Candice A. Powers, MBA Director of Revenue Cycle Beaufort Memorial Hospital.

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Presentation transcript:

Candice A. Powers, MBA Director of Revenue Cycle Beaufort Memorial Hospital

SchedulingAuthorizationRegistrationEncounterCoding/HIMBillingPosting Financial Counseling Collection Denials and Audits Traditional Revenue Cycle

 Areas are often operated in Silos  Lacking integration with bolt on technologies  As a result processes are fragmented  People and their responsibilities get lost in translation  Results in lost productivity, increased cost and underperformance

SchedulingAuth Registration EncounterCodingBillingPosting Financial Counseling Collection Denials and Audits Five Zone Strategy HIS

 Keep the analysis to the 5 zones initially  Searching for Gaps, hoping for no HOLES  Be sure to spend time with front line staff as well as managers and directors

 Technology  Process 2 questions: What works? What could work better?

HIS Pre Encounter Financial Counseling BillingPosting Financial Counseling Collection Denials/ Audits Optimal state

SchedulingAuthorizationRegistrationEncounterCoding/HIMBillingPosting Financial Counseling Collection Denials and Audits Remember ?

HIS Pre Encounter Financial Counseling BillingPosting Financial Counseling Collection Denials/ Audits Optimal state

o Scheduling, Authorization, Registration, FC must become more blended, integrated o Assess: o Financial clearance technology o Eligibility o Batch eligibility verification o Propensity Assistance o Med Nec Screening/Order Level o Quality Assurance technology and/or process o Integrate eligibility/propensity/Med Nec/QA info into the master HIS

o Billing and Posting o HIS capabilities o CCI o Unit discrepancies o Plan code discrepancies o Facility misinformation o REPORT AND FOLLOW UP o Claims Clearinghouse o Bridge routines o Productivity reporting o Take the time to eliminate the paper (less than 5%) o Alias payers daily and report back o Can you claim status? o What is your first pass yield rate? o Cash Posting o Again NO PAPER

 Worklisting  CATCH ALL LIST  Review and trend aging monthly  Reallocate resources in measurable increments Post Encounter

 Financial Counseling  What info do you have or can you get PRE ENCOUNTER?  Post encounter is a completely different ballgame  Essential for Non Profits  USE the propensity information you have now integrated  Under 501R, presumption becomes essential  Connect advocacy resources within the health system and community  Automation???  Discounts at POS? SP?  Collections  Access and transparency  Cut costs by collecting address information and feed back to HIS  Review the patient portal. How much functionality is present?  Ask questions of your partners and include them in every process change discussion  Using same propensity scoring for net 30 discount?

Denials/Audits  Denials  Full ANSI/Denial code review of your top 10  Strip the reporting directly from the 835  Standardize follow up procedure to identify and use CAS codes when adjustment taken on non 835(less than 5% remember)  Feed HIS statuses of the progress  Standardize reporting  Underpayments ARE underhanded denials  Total Claim/Total Submitted Claim/Total Denied/Net Reimbursement/Recovery  Audits  Standardize reporting  Audits will provide the roadmap for clinical improvement and administrative improvement  Are you capturing secondary denials info As a hospital, do we have access to the physician owned practice clinical documentation???

You are where you are because you are good. Without team support, your success will be minimal.

 BE PROACTIVE  Provide opportunities for larger picture education  HFMA is an excellent resource for staff development

 Evaluation process for technology holes  Check HFMA for reputable companies  Ask around, do NOT use only references provided  Evaluate until you find a fit  Do not settle  Grading system with a comment from each team member  Down to top three, more in depth review and rank  DO NOT DO THIS YOURSELF WITH ADMINISTRATION

CREATE THIS CULTURE!!!!

HIS Pre Encounter Financial Counseling BillingPosting Financial Counseling Collection Denials/ Audits