Eight strategies to get paid - Revenue Cycle Management

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Join revenue cycle management expert Elizabeth Woodcock & James Muir to dissect the eight strategies for surviving and thriving in today’s turbulent reimbursement environment. This webinar will empower you with solutions to make your practice a top performer. In addition, attendees of this live webinar can quality for CEU credits.*

After this session, you’ll be able to:

Evaluate payer contracting opportunities and pitfalls
Determine contract management procedures to ensure appropriate payment
Implement effective methods of setting patient’s expectations for payment – before the visit
Apply time-of-service collections techniques
Develop denial prevention and management procedures
Assess technologies to support efficient revenue cycle management
Identify staffing needs for successful revenue cycle management
Differentiate the elements of reporting key performance indicators for revenue cycle management

Published in: Healthcare

Eight strategies to get paid - Revenue Cycle Management

  1. 1. Welcome to the Webinar 8 Strategies to Get Paid Every Dollar You Deserve We’ll begin in a few moments.
  2. 2. Before we get started there are a few housekeeping items • This webinar is being recorded • For an uninterrupted presentation, lines will be muted for the duration of the webinar • We will address questions at the end of the presentation via the chat function • Feel free to submit questions via chat throughout the presentation • Details on getting your CEU credits will be covered at the end of the presentation • Handouts from today’s presentation will be emailed to you within 24 hours
  3. 3. MBA, The Wharton School of Business, University of Pennsylvania BA, Duke University Fellow, American College of Medical Practice Executives Certified Professional Coder Author, 12 textbooks and more than 500 Articles Founder and Principal, Woodcock & Associates Former Consultant, Medical Group Management Association; Group Practice Services Administrator, University of Virginia Health Services Foundation; Senior Associate, The Advisory Board Company 25+ Years in Revenue Cycle Management & Billing Service Administration BA, Brigham Young University Author, 2 books, hundreds of articles including articles for the MGMA Connexion and Advance For Health Information Executives Educator for many organizations including various MGMA chapters and Metro managers groups. Certifications from IBM, 3Com, Miller-Heiman, Franklin Covey and JES. Longstanding active participant with MGMA & HFMA 3 Elizabeth W. Woodcock, MBA, FACMPE, CPC Speaker, Author, Trainer www.elizabethwoodcock.com James M Muir VP Revenue Cycle Management NextGen Healthcare Speaker, Author, Educator www.linkedin.com/in/puremuir/
  4. 4. 8 Strategies to Get Paid Every Dollar You Deserve
  5. 5. Elizabeth W. Woodcock, MBA, FACMPE, CPC
  6. 6. © 2014 1.Payer contracting 2.Payment monitoring 3.Pre-visit collections 4.Time-of-service collections 5.Denial management 6.Staffing 7.KPI reporting 8.Technology 6
  7. 7. © 2014 Terms •Timely filing: “reliant on the beneficiary” •Recoupments •Termination •Process for appeals •Changes, in writing 7
  8. 8. © 2014 8
  9. 9. © 2014 Contracted Fee Schedule Match Rate On what percentage of claim lines does the payer’s allowed amount equal the contracted fee schedule rate excluding the application of claim edits and payment rules (rules that adjust the fee schedule amount) 70.78% 62.08% 66.23% 84.20% 85.21% 61.55% 74.34% 99.95% 85.76% 9
  10. 10. © 2014 •Submit list of frequently used CPT® codes – and get prices (“allowables”) at the line item level •Determine modification of reimbursement for modifiers, multiple procedures and advanced practice providers •Request disclosure re: service charges 10
  11. 11. © 2014 Insurance Coverage Benefits Eligibility Financial Responsibility 1 2 3
  12. 12. © 2014 Initial scheduling call Appointment confirmation When patient presents “Arrival Time” 12
  13. 13. © 2014 Provide patients •Insurance confirmation and benefits summary, including unmet deductible •Explanation of benefits •Price estimation from the payer •Initial patient statement/ledger •Financial agreement for scheduled procedures and surgeries Reference “Discount” v. “Contractual Adjustment”
  14. 14. © 2014 •Offer payment options •Lead with: “How much more time do you need, Ms. Woodcock?” •Encourage payment options based on your cost to collect •Capture the best rate •Pre-establish parameters of a payment plan •Maximum time (e.g., 6 months) •Minimum payments (e.g., $25) •Offer “credit card on file” option •Identify a separate payer category for payment plans 14 www.metrosources.com
  15. 15. © 2014 “Reason Code” 15 - The authorization number is missing, invalid, or does not apply to the billed services or provider. 1 - Deductible Amount “Soft” Denial “Hard” Denial 15 PR CO
  16. 16. © 2014 Protocols Action and timeframe Initial, subsequent 16 Is it worth your time? Need Thresholds! – Effort & Money
  17. 17. © 2014 Reason Code Payer Action Worklist CO18 – Exact Duplicate Claim / Service PeachCare Post $0 Payment; Put Claim on Hold Biller-Medicaid
  18. 18. © 2014 Prevention is the “best medicine” •Provider enrollment and credentialing •Accurate registration information, backed by financial clearance •Non-office services •Accurate time-of-service payments •Accurate, timely procedure and diagnosis coding, with appropriate modifiers, linkages and places of service  charge editing system 18
  19. 19. © 2014 Complex, elaborate work Compulsive, Type A workforce Customers never grateful Corbis.com 19
  20. 20. © 2014 Per day Per hour Coding - Evaluation and Management codes n/a 15 to 20 - Surgeries and procedures n/a 6 to 12 Charge entry line items - Without registration 375 to 525 55 to 75 - With registration 280 to 395 40 to 55 Payment and adjustment transactions posted manually 525 to 875 75 to 125 Refunds researched and processed 60 to 80 8 to 10 Insurance account follow-up - Research correspondence and resolve by telephone n/a 6 to 12 - Research correspondence and resolve by appeal n/a 3 to 4 - Check status of claim (telephone or online) and rebill n/a 12 to 60 Self-pay account follow-up 70 to 90 10 to 13 Self-pay correspondence processed and resolved 90 to 105 13 to 15 Guarantor billing inquiries (by phone or correspondence) 56 to 84 8 to 12 20 . © Walker, Woodcock, Larch, 2009 (forthcoming 2015), as published in The Physician Billing Process by MGMA
  21. 21. © 2014 72 Hours 50 to 70 Daily 21
  22. 22. © 2014 Key Performance Indicator Your Practice High Performers Expected Range Days in Receivables Outstanding 27.49 35 to 45 Percent of Receivables Over 120 Days 9.84% 12 to 25% Adjusted Collection Rate 99.16% 95 to 98% Cash $? $? 22 Source for “High Performers”: MGMA Performance & Practices of Successful Medical Groups, 2013, median data for multispecialty practices.
  23. 23. © 2014 23 To properly identify the adjustment: 1.Implement and use adjustment codes 2.Train payment posting and follow-up staff 3.Monitor appropriate use via audits Important: Examine report on all 100% contractual adjustments on a line item level
  24. 24. © 2014 Hardware Management information systems Insurance coverage and benefits eligibility Kiosk Charge capture; editing Coding/reimbursement support Payment monitoring Electronic remittance/funds transfer Analysis and reporting  business intelligence 24
  25. 25. Outsourcing Options
  26. 26. What Exactly Does RCM Services Offer? NextGen RCM Services helps clients address these challenges & others via: • Account Management & Oversight • A Tailored Solution • Access to the Full Suite of NextGen® solutions
  27. 27. How NextGen Healthcare Helps you Address Top Challenges Self-pay Collections Rising operating cost Preparing for new reimbursement models Optimizing an existing EHR Self-Pay Collections Get the support of RCM experts who collect more efficiently & at a lower cost — optimizing your workflow, back office functions, and bottom-line, while eliminating strain on your time, money & internal resources. We deliver the staff training, best practices, process enhancements, technology & professional resources to connect with a higher volume of patients more efficiently and get every dollar you have earned. Our unified clinical & financial management solutions are built to manage & anticipate change with functionality for ACOs & risk-based models. Our HIT experts configure your systems to take full advantage of technology to drive revenue to its fullest potential & improve your staff productivity.
  28. 28. End to End Revenue Cycle Management (Typical Deployment) SYSTEM ADMINISTRATION, PM DATABASE CONFIGURATION, WORKLOG MANAGER, TRAINING, CLIENT CUSTOMER SERVICE CHARGE ENTRY INBOUND SERVICE AUTHORIZATION SCHEDULING CHECK-IN REGISTRATION POS COLLECTIONS ASSIST WITH CHARGE CAPTURE ACCOUNT MANAGEMENT/ OVERSIGHT PRE-SERVICE POINT OF SERVICE POST-SERVICE CLAIM RECONCILIATION BILLING & COLLECTIONS REFERRAL MANAGEMENT INSURANCE ELIGIBILITY VERIFICATION ANALYSIS PATIENT STATEMENTS & CORRESPONDENCE CODING SERVICES CLAIM SCRUBBING CLEARINGHOUSE EDITS CLAIM SUBMISSION EDI & PAPER PAYMENT POSTING ERA & PAPER CLAIM RESOLUTION PATIENT CUSTOMER SERVICE A/R MANAGEMENT INSURANCE FOLLOW-UP DENIAL MANAGEMENT & RESOLUTION APPEALS MANAGEMENT REFUNDS & OVERPAYMENTS A/R FOLLOW-UP DELINQUENT ACCOUNTS CONTRACT MANAGEMENT FINANCIAL RECONCILIATION TO BALANCE MONTH/DAY PERFORMANCE REPORTING DASHBOARDS DATA WAREHOUSE REPORTING INSIGHT REPORTING TRANSITION TO EXTERNAL COLLECTIONS CODING AUDITS CREDENTIALING/ PROVIDER ENROLLMENT = RCM Services = Client = 3rd Party Vendor CARE MANAGEMENT CLINICAL DATA MANAGEMENT VIRTUAL CLINICAL DOCUMENTATION ENHANCED CARE DELIVERY CARE COORDINATION
  29. 29. End to End Revenue Cycle Management (Tailored Deployment) SYSTEM ADMINISTRATION, PM DATABASE CONFIGURATION, WORKLOG MANAGER, TRAINING, CLIENT CUSTOMER SERVICE CHARGE ENTRY INBOUND SERVICE AUTHORIZATION SCHEDULING CHECK-IN REGISTRATION POS COLLECTIONS ASSIST WITH CHARGE CAPTURE ACCOUNT MANAGEMENT/ OVERSIGHT PRE-SERVICE POINT OF SERVICE POST-SERVICE CLAIM RECONCILIATION BILLING & COLLECTIONS REFERRAL MANAGEMENT INSURANCE ELIGIBILITY VERIFICATION ANALYSIS PATIENT STATEMENTS & CORRESPONDENCE CODING SERVICES CLAIM SCRUBBING CLEARINGHOUSE EDITS CLAIM SUBMISSION EDI & PAPER PAYMENT POSTING ERA & PAPER CLAIM RESOLUTION PATIENT CUSTOMER SERVICE A/R MANAGEMENT INSURANCE FOLLOW-UP DENIAL MANAGEMENT & RESOLUTION APPEALS MANAGEMENT REFUNDS & OVERPAYMENTS A/R FOLLOW-UP DELINQUENT ACCOUNTS CONTRACT MANAGEMENT FINANCIAL RECONCILIATION TO BALANCE MONTH/DAY PERFORMANCE REPORTING DASHBOARDS DATA WAREHOUSE REPORTING INSIGHT REPORTING TRANSITION TO EXTERNAL COLLECTIONS CODING AUDITS CREDENTIALING/ PROVIDER ENROLLMENT = RCM Services = Client = 3rd Party Vendor CARE MANAGEMENT CLINICAL DATA MANAGEMENT VIRTUAL CLINICAL DOCUMENTATION ENHANCED CARE DELIVERY CARE COORDINATION
  30. 30. Your NextGen RCM Account Manager: • Is your Client Liaison for all issues & resolutions • Is responsible for monitoring the overall performance of your account (oversight) • Will explain & help you understand all KPIs & Reports discussed in your regularly scheduled meetings. • Has access to specialist teams & resources within NextGen to evaluate & resolve any specific issues.
  31. 31. Account Manager Functions Can Be Broken Down Into Four Areas 1. Oversight – Financial Performance – Operations – Best Practices 2. Guidance – Establishing Practice Goals – Addressing Outstanding & New Items/Issues – Addressing Items Impacting Revenue 3. Education – Call Center Statistics – Training – Policy & Procedures – Payer Notifications 4. Ongoing Support – Systems & Software – Integration & Technical – Changes in practice environment
  32. 32. Getting Your Complimentary RCM Assessment Attendees of this Webex are eligible for a free consultation with their NextGen Healthcare Director of Revenue Cycle Management to learn how they can qualify for a free RCM assessment valued at $3,500. Email Jill Ryan to set up your appointment: jryan@nextgen.com
  33. 33. Panelists Q&A Elizabeth W. Woodcock, MBA, FACMPE, CPC Speaker, Author, Trainer www.elizabethwoodcock.com James M Muir VP Revenue Cycle Management Speaker, Author, Educator www.linkedin.com/in/puremuir/
  34. 34. Getting Your AAPC CEU Credit (1.0 CEUs) Attendees of this Webex are eligible for AAPC CEU Credits!* Email Jill Ryan to receive the documentation for your AAPC CEU Credits: jryan@nextgen.com * This program has the prior approval of AAPC for 1.0 CEUs of continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. AAPC accepts credit hours for the live webcast of this presentation. Recorded sessions are not eligible for credit.
  35. 35. Getting your ACMPE Credit Hours (1.0 CEU) Here are the instructions for viewing your transcript on line and entering your ACMPE credit hours: • Go to http://www.mgma.com/myTranscript/ • Log in with your membership ID and password. • Follow the instructions and the CEUs will appear up on your Transcript in 24- 48 hours* • For the Credit hour calculation add the total number of clock hours for the duration of the program. * Note: ACMPE accepts credit hours for the live webcast of this presentation. Recorded sessions are not eligible for credit.
  36. 36. Thank you Contact information for any additional questions: James Muir Vice President RCM JMuir@rcmguy.com www.linkedin.com/in/puremuir/ Elizabeth W. Woodcock, MBA, FACMPE, CPC Speaker, Author, Trainer elizabeth@elizabethwoodcock.com

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