Strategies to Improve Practice Cashflow

Sterling Solutions, Ltd.
Strategies to Improve
Cash Flow
Secret Weapons that Can ImproveYour Practice Revenue

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Today’s Expert
Ronald B. Sterling, CEO of Sterling Solutions, Ltd., is a
nationally-recognized thought leader on leveraging EHRs to
boost practice revenue through smart selection and
implementation of electronic health record and practice
management systems.
Ron has advised healthcare organizations and practices across
the country. Ron has analyzed software from over 150
vendors.
Ron publishes the popular EHR Blog,Avoid-EHR-
Disasters.com and authored the HIMSS Book of the Year
Award winning Keys to EHR/EHR Success - Selecting and
Implementing an Electronic Medical Record. Ron has
contributed hundreds of articles to a wide range of
publications including the widely used MarketingYour Clinical
Practice.

RCM Issues
Revenue Sources Changing
 Fee-For-Service Decreasing
 Increasing
- Shared Savings
- Accountable Care Organizations
- eVisits
- Patient Portal Services
- Patient Service
 Performance/Results Oriented Payments

RCM Focus Changes to
Support Evolving Payment Models
 From -
 E&M
 Charge Capture
 To -
 Maintaining Quality and Performance
 Patient Service
 Proving Quality
 Patient Centered Specialty Practice
 Patient Centered Medical Home

Issues that Influence RCM Strategy
 Meaningful Use
 HIPAA Security Standards
 Accountable for Integrity
 Assure Accessibility
 ACA Effect
 Higher Deductible
 Health Insurance Exchanges
 “Cloning” Records

 Preserve Information to Support RCM
 Notes
 New Service Documentation Tools
- Clinical Messaging
- Patient Remote Patient Monitoring Systems
 Patient Quality and Service Objectives
- Coordinate Patient Populations
- Track Patient Care
 Performance Standards
- Quality Improvement
8
RCM Support Is Complicated

RCM Support Is Complicated
 Payers/ACOs MayVary
 Sustain an Audit of Supporting Documentation
 Requests for Documents
 Examination of EHR Based Records
- Computer Assisted Review Tools
- Review of Audit Trails
- Review Context of Care
9

Evolving RCM is Complicated
 EHR May Not Accommodate
 Tracking of Key RCM Measures
 Relevant Status Over Activities
 May Require Changes to EHR Use
 Activities Measures
 Documentation toTrigger RCM Requirements

 May Require Additional Documentation
 Meaningful Use Like Attestation
 Global Reporting
 Performance Tracking
 Payment May Not Be Associated with a Patient
 Quality Incentive
 “SGR Fix” Payments
Evolving RCM is Complicated

 EHR Records areVulnerable
 Payer Patient Service Expectations
 First Response
 Final Resolution/Recommendation
 Due Diligence to Protect Patient Records
 Avoid Degradation
 Maintain Accuracy and Consistencyy
EHR Challenges Related to RCM

EHR Challenges Related to RCM
ICD10 Starts October 1, 2015
 Not Just About Coding
- Clinical Decision Support (MU)
- Health Maintenance Items
- Classification of Plans,Visits and More
 ICD10 Specificity
- Site
- Laterality
- Visit Type
- More

Clinical RCM Objectives
 Verify Record Standards
 Maintain Integrity of Patient Records
 Protect Against
 Unsubstantiated Services
 Quality Lapses
 Claim Fraud
 Support Contractual, Professional and Industry Standards

Agree on Operational Standards
 Standards Based on
 EHR Features
 Product Use
 Payer/ACO
 Practice
 Services
 Doctors

RCM Checklist Items
 Notes Signed Within X Hours/Days
 Regular OfficeVisits
 eVisits
 Evolving Activities (Ex.ACO Support)
 EHR Interface with PMS/Billing
 Accuracy
 Timeliness
 ICD9/10 Coding
 Changes
 Substantiation

RCM Checklist Items
 Reconcile
 Charges
 Appointments
 Cancellations
 No Shows
 Supporting Documentation for Clinically
Significant Events
17

RCM Checklist Items
Patient Portal Traffic
 Patient Submission of Information
- New Patients
- Follow Up
 Turnaround Time
 Follow Up on Undelivered Messages
 Documentation Supports Care Standards

EHRPatient Portal Patient Request
Response
Information
Messages – Sent to Inbox and Information Entered into EHR.
Information Accepted – Information Flagged and Posted to Patient Chart.
Patient Portal

RCM Checklist Items
 Outgoing and Incoming Electronic Traffic Check
 Rx
 Transition of Care
 Lab Results
 Patient Orders
 Other Results
 Workflow Management
 Patient Appointments Cleared and Completed
 To-dos and Messages Completed

RCM Checklist Items
 Internal Messaging
 Part of Patient Service Strategy
 Status and Response byType
 Workflow Issues
 Incoming Documents/Images
 Status of Items to be Indexed
 Routing of Indexed Items
 Documentation of Decisions
 Changes to Care Plan
 Document Patient Notification

RCM Checklist Items
 Quality Assurance
 Documentation Standards
 Outlier Detection – Treatment and/or Management
 Meaningful Use

RCM Checklist Items
Quality Patient Services
 Test Results Follow Up
 Procedure/Surgery Follow Up
 Referral Follow Up
 ReminderTransmission
 Reminder Follow Up
 Health Maintenance Items
 Outstanding Orders
 Obsolete Orders

RCM Reporting
 Maintain Statistics to Prove Performance
 Payer
 Patient Population
 Provider
 Location
 Report on Standards
 Performance
 Trends

Supporting Claims and Collections
 In addition to copy of notes to match
E&M code with documentation….
 Includes proving care standards
 Depends on operational performance
 Requires timely and accurate records
 Meaningful Use reporting and Clinical
Quality Measures are a window into
the future of RCM

RCM and EHR Cases
 PMS receives charges for office visits from EHR but EHR does
not post transactions for patient advice, RPMS monitoring and
other activities that are billed/paid under a quality initiative.
 What are the RCM issues?
 What are the RCM problems in light of an ACO environment?
 What is a workaround to maintain financial information?

RCM and EHR Cases
 Practice receives a quality incentive payment for
managing an at risk patient population. The PMS only
posts fee for service charges.
 How and where should the payment be posted?
 Can the payment be posted directly to the accounting system
and bypass the PMS?
 How will realization reports be affected?

RCM and EHR Cases
 EHRVendor advises practice to not sign
patient notes in case the doctor wants to
change the document.
 What are the fee for service issues?
 What are the professional liability issues?
 What are the RCM problems in light of an ACO
environment?

RCM and EHR Cases
 EHR Messages are not included as part of the
patient record according to the EHR design.
 How does this design complicate quality patient
care?
 What are the operational accommodations needed
to support quality care based RCM?

Go Forward Plan
 Monitor EHRVendor tools to
support RCM under evolving
payment and performance systems
 Meaningful Use as a Start
 Maintain EHR Documentation and
Performance Standards to take
advantage of EHR and align your
practice with evolving revenue
models (ACO, Shared Savings, PCSP,
etc.)

QUESTIONS
ANSWERS

RONALD B. STERLING, CPA
rbsterling@sterling-solutions.com
(301)681-4247
BLOG: Avoid-EHR-Disasters.com

Conventus Contact Information
Susan Lieberman, MBA
Vice President, Risk Management
Conventus Inter-Insurance Exchange
877-444-0484, x466
www.conventusnj.com

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