shelly guffey making the most of your revenue cycle management technology 11.15.12
TRANSCRIPT
SHELLY GUFFEY
MAKING THE MOST OF YOUR REVENUE
CYCLE MANAGEMENT TECHNOLOGY11.15.12
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• Identify key questions
• Prepare your staff to fully leverage technology
• Create written policies
OBJECTIVES
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• Declining Medicare reimbursements
• Growing patient responsibility for payments
• Industry transitions will impact revenue flow
STATE OF THE HEALTH CARE INDUSTRY
Source: American Health Information Management Association
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MANAGING YOUR REVENUE CYCLE
Source: MGMA’s Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid, 2nd ed.
• Many medical practices report a gross collection rate of 60% or less– For every $1.00 billed, physicians are
only reimbursed $0.60
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IMPACT OF USING TECHNOLOGY
• Practices who use revenue cycle management technology consistently outperform their peers– Cost
– Revenue
REVENUE CYCLE MANAGEMENT TECHNOLOGY
Source: LarsonAllen study, 2010
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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%
REVENUE CYCLE MANAGEMENT TECHNOLOGY
Source: LarsonAllen study, 2010
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REVENUE CYCLE MANAGEMENT TECHNOLOGY
How can you make the most of your revenue cycle
management technology?
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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
FIT WITHIN YOUR
EXISTING WORKFLOW
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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
QUESTIONS TO ASK
VENDORS ABOUT THEIR
SUPPORT
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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
TEST OPTIONS
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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
TRAIN STAFF TO USE NEW
TECHNOLOGY
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CREATE POLICIES FOR TECHNOLOGY USE
• Create standards for billing processes
• Record policies in writing
MAKING THE MOST OF YOUR TECHNOLOGY
ESTABLISH POLICIES TO
IMPROVE EFFICIENCY
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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
UTILIZE REPORTS
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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
CORRECT CLAIMS
REJECTIONS
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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
IDENTIFY FREQUENT
REJECTIONS
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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
CHECK PATIENT
ELIGIBILITY
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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
EDUCATE YOUR
PATIENTS ABOUT
PAYMENTS OWED
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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
COLLECT PATIENT
PAYMENTS
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OFFER ELECTRONIC PAYMENT OPTIONS
• Enable off-hours patient payments
• Create online payment portal for easy access
MAKING THE MOST OF YOUR TECHNOLOGY
OFFER ELECTRONIC
PAYMENT OPTIONS
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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
SELECT TECHNOLOGY THAT GROWS
WITH YOU
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TO MANAGE YOUR REVENUE CYCLE, ALWAYS:
• 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
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TO MANAGE YOUR REVENUE CYCLE, ALWAYS:
• 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
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TO MANAGE YOUR REVENUE CYCLE, DAILY:
• 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
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TO MANAGE YOUR REVENUE CYCLE, WEEKLY:
• 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
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TO MANAGE YOUR REVENUE CYCLE, MONTHLY:• 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
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KEY TAKEAWAYS
• 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
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Q + A
THANK YOU.
THE BEDSIDE MANNER YOUR
REVENUE DESERVES™
11.15.12