This document discusses strategies for accelerating a medical practice's revenue cycle from patient encounter through account resolution. It identifies characteristics of best performing practices, including using technology efficiently, having strong staff, understanding payer policies, and having standardized processes. It emphasizes the importance of efficient encounters through activities like eligibility verification, collecting payments at the time of service, timely claim submission, and using automation. It also stresses measuring revenue cycle performance through reporting on key metrics like collections, accounts receivable, and following benchmarks to identify opportunities for improvement.
Accretive Health - Revenue Cycle Management - Medical Billing Services AccretiveHealth
Our technology is a critical component of our end-to-end solution. It integrates seamlessly with clients' existing systems through standard protocols to provide a complete view of the revenue cycle from front to back without requiring a system conversion. This allows us to effectively analyze performance, identify issues, and drive improvements across the entire revenue cycle process.
Healthcare Industry Highlight: Revenue Cycle ManagementCascadia_Capital
In our most recent Healthcare Industry Highlight Report on Revenue Cycle Management, we outline the trends driving consolidation and increased market activity and make predictions on the outlook and future of the RCM ecosystem.
Sun Knowledge - Practice Management and Revenue Cycle Management Services PPTMichael Smith
Sun Knowledge – A Practice Management and Revenue Cycle Management Company.
Contact Details:
New York Office - 41 Madison Avenue, 25th Floor, NY 10010
Phone - +1 212-400-6100, Email - contact@sunknowledge.com
Website - www.sunknowledge.com
Facebook - https://www.facebook.com/SunKnowledge
Twitter - https://twitter.com/sunknowledge
LinkedIn - https://www.linkedin.com/company/sun-knowledge
Google plus - https://plus.google.com/+SunknowledgeInc
We provide our tailored solutions for any healthcare practices helping them gain more reimbursements with reduced TAT. Over the years, we have developed our specialization with an astute understanding of Payer processes helping you set the tone with better collections.
Our clients prefer us for:
~ Powerful references from major healthcare providers and health insurance payers
~ Instant reduction of billing costs by 70%
~ Managing high volume claims with robust processes
~ Collections of up to 97%
~ 99% medical billing & coding accuracy
Sun Knowledge is a revenue cycle management company and expert in various practice management software. We also provide services for following medical billings, medical coding, account receivable, denial managements, claims adjudications, claim processing, authorization and verification, insurance follow up, and many more.
We are specialize in Hospitals, urgent care centers, DME, orthotics, prosthetics, Nursing home, physician office and many more billing industry.
Physician Billing Services (PBS) provides revenue cycle management services such as medical billing, coding, and collections to healthcare providers. It aims to partner with consulting groups to expand its client base. As a partner, a consulting group would refer clients to PBS for revenue cycle services, earn commissions, and have PBS support its sales efforts. To partner with PBS, a group would need to promote PBS's services and provide client referrals.
Exploring Methodologies and Discount Rates in Valuing Intangible AssetsPYA, P.C.
The document provides biographical information on two professionals, W. James Lloyd and Brian Burns, who will be presenting on methodologies and discount rates for valuing intangible assets. It includes their educational backgrounds, credentials, experience, areas of expertise, and contact information. The agenda for their presentation is also outlined, covering topics such as intangible asset valuation for financial reporting, identifying intangible assets, valuation approaches, discount rates, and common pitfalls.
Team Hcrs Presentation Review Draft V2a 08 30 2011GCAPEL
The document summarizes the value proposition and approach of Team HCRS, which is comprised of HCRS Medical Coding, Auditing and Payment Integrity Specialists and TC3. Team HCRS provides medical coding, auditing, and payment integrity services to over 70 clients nationally. They have a multi-layered technology and human-driven approach that achieves high returns on investment through the identification and recovery of improper payments.
Eight strategies to get paid - Revenue Cycle ManagementJames Muir
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
The document defines revenue cycle management and its key components. It begins by providing the Healthcare Financial Management Association's definition of revenue cycle as encompassing all administrative and clinical functions from creating a patient account through payment collection. It describes revenue cycle processes as interdependent and notes that early errors can significantly impact revenue recovery costs. The rest of the document provides more details on the various components and goals of revenue cycle management.
Accretive Health - Revenue Cycle Management - Medical Billing Services AccretiveHealth
Our technology is a critical component of our end-to-end solution. It integrates seamlessly with clients' existing systems through standard protocols to provide a complete view of the revenue cycle from front to back without requiring a system conversion. This allows us to effectively analyze performance, identify issues, and drive improvements across the entire revenue cycle process.
Healthcare Industry Highlight: Revenue Cycle ManagementCascadia_Capital
In our most recent Healthcare Industry Highlight Report on Revenue Cycle Management, we outline the trends driving consolidation and increased market activity and make predictions on the outlook and future of the RCM ecosystem.
Sun Knowledge - Practice Management and Revenue Cycle Management Services PPTMichael Smith
Sun Knowledge – A Practice Management and Revenue Cycle Management Company.
Contact Details:
New York Office - 41 Madison Avenue, 25th Floor, NY 10010
Phone - +1 212-400-6100, Email - contact@sunknowledge.com
Website - www.sunknowledge.com
Facebook - https://www.facebook.com/SunKnowledge
Twitter - https://twitter.com/sunknowledge
LinkedIn - https://www.linkedin.com/company/sun-knowledge
Google plus - https://plus.google.com/+SunknowledgeInc
We provide our tailored solutions for any healthcare practices helping them gain more reimbursements with reduced TAT. Over the years, we have developed our specialization with an astute understanding of Payer processes helping you set the tone with better collections.
Our clients prefer us for:
~ Powerful references from major healthcare providers and health insurance payers
~ Instant reduction of billing costs by 70%
~ Managing high volume claims with robust processes
~ Collections of up to 97%
~ 99% medical billing & coding accuracy
Sun Knowledge is a revenue cycle management company and expert in various practice management software. We also provide services for following medical billings, medical coding, account receivable, denial managements, claims adjudications, claim processing, authorization and verification, insurance follow up, and many more.
We are specialize in Hospitals, urgent care centers, DME, orthotics, prosthetics, Nursing home, physician office and many more billing industry.
Physician Billing Services (PBS) provides revenue cycle management services such as medical billing, coding, and collections to healthcare providers. It aims to partner with consulting groups to expand its client base. As a partner, a consulting group would refer clients to PBS for revenue cycle services, earn commissions, and have PBS support its sales efforts. To partner with PBS, a group would need to promote PBS's services and provide client referrals.
Exploring Methodologies and Discount Rates in Valuing Intangible AssetsPYA, P.C.
The document provides biographical information on two professionals, W. James Lloyd and Brian Burns, who will be presenting on methodologies and discount rates for valuing intangible assets. It includes their educational backgrounds, credentials, experience, areas of expertise, and contact information. The agenda for their presentation is also outlined, covering topics such as intangible asset valuation for financial reporting, identifying intangible assets, valuation approaches, discount rates, and common pitfalls.
Team Hcrs Presentation Review Draft V2a 08 30 2011GCAPEL
The document summarizes the value proposition and approach of Team HCRS, which is comprised of HCRS Medical Coding, Auditing and Payment Integrity Specialists and TC3. Team HCRS provides medical coding, auditing, and payment integrity services to over 70 clients nationally. They have a multi-layered technology and human-driven approach that achieves high returns on investment through the identification and recovery of improper payments.
Eight strategies to get paid - Revenue Cycle ManagementJames Muir
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
The document defines revenue cycle management and its key components. It begins by providing the Healthcare Financial Management Association's definition of revenue cycle as encompassing all administrative and clinical functions from creating a patient account through payment collection. It describes revenue cycle processes as interdependent and notes that early errors can significantly impact revenue recovery costs. The rest of the document provides more details on the various components and goals of revenue cycle management.
In this webinar slide deck, we review tips and best practices to improve your patient payment collections. This includes details on patient statement configuration and online bill payment options.
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
Hot Valuation Issues for Physician AgreementsPYA, P.C.
The document summarizes key issues related to physician compensation agreements and the impact of healthcare reform. It discusses the increased complexity of compensation models with multiple layers and components. Ensuring fair market value and commercial reasonableness of the overall arrangement is important as the sum of individual components could exceed what is reasonable. The presentation also covers analyzing losses, benchmarks, and factors considered in commercial reasonableness determinations. Healthcare continues shifting toward value-based payments, quality incentives, and bundled payments through initiatives like Accountable Care Organizations.
The document discusses how hospitals and health systems can prepare for bundled payments and pay-for-performance contracting. It outlines challenges such as fluctuating profits, rising costs, and shifting to outpatient care. It also discusses the need for data aggregation and business intelligence tools to track costs, utilization, and quality measures in order to succeed under new payment models.
PYA Principal Carol Carden recently spoke on the topic “Valuation Issues in Healthcare” at the Tennessee Society of Certified Public Accountants’ Healthcare Conference.
PYA Principal Carol Carden presented on current issues in healthcare valuation at The Texas Society of Certified Public Accountants Business Valuation, Forensic, and Litigation Services Conference at the Hilton Fort Worth, October 14, 2014.
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
Technomine is an ISO 9001:2008 certified outsourcing company founded in 2008 that provides business process outsourcing services primarily in the healthcare domain, including medical billing, coding, revenue cycle management, and staffing services. They leverage technology, processes, and domain expertise to maximize financial and operational performance for clients. Technomine aims to help clients focus on their core business by taking over non-core activities and ensuring quality, consistent performance and value.
Real World Issues with Implementing Compliant Financial Assistance and Billin...PYA, P.C.
PYA co-presented “Real World Issues with Implementing Compliant Financial Assistance and Billing and Collection Policies” at the 2014 AHLA Tax Issues for Health Care Organizations program.
Determining Value & Physician Compensation When Purchasing a PracticePYA, P.C.
This document discusses considerations for valuing a physician practice and determining physician compensation when a hospital is acquiring the practice. It covers regulatory issues under Stark and anti-kickback laws, common valuation methods including asset-based and income approaches, factors for determining fair market value and commercial reasonableness, and structuring post-acquisition physician employment compensation.
Best Practices for Physician Call Coverage CompensationMD Ranger, Inc.
This document provides best practices for setting physician call coverage compensation. It begins with an overview of the history of call coverage and discusses factors to consider when deciding whether to pay physicians for call such as commercial reasonableness and opportunity costs. It then reviews typical payment methods and rates for call coverage based on specialty, with the highest paid specialties being critical care, OB, anesthesia, neurosurgery, and trauma surgery. The document outlines key elements to include in call coverage agreements and effective strategies for using market data and formulas to set standardized call rates while ensuring compliance. It emphasizes using externally validated benchmarks and documentation of fair market value.
Revenue Cycle Management: Market Dynamics & Opportunities in a Changing Healt...Cognizant
Sourcing revenue cycle management can help healthcare insurers overcome growing reimbursement complexities. Yet providers say managing dozens of RCM vendors comes with its own complications. That’s why they’re increasingly sourcing comprehensive RCM solutions with a single vendor to generate greater efficiencies, reduce costs and improve patient satisfaction.
Both Stark and AKS require that physician contracting rates be negotiated at fair market value. What the regulations lack is clear, tactical advice for determining and documenting FMV. Physician contract compliance can be less of a headache if your organization takes a planned, methodical approach to obtaining and recording payment rates.
PYA Senior Consultant Kathryn Culver presented "Fundamentals of Healthcare Valuation" before the Tennessee Society of Certified Public Accountants (TSCPA). The presentation:
Provided a healthcare valuation overview.
Discussed healthcare valuation approaches.
Covered healthcare valuation considerations and trends.
PYA Presentation: “Thorny Issues in FMV and Commercial Reasonableness"PYA, P.C.
PYA Principals Jim Lloyd and Lyle Oelrich presented "Thorny Issues in Fair Market Value and Commercial Reasonableness" at the Greater Kansas City Society of Healthcare Attorneys, Wednesday, April 16, 2014.
5 Mistakes Hospitals Make with Call Coverage AgreementsMD Ranger, Inc.
This deck covers 5 critical mistakes that hospitals make with call coverage agreements and how to avoid them going forward.
We will cover:
- Effective strategies for setting call rates
- Determining commercial reasonableness
- The most cost-effective ways to pay for call
- Which services are likely to be paid
- ...and more!
What is revenue cycle management? How does it impact your practice’s ability to maintain profitability? What are the critical steps to take when managing your revenue cycle? This Quirk Healthcare Solutions Insights webinar will lead you through the important healthcare provider business practice of revenue cycle management. We’ll discuss the stages of RCM, development of a fee schedule, establishing financial policies, billing and collection cycles, and the practical application of revenue cycle management.
Trans-quest is a Healthcare Solutions provider..with a key focus on Revenue Cycle Management services for Physician Groups with a special emphasis on AR & Denial Management. Besides, Trans-quest has medical transcription capabilities and have been servicing various Group Physicians ranging from Multi Specialty, Cardiology, Endocrinology, Neurology, Ophthalmology, Oncology etc.
A Case Study with Orlando Health: Driving new levels of business performance ...GE Healthcare - IT
This document provides an overview of Orlando Health's revenue cycle management processes and how they use GE Healthcare's Centricity Business solution. It describes Orlando Health's accounts receivable team structure, monthly reconciliation process with payers, and how they leverage various Centricity Business modules like BAR, ETM, and Informatics to streamline workflows, reduce days in the revenue cycle, and improve financial performance.
In this webinar slide deck, we review tips and best practices to improve your patient payment collections. This includes details on patient statement configuration and online bill payment options.
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
Hot Valuation Issues for Physician AgreementsPYA, P.C.
The document summarizes key issues related to physician compensation agreements and the impact of healthcare reform. It discusses the increased complexity of compensation models with multiple layers and components. Ensuring fair market value and commercial reasonableness of the overall arrangement is important as the sum of individual components could exceed what is reasonable. The presentation also covers analyzing losses, benchmarks, and factors considered in commercial reasonableness determinations. Healthcare continues shifting toward value-based payments, quality incentives, and bundled payments through initiatives like Accountable Care Organizations.
The document discusses how hospitals and health systems can prepare for bundled payments and pay-for-performance contracting. It outlines challenges such as fluctuating profits, rising costs, and shifting to outpatient care. It also discusses the need for data aggregation and business intelligence tools to track costs, utilization, and quality measures in order to succeed under new payment models.
PYA Principal Carol Carden recently spoke on the topic “Valuation Issues in Healthcare” at the Tennessee Society of Certified Public Accountants’ Healthcare Conference.
PYA Principal Carol Carden presented on current issues in healthcare valuation at The Texas Society of Certified Public Accountants Business Valuation, Forensic, and Litigation Services Conference at the Hilton Fort Worth, October 14, 2014.
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
Technomine is an ISO 9001:2008 certified outsourcing company founded in 2008 that provides business process outsourcing services primarily in the healthcare domain, including medical billing, coding, revenue cycle management, and staffing services. They leverage technology, processes, and domain expertise to maximize financial and operational performance for clients. Technomine aims to help clients focus on their core business by taking over non-core activities and ensuring quality, consistent performance and value.
Real World Issues with Implementing Compliant Financial Assistance and Billin...PYA, P.C.
PYA co-presented “Real World Issues with Implementing Compliant Financial Assistance and Billing and Collection Policies” at the 2014 AHLA Tax Issues for Health Care Organizations program.
Determining Value & Physician Compensation When Purchasing a PracticePYA, P.C.
This document discusses considerations for valuing a physician practice and determining physician compensation when a hospital is acquiring the practice. It covers regulatory issues under Stark and anti-kickback laws, common valuation methods including asset-based and income approaches, factors for determining fair market value and commercial reasonableness, and structuring post-acquisition physician employment compensation.
Best Practices for Physician Call Coverage CompensationMD Ranger, Inc.
This document provides best practices for setting physician call coverage compensation. It begins with an overview of the history of call coverage and discusses factors to consider when deciding whether to pay physicians for call such as commercial reasonableness and opportunity costs. It then reviews typical payment methods and rates for call coverage based on specialty, with the highest paid specialties being critical care, OB, anesthesia, neurosurgery, and trauma surgery. The document outlines key elements to include in call coverage agreements and effective strategies for using market data and formulas to set standardized call rates while ensuring compliance. It emphasizes using externally validated benchmarks and documentation of fair market value.
Revenue Cycle Management: Market Dynamics & Opportunities in a Changing Healt...Cognizant
Sourcing revenue cycle management can help healthcare insurers overcome growing reimbursement complexities. Yet providers say managing dozens of RCM vendors comes with its own complications. That’s why they’re increasingly sourcing comprehensive RCM solutions with a single vendor to generate greater efficiencies, reduce costs and improve patient satisfaction.
Both Stark and AKS require that physician contracting rates be negotiated at fair market value. What the regulations lack is clear, tactical advice for determining and documenting FMV. Physician contract compliance can be less of a headache if your organization takes a planned, methodical approach to obtaining and recording payment rates.
PYA Senior Consultant Kathryn Culver presented "Fundamentals of Healthcare Valuation" before the Tennessee Society of Certified Public Accountants (TSCPA). The presentation:
Provided a healthcare valuation overview.
Discussed healthcare valuation approaches.
Covered healthcare valuation considerations and trends.
PYA Presentation: “Thorny Issues in FMV and Commercial Reasonableness"PYA, P.C.
PYA Principals Jim Lloyd and Lyle Oelrich presented "Thorny Issues in Fair Market Value and Commercial Reasonableness" at the Greater Kansas City Society of Healthcare Attorneys, Wednesday, April 16, 2014.
5 Mistakes Hospitals Make with Call Coverage AgreementsMD Ranger, Inc.
This deck covers 5 critical mistakes that hospitals make with call coverage agreements and how to avoid them going forward.
We will cover:
- Effective strategies for setting call rates
- Determining commercial reasonableness
- The most cost-effective ways to pay for call
- Which services are likely to be paid
- ...and more!
What is revenue cycle management? How does it impact your practice’s ability to maintain profitability? What are the critical steps to take when managing your revenue cycle? This Quirk Healthcare Solutions Insights webinar will lead you through the important healthcare provider business practice of revenue cycle management. We’ll discuss the stages of RCM, development of a fee schedule, establishing financial policies, billing and collection cycles, and the practical application of revenue cycle management.
Trans-quest is a Healthcare Solutions provider..with a key focus on Revenue Cycle Management services for Physician Groups with a special emphasis on AR & Denial Management. Besides, Trans-quest has medical transcription capabilities and have been servicing various Group Physicians ranging from Multi Specialty, Cardiology, Endocrinology, Neurology, Ophthalmology, Oncology etc.
A Case Study with Orlando Health: Driving new levels of business performance ...GE Healthcare - IT
This document provides an overview of Orlando Health's revenue cycle management processes and how they use GE Healthcare's Centricity Business solution. It describes Orlando Health's accounts receivable team structure, monthly reconciliation process with payers, and how they leverage various Centricity Business modules like BAR, ETM, and Informatics to streamline workflows, reduce days in the revenue cycle, and improve financial performance.
5 Ways Your Pharmacy Can Boost Your Revenue CycleCompleteRx
With rising drug costs and decreasing reimbursements contributing to shrinking margins (in 2014, according to Modern Healthcare, 61.3 percent of healthcare providers reported decreased margins from the previous year), hospitals continue to scrutinize their revenue cycles to ensure they stay in the black, and there’s an oft-overlooked resource they would do well to consider: pharmacy. Historically, the hospital pharmacy has been labeled a cost generator, but there are actually many ways this strategic department can positively impact each stage of the revenue cycle – from point of service to claim submission and more. This webinar will explore innovative tactics, including optimized processes, improved data management, and creative patient programs, which hospital pharmacies across the country can leverage to boost overall hospital revenue.
Integrating Care Coordination in the Revenue CycleTraceByTWSG
West Jefferson Medical Center expert, Darlene Gondrella, reviews strategic initiatives for hospitals to integrate care coordination and revenue cycle teams for better outcomes across the organization.
•Engage care coordination in the revenue cycle process
•Integrate clinical and revenue cycle teams
•Bridge communication gaps across the organization
•Reduce readmissions through an integrated approach to patient discharge and follow-up
6 revenue cycle metrics you must be tracking nowango mark
Learn how you can improve the financial performance year on year. Leverage your practice revenue cycle metrics by setting benchmarks & KPIs for your billing department - http://bit.ly/2hwlqpm
The August cycle meeting covered quarterly and monthly performance, top accounts and products, sales targets, and awards. Quarterly sales were up 120% year-to-date compared to the previous year. The top 20 accounts by area and top 10 selling products in each region were also discussed. The meeting recognized salespeople who met targets and awarded the best performing individuals. Next steps and strategies to boost sales further were outlined.
Five Ways For Improving Hospital Revenue Cycle ManagementHealth Catalyst
The document discusses five ways to improve hospital revenue cycle management. It recommends trending and benchmarking healthcare data using an enterprise data warehouse to analyze performance over time and compare to others. Mining the data in an EDW can reveal problems and ways to improve revenue cycle processes. The document also suggests constantly asking frontline staff for suggestions, monitoring payer contracts, and maintaining caring patient touchpoints to improve the revenue cycle. An example is given of a physician group that improved collection times by analyzing registration desk data and improving processes.
The benefits of revenue cycle and compliance collaborationBESLER
This presentation highlights the importance of the working relationship between hospital Revenue Cycle and Compliance teams. This complimentary partnership can become seamless by utilizing the data analytics obtained from 835 and 837 data sets, Return to Provider (RTP), CERTs, Readmissions, ZPICs, HACs, RACs and Transfer DRGs. The combination of this data can assist in quickly identifying and resolving issues prior to provider submission, reducing days in AR and improving cash in the door.
The Key to Transitioning from Fee-for-Service to Value-Based ReimbursementsHealth Catalyst
The shift from fee-for-service to value-based reimbursements has good and bad consequences for healthcare. While the shift will ultimately help health systems provide higher quality lower cost care, the transition may be financially disastrous for some. In addition, the shifting revenue mix from commercial payers to Medicare and Medicaid is creating its own set of challenges. There are, however, three keys to surviving the transition: 1) Effectively manage shared savings programs to maximize reimbursement. 2) Improve operating costs. 3) Increase patient volumes. With an analytics foundation, health systems will be able to meet and survive today’s healthcare challenges.
The document provides objectives and content for Chapter 4 of the textbook "Accounting Information Systems, 6th edition". It covers the revenue cycle, including key processes like sales orders, billing, cash receipts, and collections. It describes the flow of transactions, necessary documents and journals, risks and controls at each step. It also discusses how technology can automate or reengineer the revenue cycle through systems like real-time processing, EDI, point-of-sale, and the implications for internal controls.
This medical billing flow chart outlines the process from a patient visit to a provider's front office to insurance billing and payment. It shows that the billing office handles converting visit details to insurance formats, submitting claims to insurance companies, and following up on payments or denials with cash posting and accounts receivable management. Key steps include preliminary screening of visits, dispatching to a clearing house, and claim adjudication by insurance companies.
The document discusses key aspects of the revenue cycle for hospital and physician billing. It covers common billing acronyms and forms, the steps in the revenue cycle including scheduling, registration, charge capture, billing, follow up, and common denials. It provides explanations of registration, coding, billing edits, payment calculations, claim submission and the collection process.
The document outlines the medical billing flow chart and revenue cycle management system. It involves verifying patient eligibility, coding medical records, entering demographic and charge data, transmitting claims to clearinghouses, receiving explanations of benefits (EOBs), posting payments, and following up on denials to increase collections. Key steps include eligibility checks, coding, data entry, quality audits, transmission, cash posting, and accounts receivable management.
Achieving Success with Billing and CollectionsJohn Mazza
John Mazza presented on achieving success with billing and collections. He emphasized being proactive by ensuring accurate patient information, collecting payments upfront, and using online tools to check eligibility and benefits. He also stressed the importance of timely filing, tracking missing charges, following up on accounts, training staff, and monitoring key performance indicators like collection percentage and days in receivables. The overall message was that practices need proactive processes and well-trained staff to bill correctly and maximize revenue from collections.
This document provides a draft model for developing a Patient Access department at Four County Centers. It includes mission and vision statements, a description of services, and proposed key performance measures. Some of the priorities and goals outlined are improving the patient registration flow, ensuring HIPAA compliance, implementing financial counseling, transitioning paper processes to electronic formats, and achieving customer satisfaction, collection, and accuracy targets. Establishing a call center is also discussed to help schedule clients and free up front desk staff.
This document provides a draft model for developing a Patient Access department at Four County Centers. It includes mission and vision statements, a description of services, and proposed key performance measures. Some of the priorities and goals outlined are improving the patient registration flow, ensuring HIPAA compliance, implementing financial counseling, transitioning paper processes to electronic formats, and achieving customer satisfaction, collection, and accuracy standards above 80%. Establishing a call center is also discussed to help schedule clients and free up front desk staff.
How can you be successful at healthcare revenue cycle management.pdfCosentus
The best way to be successful at healthcare revenue cycle process is to outsource RCM services. Cosentus is one of the best companies that can help you get the desired result in your healthcare RCM. Visit their website today and get the best RCM service!
ERA Posting Improves Practice Efficiency
1) Implementing electronic remittance advice (ERA) and funds transfer (EFT) improves medical practice efficiency by automating the payment posting process and reducing staff time spent on manual tasks.
2) Setting up ERA requires enrolling with payers, customizing system profiles for each payer's ERA formats, and automating payment posting based on standard explanation codes.
3) Once set up, the ERA process involves downloading remittance files from a clearinghouse or payer, importing them into the practice management system to create payment batches, and reconciling posted payments with bank deposits for accuracy.
Beacon Partners White Paper Understanding Revenue Cycle Strategypvillacci
The document discusses optimizing the revenue cycle process through people, processes, and technologies. It emphasizes the importance of well-educated staff, clearly defined processes and policies, and integrating different technologies like EMRs. The revenue cycle manager must measure performance, identify areas for improvement, and ensure effective communication across departments to streamline the revenue cycle and minimize errors. Denials reveal inefficiencies and where processes can be improved to increase payments received.
Technology: Increase Revenue, Decrease Workload An AOA WebinarHealth iPASS
The growing chorus of patients with high deductible plans places a greater burden on medical providers to implement patient revenue cycle solutions that optimize net collection rates. Patients are now the largest payers in healthcare. Patient payment technology solutions have the unique ability to promote healthcare price transparency by educating and empowering healthcare consumerism with insurance eligibility information, cost-of-care estimates, co-pay and deductible amounts, and estimates of what balance may be owed post insurance claim adjudication. Learn more about how and why implementing a patient payment collection technology solution empowers, engages, educates, and delights patients through a convenient and intuitive patient check-in kiosk. Plus, learn more about the new “vitals” to track patient revenue cycle management to improve patient net collection rates in this webinar slide deck.
Provides an overview of the current revenue cycle management and its processes and offers a point-of-view on today’s RCM trends and areas of transformation.
This document provides an overview of revenue cycle management in healthcare. It discusses the key stages in the revenue cycle process including patient registration, insurance verification, claim filing, coding, documentation, reimbursement, payment posting, and account receivables. The document emphasizes that any errors during the revenue cycle can make it difficult to trace and rectify payments. It also outlines the importance of revenue cycle management in ensuring proper claim management and timely settlement to avoid delays and legal obligations. Revenue cycle management involves managing the various players, including patients, healthcare providers, billing companies, and insurance players to align goals and work efficiently.
Adam Gobin presented on Emory Healthcare's denial management process. They applied management engineering techniques like DMAIC to streamline denial workflows through hyper-specialization and centralization. Key steps included defining denial categories, measuring trends through reports, analyzing patterns, improving through standardized workflows, and controlling quality. This led to significant improvements such as reduced write-offs, registration denials, and medical record requests as well as increased payments for aged claims. Lessons included planning resources, stakeholder buy-in, and using standardized reporting for accountability.
The document discusses a lunch and learn meeting for practice managers on revenue cycle management. It provides tips for managers to evaluate their operations in key areas like finances, billing, and collections. This includes establishing cash controls, tracking monthly performance, ensuring proper documentation and billing processes, and meeting industry benchmarks for accounts receivable and collection rates. The goal is for practices to manage their revenue cycle like a business to increase productivity, efficiency and overall revenues.
Medical Lockbox Innovations in Revenue Cycle Management Drive Profitability f...Vivastream
Medical lockbox innovations in revenue cycle management can drive profitability for healthcare providers. Implementing a full revenue cycle management solution can automate inefficient manual processes, improving productivity, cash flow, and payment recovery. By integrating lockbox services with RCM solutions, banks can help providers achieve straight-through processing, reducing days in accounts receivable by over 15% and increasing annual cash flow by millions of dollars through faster payment posting and collections.
Medical Billingz | Health Management.pptxa92195588
At Medical Billingz you’ll get all the essential information about medical billing and coding basics and tools. We aim to provide accurate and up-to-date information on this continuously evolving topic so that everyone has the most updated information about medical billing and its future.
The document discusses the importance of medical revenue cycle management (RCM) for physician practices. It outlines key factors that affect practice revenue, including proper billing/coding, credentialing, preauthorizations, and accounts receivable (A/R) management. The document uses an example to show that while a lower RCM fee may seem better, a service that improves reimbursements by 5% and charges a slightly higher fee of 5.75% can provide greater overall revenue to the practice. Effective RCM requires ongoing attention to timely claim filing, proper use of modifiers, credentialing updates, eligibility verification, and A/R monitoring through metrics like payment rates and days in A/R. Outsourcing RCM to an experienced
Common Challenges in Dermatology Billing and How to Overcome.pptxalicecarlos1
Common Challenges in Dermatology Billing and How to Overcome?
Dermatology billing faces challenges like incorrect coding, denied claims, and changing insurance policies. Ensure staff are trained in dermatology-specific codes and use robust systems for checking claims before submission. Stay informed about insurance updates and communicate clearly with patients about their financial responsibilities. Medical Billers and Coders (MBC) can help by ensuring accurate coding, timely claim submission, and effective follow-up on denied claims, allowing you to focus on patient care.
Read more about How to Overcome Challenges in Dermatology: https://shorturl.at/D7ANX
#DermatologyBilling #MedicalBilling #RevenueCycleManagement #HealthcareBilling #BillingChallenges #MedicalCoders #MedicalBillersAndCoders
Process Improvement: A Consultant's View of your Healthcare Revenue Cycle | A...Meduit
Get a look at how well your revenue cycle processes are functioning and learn how to identify the initiatives your healthcare facility can take to reduce days in A/R and boost revenue! Download the live event recording here: https://lab.meduitrcm.com/process-improvement-innovationlab-webinar/
Accelerating your revenue cycle webinar series Draft 2 _ 072013
1. Accelerating your
Revenue Cycle:
From Patient Encounter Through Account Resolution
Chastity D. Werner, RHIT, CMPE, NCP
NextGen Educational Series
July 22, 2014
2. Learning Objectives
Characteristics of Best Performers
Efficient Encounters = Revenue Cycle Success
Measuring Revenue Cycle Performance
Identifying Your Opportunities
3. Accelerating your Revenue Cycle:
Characteristics of Best Performers
• Technology
• Staff
• Payers
• Process
From Patient Encounter Through Account Resolution
4. Characteristics of Best Performers
Technology
• Systems
Interface when possible
Efficient templates
6. Characteristics of Best Performers
Technology
• EHR/PMS communicate
• Upgraded regularly
• Continued education
• Embrace new opportunities
7. Schedulers
Efficient, strong phone & customer service skills,
understands billing process, well trained in patient
collections and payer policies and procedures.
Characteristics of Best Performers
Staff
• Right fit
• Productivity
• Weekly meetings
Front desk
Smiles, friendly, efficient, multi-tasking abilities, high
energy, strong communication skills, organized, well
trained in patient collections.
Set expectations:
They represent your office
Patients are first
Team environment
Billing issues affect all departments
Reasons for underproduction
Do not know what to do
Do not know how to do it
Do not know why they are doing it
My way is better
Something else is more important
I must be doing it, you left me alone
I am rewarded for not doing it
Weekly meeting
Charges/payments
Payer updates/changes
Patient issues
Upcoming events
Training
Areas of concern
End it on a positive note!
Always follow-up on questions/concerns
9. Characteristics of Best Performers
“The lowest level of performance by any employee,
allowed to continue without corrective action, becomes
the highest level of performance that can be required of
any other employee in a similar position with the
employer.”
Reference: Rosemarie Nelson MGMA Healthcare Consultant
The ROI of IT: Best Billing Practices
10. Characteristics of Best Performers
Payers
• Credentialing
• Payment rules
• Appeal process
• Stay up-to-date
http://www.ama-assn.org/ama/pub/physician-resources/practice-management-
center/health-insurer-payer-relations/payer-specific-information.page?
11. Characteristics of Best Performers
Payers
• Pre-auth/Pre-cert rules
• Contracted fee schedules
• Electronic options
• User names & passwords
Reference: AMA 2012 National Health Insurer Report Card
12. Characteristics of Best Performers
Process
• Does it make sense?
• Uniform
• Set expectations
• Policies & procedures
Standardized
Update regularly
14. Accelerating your Revenue Cycle:
Efficient encounters
• Scheduling
• Eligibility & benefits verification
• TOS
• Claims generation
• Payment processes
• Account resolution
• Collection process
From Patient Encounter Through Account Resolution
15. Efficient Encounters = Revenue Cycle
Success
Capture the right information
Account review
Patient expectations
Patient demographics
Work #, cell phone, email
Guarantor details
Employer information
Insurance details
“Ms. Smith,
I see you have a past due amount of
$50.00. How would you like to take care
of that today? We accept Visa,
MasterCard, or do you have an FSA?”
“We expect payment at the
time of service. ”
16. Sources: (left) Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits Annual Surveys, 1999–2012; (right) authors’
estimates based on CPS ASEC 2001–12, Kaiser/HRET 2001–12, CMS OACT 2012–21.
Projected average family premium as
a percentage of median family
income, 2013–2021
Cumulative changes in insurance
premiums and workers’ earnings,
1999–2012%
%
180%
47%
38%
Projected
172%
Efficient Encounters = Revenue Cycle
Success
17. Efficient Encounters = Revenue Cycle
Success
Percentage of Covered Workers
Enrolled in a Plan with a General
Annual Deductible of $1,000 or More for
Single Coverage
Note: These estimates include workers enrolled in
HDHP/SO and other plan types. Source: Kaiser/HRET
Survey of Employer-Sponsored Health Benefits, 2006-
2010.
“National health expenditures are
expected to increase from $2.9 trillion
to $5.5 trillion. Business and
households are projected to pay half
of total nation health care costs in
2023, while the federal government
will pay 32% and state and local
governments will pay 18%.
Confronting Costs: Stabilizing U.S. Health Spending While Moving
Toward High Performance Health Care System. 2012
18. Efficient Encounters = Revenue Cycle
Success
Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012
% of providers
who knew patient
responsibility at
the TOS
% of patients
who knew their
financial
responsibility
It costs between
$0.05-$0.74 to check
eligibility
How much will it save
you to know what your
patient owes at the
TOS?
20. Efficient Encounters = Revenue Cycle
Success
Automate
Centralize
Payer websites
Is it worth it? Choose your criteria:
Services
Payers
Everything
Use the
information
obtained!
3 days in
advance
21. Efficient Encounters = Revenue Cycle
Success
Compare
coverage to
expected treatment
& fee schedule
Contact
patient–
patient
counseling
Set alerts in
system &
schedule
Collect at
TOS
22. Efficient Encounters = Revenue Cycle
Success
TOS
• Confirm information
• Collect at check-in
• Collect at check-out
“How would you like to pay
today? We accept Visa,
MasterCard, cash and checks.”
23. Efficient Encounters = Revenue Cycle
Success
“If patient payments are not managed correctly, they can cost three to five times
more to collect than payer payments due to paper-based, manual processes.
These costs are further escalated by rising patient bad debt, which was estimated
to have been more than $65 billion in 2010.”
TOS Collection % for Providers
Reason the provider
did not collect
Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012
25. Efficient Encounters = Revenue Cycle
Success
Claim generation
• Charge lag 24 hours (48
hours out of office services)
• Claim scrubbing
Edits
Correction
Do you update your
claim edits on a
regular basis?
26. Efficient Encounters = Revenue Cycle
Success
Utilize a
clearinghouse
Submit charges
within 24-48
hours
Initial follow-up
24 hours
Level 1 rejections
997 claim rejection report
277u claim status
report
27. Efficient Encounters = Revenue Cycle
Success
Reconciliation
ERA/EFT
PPACA
Zero pays
Automate
46%
51%
6% increase over 2
year period
Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012
Reason payer
payments were not
received electronically
29. Efficient Encounters = Revenue Cycle
Success
Reference: AMA 2012 National Health Insurer Report Card
96 – Non-covered
charge(s). At least
one Remark Code
must be provided.
Claim Adjustment
Reason Codes
(CARC)
Claim adjustment
reason codes
communicate an
adjustment, meaning
that they must
communicate why a
claim or service line
was paid differently than
it was billed. If there is
no adjustment to a
claim/line, then there is
no adjustment reason
code.
16 – Claim/service
lacks information
which is needed for
adjudication. At least
one Remark Code
must be provided.
www.wpc-edi.com/reference/codelists/healthcare/
204 – The
service/equipment/drug
is not covered under
the patient’s current
plan.
30. Efficient Encounters = Revenue Cycle
Success
Reference: AMA 2012 National Health Insurer Report Card www.wpc-edi.com/reference/codelists/healthcare/
Remittance Advice
Remark Codes (RARC)
Remittance Advice Remark Codes
(RARCs) are used to provide
additional explanation for an
adjustment already described by a
CARC or to convey information about
remittance processing. Each RARC
identifies a specific message as shown
in the RARC List. There are two types
of RARCs- majority are supplemental
to the CARC codes, but some are for
information purposes only.
N130 – Consult plan
benefit documents or
guidelines for information
about restrictions for this
service.
N179 – Additional
information has been
requested from the
member. The charges will
be reconsidered upon
receipt of that information.
N386 – The decision was based on
a National Coverage Determination
(NCD). An NCD provides a
coverage determination as to
whether a particular item or service
is covered. A copy of this policy is
available at
www.cms.gov/mcd/search.asp. if
you do not have web access, you
may contact the contractor to
request a copy of the NCD.
31. Efficient Encounters = Revenue Cycle
Success
Payment Processing
• Contractual
• Non-contractual
• Post all zero pays
• Utilize system automation
• Reconciliation
32. Efficient Encounters = Revenue Cycle
Success
Payment processing
• Reconciliation Process:
1)Separate deposits
2)One batch per deposit (i.e. ERA/EFT)
3)Uniform batch description
» (i.e. $34,584.03 Anthem 5/6/2013)
4) Match to bank deposits to system
» Download each into Excel format
» Data sort by dollar amount
» Utilize other data to compare if needed
33. Efficient Encounters = Revenue Cycle
Success
Patient Statements
• Electronic statements
Cost 58% less than paper
• Make it convenient
• Two statements
Day 0
Day 30
• Collection letter Day 60
• Day 75 turnover
E-statements save providers
approximately 42% compared
to paper statements.
In paying their
medical bills
electronically
It is estimated that consumers in
the U.S. will spend more than
$300 billion online in 2016.
Increased 7%
from 2011-2012
% of patients
receiving
medical bills
via email
Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012
Reference: Gartner Group, HFMA, and HH&N Research
34. Efficient Encounters = Revenue Cycle
Success
Account resolution
• 24 hours after submission
• Universal note area
• 277/997 reports
• Automate when possible
• Appropriate reports
• Review notes & tasks
• 14-21 days clearinghouse
• 31+ days payer website/phone
Payer
High $$$ Down
DOS
Group by Patient
36. Efficient Encounters = Revenue Cycle
Success
100 claims a day X 20 days a month
2,000 claims
20% denial rate
2,000 claims X 20% = 400 claims
33% of denials are never recovered
400 X 33% = 132
132 X $100.00 (average reimbursement) = $13,200 monthly
Source: The Physician Billing Process: 12 potholes to avoid in the road to getting paid, ed 2,
Walker-Keegan, Woodcock, Larch.13
37. Efficient Encounters = Revenue Cycle
Success
Source: The Physician Billing Process: 12 potholes to avoid in the road to getting paid, ed 2,
Walker-Keegan, Woodcock, Larch.13
$10.67 staff time
$ 1.50 supplies
$ 1.75 interest
$ 1.00 overhead_______________________
$14.92
$14.92
x 400
$5,968
Monthly
_______
$5,968
x 12
$71,616
Annually
________
38. Efficient Encounters = Revenue Cycle
Success
Should it be
written off?
Contractual versus
non-contractual
adjustment
Is a
correction
needed?
If so,
correct &
resubmit!
Should it be
appealed?
Collect data,
follow payer process,
involve patient &
track status
39. Efficient Encounters = Revenue Cycle
Success
Collection process
• Automate process
• Monitor results
• Write-off at turnover
Write off utilizing specific
code; create reports by
specific code to track
agency results.
41. Efficient Encounters = Revenue Cycle
Success
Reference: http://caqh.org/eft_enrollment.php
Where do you go from here?
Decide what is right for your practice!
Investigate your options
Automate when possible
Centralize processes
Stay up-to-date on new options
Partner with your clearinghouse
Keep an open mind
Think outside the box
43. Measuring Revenue Cycle Performance
• What is important?
• Reporting and analysis
• Tracking and acting
Accelerating your Revenue Cycle:
From Patient Encounter Through Account Resolution
44. Measuring Revenue Cycle Performance
What is important?
• Collections
Cash in the door
• Production
Units to produce the cash
45. Measuring Revenue Cycle Performance
What is important? Collections!
• A/R
Charges, payments, & adjustments
– Provider
– Practice
Days outstanding
Payer mix
Collections per RVU
– Service line
– Provider
46. Measuring Revenue Cycle Performance
What is important? Collections
• Payments
Third party
– Underpayments
– Denials and rejections
Patient
– TOS collections
– Commitment to payment plans
47. Measuring Revenue Cycle Performance
What is important? Collections
• Credit balances
Patient
Third party
• Bad debt
% bad debt to total revenue
Collection agency recovery
48. Measuring Revenue Cycle Performance
What is important? Production!
• CPT/RVU production
Location
Provider
• Case mix
Location
Provider
52. Measuring Revenue Cycle Performance
Reporting and analysis
• Daily
Denials and rejections
TOS collections
Appointments with no charges
EFT/ERA reconciliations
53. Measuring Revenue Cycle Performance
Reporting and analysis
• Weekly
Third party underpayments
TOS collections
54. Measuring Revenue Cycle Performance
Reporting and analysis
• Monthly
Charges/payments/adjustments
CPT/RVU utilization
Denials and rejections summary
Bad debt
Credit balances
Patient underpayments
55. Measuring Revenue Cycle Performance
Reporting and analysis
• Quarterly
Capitation plan performance
Payer mix
– Charges
– Payments
• Annually
Fee schedule assessment
Capitation plan performance
Budgeted revenue vs. actual revenue
Budget production vs. actual production
56. Measuring Revenue Cycle Performance
Tracking and acting
• KPI
Data point or criteria
• Benchmark
Type of KPI
Data point to measure results against
Internal or external
57. Measuring Revenue Cycle Performance
Tracking and acting
• Why use KPI’s?
Measure what’s important
Identify trends
Compare progress to expectations
Incentivize desired behaviors
58. Measuring Revenue Cycle Performance
Tracking and acting
• KPIs
% Co-pays collected vs. total possible co-pays
Charge lags
– Office visits
– Off-site services
Budgeted charges
% clean claims
Unbilled charges
Staff production standards
Denials
Payer mix
59. Measuring Revenue Cycle Performance
Tracking and acting
• How do you use KPI’s?
• Dashboard
Snapshot summary of key results
– Internal benchmarks
» Historical
– External benchmarks
» Marketplace
» Industry
60. Measuring Revenue Cycle Performance
Tracking and acting
• Dashboard
Decide what’s most important
Identify the data point to measure
Identify the benchmark for comparison
Design dashboard to meet your practice’s needs
Populate dashboard
Act on variances to the benchmark
61. Measuring Revenue Cycle Performance
Key Indicators
Indicator Calculation Significance Frequency Trend
Gross Days
Receivable
Outstanding (DRO)
Total A/R divided by
Average Daily Charge
Indicates how long it
takes to convert a claim
into cash. Monthly
Should be downward trend-
Less than 30
Gross Calculation
Ratio
Total YTD Payments
divided by Total YTD
Charges
Indicates proportion of
charges that are
converted to cash. Monthly Should be upward trend.
Net Collection Ratio
Total YTD Payments
divided by Total YTD
Charges less YTD
Contractual
Adjustments
Indicates effectiveness
of collection efforts on
potential dollars,
including point of
service payments. Monthly
Should be upward trend. 96%
or greater.
% Insurance A/R
90+ Days
Insurance A/R greater
than 90 days divided by
Total Insurance A/R
Low proportion
indicates that accounts
are collected effectively.
Monthly
Should be downward trend-
Less than 10%
64. Measuring Revenue Cycle Performance
Payment Analysis
Payer Name Encounter Chg Amt Count Adj Amt Allowed Amount Fee Schedule Variance
99204 Anthem Blue Choice PPO 15302 $225.00 1 -$105.00 -$120.00 $125.93 -$5.93
99204 Anthem Blue Choice PPO 15536 $225.00 1 -$102.00 -$123.00 $125.93 -$2.93
99204 Anthem Blue Choice PPO 16075 $225.00 1 -$102.00 -$123.00 $125.93 -$2.93
99204 Anthem Blue Choice PPO 16077 $225.00 1 -$102.00 -$123.00 $125.93 -$2.93
99204 Anthem Blue Choice PPO 16078 $225.00 1 -$102.00 -$123.00 $125.93 -$2.93
99204 Anthem Blue Choice PPO 17630 $225.00 1 -$185.00 -$40.00 $125.93 -$85.93
99204 Anthem Blue Choice PPO 17631 $225.00 1 -$185.00 -$40.00 $125.93 -$85.93
99204 Anthem Blue Choice PPO 17721 $225.00 1 -$139.07 -$85.93 $125.93 -$40.00
99204 Anthem Blue Choice PPO 17722 $225.00 1 -$139.07 -$85.93 $125.93 -$40.00
99204 Anthem Blue Choice PPO 18002 $225.00 1 -$205.00 -$20.00 $125.93 -$105.93
99204 Anthem Blue Choice PPO 18121 $225.00 1 -$100.42 -$124.58 $125.93 -$1.35
99204 Anthem Blue Choice PPO 18179 $225.00 1 -$99.07 -$125.93 $125.93 $0.00
99204 Anthem Blue Choice PPO 18203 $225.00 1 -$99.07 -$125.93 $125.93 $0.00
99204 Anthem Blue Choice PPO 18363 $225.00 1 -$100.42 -$124.58 $125.93 -$1.35
99204 Anthem Blue Choice PPO 18715 $225.00 1 -$99.07 -$125.93 $125.93 $0.00
99204 Anthem Blue Choice PPO 18821 $225.00 1 -$99.07 -$125.93 $125.93 $0.00
99204 Anthem Blue Choice PPO 18862 $225.00 1 -$139.07 -$85.93 $125.93 -$40.00
99204 Anthem Blue Choice PPO 19051 $225.00 1 -$99.07 -$125.93 $125.93 $0.00
99204 Anthem Blue Choice PPO 19605 $225.00 1 -$100.42 -$124.58 $125.93 -$1.35
99204 Anthem Blue Choice PPO 19734 $225.00 1 -$99.07 -$125.93 $125.93 $0.00
99204 Anthem Blue Choice PPO 19755 $225.00 1 -$99.07 -$125.93 $125.93 $0.00
99204 Anthem Blue Choice PPO 19867 $225.00 1 -$99.07 -$125.93 $125.93 $0.00
99204 Anthem Blue Choice PPO 20213 $225.00 1 -$99.07 -$125.93 $125.93 $0.00
•Run CPT report for date span, by appropriate
payer, & including “Allowed Amount”
•Export the file from PMS to Excel
•Insert column with allowed amount if needed
•Create conditional formula to identify
variances
Compare “allowed
amount” not paid
amount
65. DOS to date of
documentation
(DOD)
Date of
Documentation
to date of coding
(if not utilizing
CAC)
Date of
Coding to
Date of
Charge
Entry
Date of
Charge Entry
to Claim
Submission
Date of Claim
submission to
Payer
Adjudication
Date of Payer
Adjudication to
Patient
Statement/Denial
Worked and
resubmitted
Total Lag Time
from DOS to
Fully
Adjudicated
Measuring Revenue Cycle Performance
Start here
tracking
results
67. Identifying Your Opportunities
• Assess the situation
Revenue cycle assessment
System assessment
• Prioritize the opportunities
• Develop plan for capitalizing
• Implement plan
• Monitor and track results
Accelerating your Revenue Cycle:
From Patient Encounter Through Account Resolution
68. Identifying Your Opportunities
Revenue cycle assessment
• Lost revenue
• Staff productivity and quality
• Provider documentation
• Payer billing issues
• Common denials
• Missing links in process
69. Identifying Your Opportunities
Revenue cycle assessment
• Select span of time
90, 120 or 180 days?
• Set expectations
Charge lag time
– 24 hours
Bill lag time
– 48 hours
Claim note
– 30 days
Work denial
– 24 hours
Collection agency turnover
– 90 days from patient responsibility
70. Identifying Your Opportunities
Patient Name (L, F) Payer DOS Code(s) Charges DCE DCF
Date
Paid Paid Adj. Balance Activity Status Rating
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Total
Average
Legend:
DCE - Date Charge Entered
DCF - Date Claim
Filed
72. Accelerating your Revenue Cycle
What Does An Accelerated Revenue Cycle Mean?
• Communication
• Efficient processes
• Effective procedures
• Optimal systems utilization
• Effective use of resources
• Attentive management
From Patient Encounter Through Account Resolution
73. Accelerating your Revenue Cycle
What Does An Accelerated Revenue Cycle Mean?
Maximum return on investment on accounts receivables.
More Revenue.
More Quickly!
From Patient Encounter Through Account Resolution
75. www.anderscpa.com/webinar-series
September 18
Sustainable Compensation Models that Incentivize:
Trends & Examples
November 6
Operational Effectiveness and Profitability: Identifying
and Prioritizing Opportunities
December 4
Keeping the Financial Pulse of Your Practice Healthy:
Benchmarking and Trends
76. Anders Health Care Services
Anders Health Care Services optimizes staff,
resources and revenue for hospitals and
physicians by offering solutions and direction to
complex practice management issues.
We provide an integrated approach from the
financial, operational, compliance and strategic
perspectives.
77. Anders Health Care Services
Jerrie K. Weith, FHFMA, CMPE
314-655-5558
jweith@anderscpa.com
Chastity D. Werner, RHIT, CMPE, NCP
314-655-5561
cwerner@anderscpa.com
78. Anders Health Care Services
Jessica Johnson jjohnson@anderscpa.com
Brian McCook bmccook@anderscpa.com
John McGuire jmcguire@anderscpa.com
Brian Meyers bmeyers@anderscpa.com
314-655-5500
www.andershealthcare.com