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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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 …

8. 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

9. 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

10. 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

11. 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?

12. 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

13. Communication Etiquette
Remote communication via 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
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

14. Blue Cross www.BCBS.com for most states
Payor Policy Library
Blue Cross
for most states
Medical Policies―search function by:
Name
Policy number
CPT
Keyword
Organized by category or alphabetically
E-Updates

15. Help Tools Unit conversion http://www.unitconversion.org/
Payor Policy Library
Help Tools
Unit conversion
Drug help tools

16. Payor Policy Library
Help Tools
CCI edits
Implant codes by vendor
Choose Cook The GPN G05183 to see if device dependent

17. 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

18. "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

19. 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
John Behn, MPA