frequency, point-to-point flights • Minimal aircraft turnaround time • Commonality in fleet (Boeing 737) • Avoid congested airports • Hub-and-spoke models and interline agreements • Promote employee teamwork and implement profit sharing plan

Southwest Airlines’ Low Cost Strategy

And Boost Revenue

Strategies to Apply Lean Mindset and Boost Revenue


Vision To generate clean compliant claims the first time with minimal effort and scale for growth

Objectives

Strategy

• Generate more revenue • Lower unit costs per requisition • Operate with reduced number of personnel

• Scan the environment to determine current state opportunities and future state bottom line benefits • Define your processes around automation and submission requirements • Align expertise with work

Typical Lab Looking Improve their Bottom Line through RCM

And Boost Revenue


Scan the Environment to Find Opportunities

RCM Data Integration

RCM Rules Engine

Reporting & Dashboards

LIS Integration

Other Support Applications

Doctor’s Office EMR / HIS Departmental Systems

Clearinghouse and Payer Integration


Familiar Challenges, Familiar Concepts

Delivery of a timely, quality

test result Generate a clean claim

Operating System Process People

Quality Improvement

Opportunity Analysis Prioritization Matrix

High Cash Impact

Low Cash Impact

Lon

g

Du

rati

on

Sh

ort

Du

ration

A1 – Claim monitoring

A2 – Rules Engine

A3 – Missing billing data

A4 – Eligibility verification

A5 – Operating System

A6 – SOP development

A1

A2

A3 A4

A5

A6



Translating Collection Challenges Into Business Opportunities

People

Process

Operating System

Challenges

• Lack of real time, consistent information • Missing information • Meeting payer specific requirements • Additional hoops that are specific to

your lab

Lean Mindset

• Leverage all integration inbound/outbound • HL7 Charge/Demographics • 837s/835s • 270/271, 277 etc

• Leverage all the fields in the interface • Single solution to manage your revenue

cycle • Patient centric billing rather than requisition

based • Determine source of truth for data updates

Benefits • Decrease end-user wait times for information • Improved time from submission to payment • Adapt to current and future industry changes • Visibility - know where every dollar is and have tools to collect • Improved collections


People

Process

Operating System

Challenges

• Inconsistent processes performed by all end-users

• Operational Process are not standardized

• Lack of business continuity • Throw FTEs at problems • Growth has become an adversary

Lean Mindset • Exception based tools

• When scrubbing demographics and charges

• Create automated rules to replace manual processes

• Mileage and travel processing • CCI, NCD, and ICD-10 checking • Financial Class, Client, Payer based

rules • Jurisdictional processing

• Direct exceptions to work areas rather than exporting excel documents

• Leverage a scheduler to generate bills, close periods, move charges through billing

• Benefits

• Cost improvement through automation • Minimize error volume • Reduce end-user workload • Optimize automated processes to reduce manual intervention • Increase compliance with payer and industry regulatory requirements




People

Process

Operating System

Challenges

• Continuous improvement is reactive • Changes occur when there is a problem

identified • Historical perceptions of billing practices • Underdeveloped staff

Lean Mindset

• Implement cross-functional continuous improvement Team w/reporting to Senior Management

• Create an operational dashboard to identify effectiveness of staff

• Charge throughput and errors • Claim status • Appeal status

• Create a scoring system of biller tasks/events to measure productivity

• Invest in your staff if there is a knowledge gap

• Reengineer workflow, perform assessment, repeat…

Benefits • Develop resources to successfully execute your business strategy • Implement a culture of continuous improvement • Optimal productivity and cost control • Depth and versatility across the bench


Methodology

Initiate Plan Execute Close

Set achievable goals

Build your team – Project Sponsor, Project Leader, Subject Matter Experts

Establish clear expectations


Methodology


Establish communication protocols

Develop plan based on objectives with consideration of system, process and people

Analyze risks, resources and responsibilities

Establish metrics for measuring outcome


Methodology


Execute project plan

Meet and provide status reports regularly

Continually assess progress and risk

Use metrics to monitor progress

Define SOPs


Methodology


Confirm expectations were met

Implement ongoing assessment of metrics to monitor status

Perform a post-mortem evaluation

Refine processes from lessons learned

Identify next target and repeat


“It always seems impossible until it’s done.” - Nelson Mandela

building clean lab test claims the right way the first time · building clean lab test claims the...

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