Why rcm performance is more important than ever


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Revenue Cycle Management: What Matters Now, Part 6 of a 6-part series. View podcast and key topics at www.alnmm.com/rcm-series

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Why rcm performance is more important than ever

  1. 1. Revenue Cycle Management: What Matters Now Why RCM Performance Is More Important Than Ever Guest Host Marnie Iorio, Tim Coan, VP of Business Development CEO ALN Medical Management ALN Medical Management
  2. 2. Downward Spiral Cash Problems Declining Reduced Lower Lower Patient Visits Charges Collections Profitability • Physician Compensation • Debt Service
  3. 3. Drivers Of Cash Flow Complete Charge Processes Proper Coding Capture Technology Automation of RCM Robust PM System Tasks Detailed Operating Trended Results Data Metrics Reporting
  4. 4. Practice Cost Allocation Occupancy 9% Other Operating 13% Physician Compensation 50% Staff Salaries & Benefits 28%
  5. 5. Reimbursement Issues Practice Payer Patient • Sub-standard • Unknown allowed • Incorrect, missing coding charges demographic information • EDI leakage • High denied (high rejects, claims rate • Failure to collect lost claims, no co-pays, claim scrubbing) • Lack of follow-up deductibles, and on non-response balance due at the claims time of service
  6. 6. Keys to Maximum Reimbursement 1. Improve coding and reduce denials 2. Fix the EDI process 3. Increase time of service collections 4. Shorten the cycle on appeals 5. Leverage all RCM technologies 6. Manage with data and metrics
  7. 7. Key Performance Indicators Net Days in Accounts Receivable (A/R) Shown by trending overall A/R performance Aged A/R as a Percentage of Billed A/R Shown by trending receivable collectability Shown by trending point-of-service collecting Point-of-Service Cash Collection efforts Cost to Collect Shown by trending operational performance Cash Collection as a Percentage of Adjusted Shown by trending the revenue cycle to convert Net Patient Services Revenue net patient services revenue to cash Bad Debt Shown by trending the effectiveness of self-pay collection efforts and financial counseling Charity Care Shown by trending the local ability to pay Shown by trending the claims generation Days in Total Discharged Not Final Billed process. Source: Healthcare Financial Management Association (HFMA) , January 2010
  8. 8. RCM: What Matters Now Why RCM Performance is More Important Than Ever Interoperability: Managing Day The Coming to Day RCM Merger of Performance Clinical and with Data Financial Data Revenue Cycle Management RCM Reporting: Technology What to Watch, Enhanced RCM When to Watch The Future of Coding and Compliance