© Copyright 2015 Afia Inc. 1 MICHIGAN OSTEOPATHIC ASSOCIATION REVENUE CYCLE EXCELLENCE IMPACT ON THE ORGANIZATION

© Copyright 2015 Afia Inc. 2 Presenter  Cynthia Sikina, Vice President, Financial Services  23 Years in the Healthcare Industry  Professional Experience Healthcare consulting Sr VP & CFO, Karmanos Cancer Center – 100 Bed Cancer Hospital CFO/COO, Wayne State University Physician Group – 700 physician multispecialty group practice Director of Financial Services, University of Michigan School of Medicine Finance Director, University of Michigan School of Medicine, Department of Surgery  Education MBA & BBA, University of Michigan, Ann Arbor

© Copyright 2015 Afia Inc. 3 Presentation Outline  Revenue Cycle Defined  Impact on Organization  Leakage Points  Best Practice  Revenue Cycle Assessment  Contact Info

© Copyright 2015 Afia Inc. 4 Revenue Cycle Defined All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. Entire life of a patient account from creation to payment. Revenue cycle processes flow into and affect one another. When processes are executed correctly, the cycle performs predictably.

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7 Impact on the Organization  Financial  Compliance  Quality  Productivity  EHR

© Copyright 2015 Afia Inc. 8 Impact on the Organization  Financial  Largest source of revenue  Service mix/margin  Payor mix  Days in accounts receivable  Actual vs expected collections  Payor incentive programs

© Copyright 2015 Afia Inc. 9 Impact on the Organization  Compliance  Documentation reflects services provided and billed  Payor rules  State reporting  Cost reporting  Payor incentive programs

© Copyright 2015 Afia Inc. 10 Impact on the Organization  Quality  Billing data used to review provider performance vs clinical protocols  Denial management feedback loop

© Copyright 2015 Afia Inc. 11 Impact on the Organization  Productivity  Track and report provider productivity  Track and report revenue cycle staff productivity

© Copyright 2015 Afia Inc. 12 Impact on the Organization  EHR  Can influence EHR vendor selection  Impacts EHR implementation & set up

© Copyright 2015 Afia Inc. 13 Revenue Cycle Leakage Points  No Referral  Registration Errors  Insurance not Verified  Charge Master Incomplete  Coding Errors  Billing Errors  Claim Underpaid  Appeal Denied

© Copyright 2015 Afia Inc. 14 Revenue Cycle Best Practice  To plug the leaks  To ensure  Compliance with payor rules  Billing for all service provided  Collecting the correct amounts  Effective denial management  To eliminate  Inefficient processes  Redundant processes

© Copyright 2015 Afia Inc. 15 Revenue Cycle Best Practice  Financial Clearance – Pre Visit  Check In – Check Out  Charge Capture  Coding  Charge Entry

© Copyright 2015 Afia Inc. 16 Revenue Cycle Best Practice  Claims Management  Patient Statements  Payment & Denial Posting  Insurance Follow Up  Denial Management

© Copyright 2015 Afia Inc. 17 Revenue Cycle Best Practice  Patient Collections  Payor Management

© Copyright 2015 Afia Inc. 18 Revenue Cycle Assessment  Project Purpose  Project Scope  Project Deliverables  Project Plan  Project Success Factors

© Copyright 2015 Afia Inc. 19 Conclusion The Revenue Cycle plays a key role in the organization with its many critical points of integration. A well-functioning revenue cycle ensures you are billing and collecting the proper amount for all services provided.

© Copyright 2015 Afia Inc. 20 Contact Information Afia, Inc. 555 Briarwood Circle, Suite 116 Ann Arbor, MI (734) Facebook Twitter LinkedIn Cynthia Sikina Vice President, Financial Services (248)