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Emerging trends in revenue cycle management presentation v6.0 final


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Emerging trends in revenue cycle management presentation v6.0 final

  1. 1. EMERGING TRENDS IN REVENUECYCLE MANAGEMENT  Presented byDavid Nordella  <br />HSM 571 – Clinical and Financial Management <br />Department of Health Services ManagementUniversity of La Verne James Peelgren<br />InstructorFall TermNovember 6, 2010 <br />
  2. 2. Presentation Overview<br />History of Revenue Cycle Management (RCM) <br />Changing Definition of RCM<br />Goals of new RCM<br />Motivations for changes in RCM<br />Improvements in hospital processes <br />Implementation <br />Benefits<br />Impact on employees <br />Summary<br />Questions<br />
  3. 3. Tedious manual labor<br />Patient discharged<br />Pre-bill Editing, Billing<br />Work-list for editing<br />Claim generated<br />Claim logged into the general ledger<br />Electronic claim file produced<br />Edited claim is sent to a clearinghouse<br />Paper report for rejected claim<br />Corrections made for remittance<br />Claim is resubmitted<br />Collection and posting of payment<br />
  4. 4. Changing Definition<br />Previous definition concentrated on the back-end of the cycle and correcting discrepancies caused by problems in the front-end<br />“All administrative and clinical functions that can contribute to the capture, management and collection of patient service revenue “, Healthcare Financial Management Association<br />
  5. 5. Motivations for changes in RCM practices<br />Labor is expensive <br />Demands from payers for coding and documentation increased with costs<br />Unsustainable and rising increases in U.S expenditures as a % of the Gross Domestic Product<br />Demographics are driving growth in use<br />Improving net collections and prompt payments improve cash flow<br />Use of technology can improve collection of unrecovered amounts by large % <br />
  6. 6. Goals of emerging RCM <br />Generate charges from Computerized Physician Order Entry (CPOE)<br />Automated performance with bi-directional feeds<br />Positive patient experience from registration through payment <br />Increased physician and nursing productivity<br />Co-ordination of payment processing with payers<br />Advance Beneficiary Notice (ABN)<br />“Connected patient “ with administrative support<br />Use of Enterprise Patient Index (EPI) for unique identifiers<br />
  7. 7. Improvements in hospital processes<br />Dashboard access to RT data<br />Powerful analytic tools for management<br />Rules-driven workflow with management by exception<br />Single database<br />Integrated solution with capacity for bolt-ons<br />Reduction of system complexity (user friendly)<br />Manual tasks frequently reviewed for conversion to automation<br />Low cost of ownership<br />Improvements in other services<br />
  8. 8. Implementation<br />Strategic review<br />Team process with integrated clinical and business teams. <br />Shared responsibilities <br />No “silo” perspectives<br />Processes>personnel>technology<br />
  9. 9. Key Performance Indicators (KPI)<br />Implementation of Data Marts for high level data<br />Beware of acronyms –what is ROI?<br />“Ideal” solution should be mapped<br />“Pragmatic” solution should be mapped for fallback if resources are limited <br />Maps reviewed<br />Maps finalized<br />Maps distributed<br />Results measured by metrics<br />Reapply process<br />
  10. 10. Benefits<br />Co-ordination with payers reduces claims, reduces administrative expenses, improves cash flow<br />Knowledge of criteria for prompt payments<br />Reduction of coding errors that produce denials<br />Easier collection of denials when an error is made by payer<br />Easier distribution of work when an error is identified by payer<br />Demonstration of goodwill by identifying over-payments as well as under-payments<br />
  11. 11. Benefits (continued)<br />Easier audits of denials<br />Earlier recognition of Present on Admission (POA) for reduction of Re-Admissions<br />Added protection against Recovery Audit Contractors compensated on contingency by Centers foe Medicare & Medicaid Service (CMS)<br />Proper RCM will complement the transition to ICD-10-CM<br />Higher employee morale from respect for career, education, compensation<br />
  12. 12. Summary<br />Improve cash flow- reduction of denials, decreasing bad debt, prompt payments and postings<br />Computerized manual tasks under rule-driven work by exception<br />Reduction of system complexity<br />Improves high-level review of structures and activity<br />Promotes transformative care by assembling all patient documents and data<br />Aligns the interests of patient, hospital, payers, Medicare<br />Complements rather than compete with other technology initiatives <br />
  13. 13. Questions?<br />
  14. 14. Contact <br />David Nordella<br />805.991.6001<br /><br />