practice pulse rcm analysis and e.h.r. healthcheck angela jarrett, cpc, cmpa senior professional...
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Practice Pulse RCM Analysis and E.H.R. HealthCheck
Angela Jarrett, CPC, CMPA
Senior Professional Services Consultant
RCM Analysis Overview
Increase productivity, increase staff knowledge, increase revenue, modify workflows, increase staff measurements and outcomes
• Analysis• Professional Consulting • Living RCM
RCM Analysis Agenda
• Overview• Revenue Cycle Management Analysis
Report• System Work Flow Analysis and
Design• Professional Consulting and Support• Goal
Revenue Cycle Management Analysis
This information is intended to provide the staff with an analysis of overall system status as well as a review of system usage and overall performance.
Administration – Exclusive Review of specific Admin Tables
Financial PerformanceSystem MaintenanceManagement Goals and Outcomes,
Measurements and Expectations
A Peek Behind The Curtain
$ Squeezing the Sponge $
Stay In the Bell Curve
HRSA Top 5 Financial Classes: Medicare, Medicaid, Slide Fee, Self Pay
and Commercial. Are the providers coding ALL patients the SAME way? With the RCM ANALYSIS Report…
you will know!
Workflow, workflow, workflow!
A workflow consists of an orchestrated and repeatable pattern of business activity enabled by the systematic organization of resources into processes that transform materials, provide services, or process information.
System Workflow Analysis and Design
Identify workflow, system functional weaknesses and staff competency
Front Desk Staff ObservationBilling Department Staff ObservationEDI Database Review Development of Optimized Workflows
Plan
Professional Services Consulting and Support
Identify required maintenance, staff re-training and overall optimization RCM to “Living RCM Standards’
Administration TrainingSystem TrainingBilling/Patient Financial Services TrainingPayment Entry - Insurance/PatientReports TrainingClosing Date Procedures Training
RCM ANALYSIS Tier 1, 2, 3 and beyond
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Administration – Exclusive Review of specific Admin Tables
EDI Database Review
Tier 2 Tier 3Visualutions Revenue Cycle Management Consulting Services
Billing/Patient Financial Services Training- All aspects of billing, training adding EDI Transmission and Response refresher
Management Goals and Outcomes, Measurements and Recommendations
Staff Observation and Discussion End User- Registration, Scheduling, Pre/Post Payment Collections, etc.
Billing/Patient Financial Services- Charge Entry, charges management, processing, EDI Sub/Resp., Claims management, follow-up, payment posting
Administration Training
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System Training (Super/End User Training)- Include Gap areas, UDS deep dive, etc.
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Tier 1
Development of Optimized Workflows Plan
Financial Performance - Report and Dashboards Created
System Maintenance
Name Plan Duration Assigned Total Hours
Revenue Cycle Management Analysis
Day 1
Financial Performance - Report and Dashboards Created 2hrs Online 2
Administration – Exclusive Review of specific Admin Tables 4hrs Onsite 4
System Maintenance 4hrs Onsite 4
Management Goals and Outcomes, Measurements and Expectations 2hrs Onsite 2
System Work Flow Analysis and Design
Day 2
Observation Front Desk 4hrs Onsite 4
Observation Billing/Patient Financial Services4hrs Onsite 4
Day 3EDI Database Review 4hrs Onsite 4
Development Optimized Workflows Plan4hrs Onsite 4
Implementation and Post implementation Support
Beyond
Admin Follow Up Training2 Days Onsite Training 16
System Training (Super/End User Training)2 Days Onsite Training 16
Billing Training16hrs Onsite Training 16
Payment Entry - Insurance/Patient4hrs Remote Training 4
Reports Training4hrs Remote Training 4
Reports Training Follow Up/Scoping2hrs Remote Training 2
Closing Date Procedures Training2hrs Remote Training 2
Collections Training4hrs Remote Training 4
Our Goal
WHAT IS… The E.H.R. HealthCheck
The objective of this program is to assist customers that find themselves still struggling with how to implement the changes required by CMS, Government etc…
The overall goal is to help practices change their concept and thought process regarding the software by accepting change in their workflow.
The key initiatives for this service are: Analyze our customers’ workflow Fabricate a systematic workflow process Create benchmarks for each process Ultimately generate revenue
PROCESS FOCUS
1. Evaluation – Evaluate the overall office processes to include the current roles of the staff and utilization of EHR system during the day-today operations.
2. Analysis – Analyze the efficiency of the tools within the EHR system as it relates to the client's EHR vendors best practices.
3. Recommendations – Consultation on the discoveries found during the analysis as to find mitigation on broken processes.
4. Implementation – Based on the recommendations agreed upon, we will incorporate the needed workflows as well as introduce new products and functionalities to move towards Meaningful Use compliance. (i.e. Patient portal, HL7 interfaces, etc...)
5. Evaluation – Perform a post-evaluation of the overall office processes to include the current roles of the staff and utilization of the EHR system during daily operations as comparison to your initial evaluation.
Benchmarking ExamplesCheck-In Process• Has check in lag time improved?• Is the end user capturing all necessary MU Information at Registration? • Are demographics being updated? • Decrease in No Show Rate?
Clinical Process• IIs the Clinical Support Staff managing the encounter types, scheduled visit and LOC correctly? • Did the clinical staff capture the Meaningful Use data?• Is tasking/orders tracking used correctly?• Lag Time Improvement • Services and referral follow-up lag time improvement.
Provider Process• Are providers documenting HPI and CPOE A@P thoroughly for ICD-10 standards. • Are providers completing note during the visit, after the patient leaves or later?• % of On Hold, In Progress, Completed Orders. • Are all charges captured. • Are the providers creating an Append and documenting this correctly? • Are providers completing prescriptions, ordering labs and x-rays procedures?• Are providers scheduling the patient’s next appointment?
What to Expect When We Arrive
1st •We will examine and analyze your front office, clinical staff, and provider processes.
2nd •Based on our findings, we will deliver a strategy that will allow your agency to employ Best Practices based to assure your success.
3rd •We will help you modify your workflows, as needed, and introduce you to any new product functionality that has been evolved since your implementation.
4th •We will conduct an Exit Interview to discuss finding and recommendations.
5th •A written evaluation and recommendations will be provided for future improvements. We would like to keep track of your progress with a follow up call 30 to 60 days from the Check-up visit.
CRITICAL CLINICAL ASSESSMENT AREAS: EHR Implementation Team Workflow Design
Appointment Scheduling
Patient Check In
Clinical Check In
Provider Process
Orders/E-Rx /Referral/Pt Education
Clinical Check Out
Office Check Out Billing
Investment
There’s an investment on the client’s part for this to be successful:• Time – The practice has to invest in the time
to learn. • Adjustment – To the changing times and
regulations of CMS • Attitude – How you react will affect your staff• Concepts – We need to be open to new ideas• Workflow – A re-training or new workflows
and concepts
Who is our target audience?
• Our Customers• Our clinical support staff• Our providers
YOU!
DECIDE…..COMMITT….ACHIEVE!
Questions and Answers
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Thank you.