John Behn, MPA Laurie Daigle, CPC Business Office: Evaluations and Strategies for Continuous Quality Improvement John Behn, MPA Laurie Daigle, CPC

Agenda Evaluate Business Office leadership’s understanding of facility needs and the BO’s role in the revenue cycle Evaluate individual strengths, skills and growth opportunities Develop mentoring plan Provide support and tools for growth and improvement

Evaluate Business Office Management Business Office management must understand the value of BO contribution to the revenue cycle, and support training and education to achieve best practices The business office (BO) must completely understand the size and scope of services offered by the hospital The BO must have an understanding of chargemaster functionality The BO must utilize this understanding to resolve edits prior to submission Use edit opportunities to look for other issues: Missed ER charges Missed or incorrect outpatient infusion codes Missed companion codes The BO must have the empowerment and knowledge to push back through the revenue cycle to address concerns The BO should not be empowered to make code changes without documented approval from coding and/or servicing department Business Office leadership should have a comprehensive training program to support expectations

Establish Expectations Share Current State metrics with the team and ask for feedback Production expectations Quality expectations Customer Service expectations Education and training opportunities Develop a comprehensive process Ensure representative inclusion in the process Ensure proper participation

Revenue Cycle meetings Team meetings One-on-one meetings Meet Regularly Revenue Cycle meetings Team meetings One-on-one meetings Establish expectations Set and review goals Track progress

Management must be prepared Plan agenda for team meetings Meeting Agendas Management must be prepared Plan agenda for team meetings Establish expectations Each person should have a role Round table discussions

Develop Clear and Obtainable Quality Standards Fair and realistic quality standards to be applied equally to each team and each team member Quality expectations apply to: Clinical interactions Revenue cycle components Payor and vendor interactions Patient interactions Employee Satisfaction Surveys frequently cite ownership and appreciation …

Roll Out Measurements and Apply Objectively Determine quality benchmarks Communicate expectations Develop objective audit mechanisms Evaluate for process improvement Repeat audits regularly Be consistent Report progress regularly to the team, individuals and management

Billing and Follow-up Billing and follow-up measured for: Knowledge of payor-specific guidelines Revenue code or CPT/HCPC assignment by payor Payor-specific billing requirements Accurate and effective claim checks Scrubber (clearinghouse) resolution Timely resolution and resubmission of scrubber errors Accurate trending and training Reduction of unsubmitted claims by reason Provide the tools and training required to achieve success Create canned text for common comments Allow for consistency that can be used for reporting

Customer Service Call monitoring measures: Knowledge and understanding of billing notes and remits Accuracy of information interpreted and communicated Dropped calls Adherence to HIPAA requirements Resolution of calls and required follow-up Account documentation measures: Notes should be clear, concise and accurate Billing history should not be used as editorial Create canned text for common comments Allow for consistency that can be used for reporting

Tailor Training Opportunities Isolate opportunities What strengths and weaknesses have been identified? What steps can be taken to address the issues? Have best practices been identified? If so, have the practices been shared with other Business Office departments? Who can benefit from additional training? How can necessary training and education be delivered?

Training Modules and Improvement Plans Be specific Identify peers to provide subject matter expertise Invite feedback from the team Offer support and encouragement Provide training and corrective action Consider quality incentive programs Repeat the process on a consistent basis Super Users on the Same Team may be much more effective trainers than Management of outside resources

Communication Etiquette Remote communication via email and to some extent telephone is subject to interpretation by the receiver of information Business Office team members are accustomed to working in all CAPS in software systems CAPS are considered yelling in email Lack of punctuation causes multiple interpretations Users may not be aware of, or may not properly interpret HIPAA guidelines with regard to PHI Clarify guidelines identifying specifically what can be shared with whom

Blue Cross www.BCBS.com for most states Payor Policy Library Blue Cross www.BCBS.com for most states Medical Policies―search function by: Name Policy number CPT Keyword Organized by category or alphabetically http://www.anthem.com/wps/portal/ahpprovider?content_path=provider/ct/f5/s1/t0/pw_003150.htm&label=Medical%20Policies%20and%20Clinical%20UM%20Guidelines&state=ct E-Updates https://messageinsite.com/networkeupdate

Help Tools Unit conversion http://www.unitconversion.org/ Payor Policy Library Help Tools Unit conversion http://www.unitconversion.org/ Drug help tools http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm http://www.txvendordrug.com/formulary/clinician-administered-drugs.shtml

Payor Policy Library Help Tools CCI edits http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEHOPPS/list.asp#TopOfPage Implant codes by vendor http://www.cookmedical.com/ccodes.do?sbu=esc http://www.americanmedicalsystems.com/DAM_public/5816.pdf http://www.bostonscientific.com/Search.bsci?navRelId=1000.1036&baseTile=corpweb&searchType=corpweb_all&currentPage=1&q=AMPLATZ http://www.crbard.com/products/reimbursement/ccodes/index.cfm http://www.cordis.com/ Choose Cook The GPN G05183 to see if device dependent

Summary: Issue / Solution Unclear expectations / Identify current state, future goals Inconsistent or unbalanced feedback / Develop measurable benchmarks No path to achieve improvement / Provide resources, determine learning styles and most effective teaching methods Utilize mentors to support learning differences Audit regularly Provide feedback consistently to all (training and discipline in private, praise in public) Celebrate success by raising the bar

"Everyone who got where he is has had to begin where he was "Everyone who got where he is has had to begin where he was." - Robert Louis Stevenson

Thank You Stroudwater Revenue Cycle Solutions was established to help our clients navigate through uncertain times and financial stress. Increased denials, expanding regulatory guidelines and billing complexities have combined to challenge the financial footing of all providers. Our goal is to provide resources, advice and solutions that make sense and allow you to take action. We focus on foundational aspects which contribute to consistent gross revenue, facilitate representative net reimbursement and mitigate compliance concerns. Stroudwater Revenue Cycle Solutions helps our clients to build processes which ensure ownership and accountability within your revenue cycle while exceeding customer demands. Contact us to see how we can help. Laurie Daigle, CPC ldaigle@stroudwater.com 603-553-5303 John Behn, MPA jbehn@stroudwater.com 207-221-8277