chug 2015 fall conference

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© 2015 Hayes Management Consulting. All rights reserved.Proprietary and Confidential. Do not distribute.

PRESENTED BY:

CPS Housekeeping – Get your broom!

Angela Hunsberger – Hayes Management Consulting Lorie Richardson, LPN - Hayes Management Consulting

CHUG 2015Fall Conference

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IntroductionsLorie Richardson, LPNDirector of Account ManagementPrincipal ConsultantHayes Management Consulting

• 25 years nursing experience– Inpatient and Ambulatory

• 10 years experience implementing, training, and optimizing Centricity

• 40+ Centricity Implementations• Epic Ambulatory certified• Provider Trainer• EMR Optimization Specialist• Training and Onboarding Specialist• PMP – In Progress

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IntroductionsAngela HunsbergerSenior Healthcare ConsultantAmbulatory Services TeamHayes Management Consulting

• 17 years in healthcare• 10 years experience implementing, training,

and optimizing Centricity • 50+ Centricity Implementations• PM, EMR, and Portal Optimization Specialist• Training and Onboarding Specialist• PMP – In Progress

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Centricity Housekeeping• When Centricity was initially installed your database likely started out pristine, fresh,

and had a lemon scent.• Keeping both your PM and EMR clean is a challenge when several people, processes,

and departments are involved.• Over time, neglected chores cause unwanted residue in the nooks and crannies of

Centricity. This messy build up results in the loss of valuable time and money for your organization.

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Centricity Housekeeping• Get your broom! It’s time to do a clean sweep of Centricity.

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Agenda• While every office is unique, we all share some common

housekeeping tasks. • Today, you will learn about key areas of Centricity that need

attention on a daily, weekly, monthly, quarterly and yearly “housekeeping” schedule.

• These chores apply to Office Managers, IT Administrators, Billing, and Clinic Leads.

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Where to Start:• Stay on track with regular scheduled maintenance. Start by making your own

system housekeeping calendar using this presentation as a guide:– Include daily, weekly, monthly, quarterly, and yearly tasks– Have each staff member make a list– Assign responsibility for accountability

• You can even color-code your list by role or department. • Some tasks require involvement from one or more departments

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Daily Tasks

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Daily Task Examples:• Appoint a Meaningful Use expert who is available to help with

questions as they arise on a daily basis. – Sometimes it’s difficult for the existing support and IT staff to fill this

role.

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Daily Task Examples:• Resolve all payments. Unapplied funds affect system closing, reports and

outstanding balances on patient accounts. The longer unapplied funds sit around, the more difficult they become to post.

• Close daily batches. Batches are like cash registers for charges and payments. Close your register daily for balancing and reporting purposes.

• Run daily reports. Run your daily reports

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Daily Task Examples:• Perform an EMR charge sweep. This allows you to bring over charges

that were entered after the initial visit or charges that do not have a coordinating appointment. – EMR charges left unbilled are a costly mistake.

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Daily Task Examples:INSTRUCTIONS:1. In Centricity PM, go to Billing. In the Billing

Criteria Box, checkmark the box in the lower left corner that says “Include only visits awaiting unretrieved charges”.

2. Bullet the radio button in the upper right corner for “All” dates.

3. Do not enter any additional criteria.4. Click OK. If it asks you if you would like to

continue, click Yes.

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Daily Task Examples:• Adjust capitated insurance balances. Adjust off daily or setup the fee

schedule to automatically adjust off the balance when the charge is posted.

• Send Insurance Claims. Regular claim filing provides a steady stream of insurance payments or denials. File electronic and paper claims daily.– Sending claims electronically also retrieves remittance files and EDI reports that

update your visit statuses.– Include primary, secondary, and tertiary filing

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Daily Task Examples:• Resolve rejected insurance claims. The newer the rejection, the

easier it will be to resolve. – Contact your software support if you do not understand a rejection reason

rather than refilling the claim or dropping it to paper. Clearinghouse and payor edits are known to change so contact support and fix the rejection correctly the first time around.

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Daily Task Examples:• Follow up on appeals and denials. Lack of follow up results in missed

revenue. Track your appeals and denials and look for trends. Do not be afraid to reach out to your insurance representatives to discuss and resolve. Use correspondence notes to track follow up.

• Post insurance and patient payments. Payments should be posted daily to allow for accurate reporting and to reflect the most current state of outstanding accounts.

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Daily Task Examples:• Perform internal collections tasks. Collections for both insurance and patient balances

are important. • Follow up with external collections. When you turn over accounts to external

collection agencies, adjust off account balances with the appropriate adjustment type so they do not remain on your current A/R. When the payment is received, adjust the amount back on with the appropriate adjustment type.

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Daily Task Examples:• Work task queues. Use queues to track productivity. Organize your

queues according to how your billing tasks are divided. Use the productivity reports to rebalance the workloads.

• Review System Audit Logs. One CHUG user suggested on the forum to have IT staff to write scripts that automatically record problems and write to error logs then have it automatically email a designated group when the job is complete or an error occurred.

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Daily Task Examples:

• Backups. Verify Centricity is successfully backed up daily.• Interface Errors. Routinely check interface errors. Work

the queue daily (or more as needed) and look for documents or labs that failed.

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Daily Task Examples:• Watch Fax Queue. Assign someone to monitor the queue to resend failed

faxes, etc.• Secure Message Inbox or Proxy Desktops. With the increase of patient

portal communication, ensure all messages and action items are responded to in a timely manner.

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Weekly Tasks

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Weekly Task Examples:• Appoint department of office managers to run CQR reports on

a weekly basis. If calculations are incorrect or a workflow needs to be modified, you don’t want to wait a month or a whole quarter before identifying the problem.

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Weekly Task Examples:• Send out patient statements. Sending out weekly, rather than monthly,

level out the amount of payments and phone calls received.

• Close out credit balances. Credits and refunds are often overlooked. Left untouched, these will skew your financial reports. Get the credit balances off of your A/R.

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Weekly Task Examples:• Audit “unsigned” items in EMR. There is a common gap between EMR

systems and billing processes. Audit unsigned items in EMR, including documents, flags/notifications, orders, referrals, etc.

• Review your provider and clinic staff desktops on a weekly basis. Unsigned documents and clinical list changes can interfere with routine patient care and can hold up the billing for the patient visit. – Implement a policy for signing off clinical items in a timely manner and enforce the

policy when users are not compliant.

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Weekly Task Examples:• Go through returned mail. It is a waste of time and money to continue to send

outstanding patient balances to bad addresses. In addition, you are helping to provide quality patient care by facilitating the correct mailing address for important medical care such as test or lab result notifications sent by mail.

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Weekly Task Examples:• Monitor New Provider Desktops: Until the new provider is comfortable

with routine tasks, monitor the desktop to ensure all documents, labs, and phone notes are addressed in a timely manner.

• Check all visit charges from EMR. Use a custom report to include Visits, with a signed document in EMR, that did not have an E&M code.

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Monthly Tasks

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Monthly Task Examples:• Keep an eye on the attestation deadline and make sure

providers are trending in the correct direction and staying above thresholds. Create a spreadsheet to keep numbers for comparison and add updated numbers at least monthly.

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Monthly Task Examples:• Review top payor rejections. A regular audit of payor rejection reasons

will help identify issues on the front end. What tools does your clearinghouse or system offer for this analytical reporting?

• Review top payor denials. Different from rejected claims, denials are the reasons claims are not paid. Review denial reports by payor to identify trends.

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Monthly Task Examples:• Reconcile and compare monthly reports. Monthly reports are important

for balancing, trending, and benchmarking. These reports give you a high-level dynamic picture of the financial health of your organization. – Reconciling monthly reports will ease end of year closing.

• Hard close. Financial data will fluctuate because soft-closed batches can be overridden and data can be edited. Hard closing batches permanently locks down the financial data, which allows for accurate reports and benchmarking.

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Monthly Task Examples:• Audit all unpaid visits. Keeping tabs on where your outstanding

balances exist in the revenue cycle can help you pinpoint breakdowns and stay on top of problems. – It is a healthy practice to audit all outstanding patient visits and break them down

by provider, insurance carrier, or financial class.

• Audit average A/R days. Start with examining your current A/R days for your biggest insurance payors. Once you know where you are, you can set a realistic target goal. For patient accounts, examine the workload distribution within your patient accounting department. Review documentation within the visits and queues to ensure that these accounts are worked and followed up on in a timely manner.

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Monthly Task Examples:• Audit Charge Lag Time. Measure the time between the patient visit and

charge entry. • Test System Backups. Your backup log may say it backed up completely,

but how often do you check to see if the data is really there? • Snapshot Audit of Visit Statuses. Take a snapshot audit of billing statuses

in Centricity to ensure each visit completes the AR lifecycle in a timely manner.– Email me for a copy of a Visit Status Audit Worksheet

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Monthly Task Examples:• Install KB and Medispan updates. This keeps your

system up to date and compliant with Meaningful Use.

• Provider Desktops. Review provider desktops (especially those who have left the practice) to ensure all action items have been completed.

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Monthly Task Examples:• Update Training Material. Training material is not always updated on a regular

basis. This can create a problem when trying to train new staff and providers. Although small changes are made throughout the month- they all add up over time! Keep your training material up to date and assign someone to be responsible for distributing new material, as needed, to all locations.

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Quarterly Tasks

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Quarterly Task Examples:• Be aware of providers joining or leaving the organization who

will need to be registered for MU or, depending on their duration for the year, may not need to attest with your group.

• Audit workflows routinely to make sure we are doing things in the spirit of the measure. Avoid clicking buttons just to click buttons, but try to leverage the data we are collecting.

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Quarterly Task Examples:• Clean up custom lists. Diagnosis codes are not automatically removed during

regular service pack updates. Expired problem codes should be removed from these lists promptly. Edit clinical lists to add or remove relevant immunizations, lab codes, modifiers, order sets, or reference tables. If you are sending charges over from your EMR, audit those lists because the system could be sending outdated information to billing. – Cleaning the front-end in your database will aid in preventing back-end insurance denials

and ensure that the patient’s treatment plan and document is up to date.

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Quarterly Task Examples:• Security Audit. System security can easily get out of control

especially if multiple users have authority to assign permissions. A routine audit will help keep the lists manageable and clean.

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Quarterly Task Examples:• Install system updates. Most system vendors release quarterly updates.

Read the release notes first, print a security report, and then install the system updates. – Updates typically include important fixes to known issues. Some even include

advanced features and functionality. – Remember to update all the components to your system, including plug-ins or other

software. – Read the release notes on these updates. Sometimes they include changes to the

back-end of the system that may require action in the billing, EDI setup, or other areas.

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Quarterly Task Examples:• Paper Claims setup. Review all of your carriers to ensure that they are

going electronic when possible. This will provide a better audit trail for claims filing, allow an additional scrub due to going electronic, and will also promote a faster turnaround time on adjudication.– TIP: Use the Insurance Carrier Maintenance Report– TIP: Filter for paper claims in billing

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Quarterly Task Examples:• Review remittance settings and task management queues. Update as

trends for the top payor denial codes change. • Audit coding and compliance. Perform a quarterly billing audit. Take a few

visits from each provider and audit the chart for documentation, audit the CPT codes used and the insurance submission process. – Are your providers billing the most appropriate level of service possible? – Is your billing staff constantly correcting codes manually on claims but not on the EMR

side? – Does the billing and EMR office visit match if you were to be audited?

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Quarterly Task Examples:• Backup EMR Forms, Text Components, and any CCC form

customizations. Save time, money, and grief by locating your EMR forms and saving a backup on a network drive.

• Sweep up inactive users. Inactivate users who are no longer with your organization. Doing so will keep your data nice and neat and will remove unnecessary clutter for active users.

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Quarterly Task Examples:• Update EMR tools. Add/remove new immunizations/injections to flow

sheets, orders, and history.• Validate Reports. Validate data on custom and system reports.• Offer Staff Training. Refresh or update staff knowledge by offering

“advanced learning sessions quarterly.

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Quarterly Task Examples:• Shadow a patient. Observe and shadow a couple of patient

appointments from beginning to end. You will see the patient flowing through the office and it is a good time to identify bottlenecks, training opportunities, or workflow optimization opportunities. You will also gain an understanding of routine tasks on the front-end that trickle down to billing.

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Yearly Tasks

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Yearly Task Examples:• Plan for upcoming stage or phase of Meaningful Use. The

requirements for providers change on a regular basis, make sure to have workflows in place to meet newly release quality measures, and plan for any menu measures that are becoming core measures for your group.

• Ensure we are not collecting data or completing measures that have been removed.

• Consider performing an internal mock audit of the Meaningful Use performance within your organization. – Medicare is auditing approximately 40% and you want to stay ahead of

any potential loss in revenue. There are measures, such as Security Risk Assessment, that depend on much more than just provider workflow. An internal Meaningful Use team would be a great way to approach this.

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Yearly Task Examples:• Update fee schedules. Fee schedules not only store your

prices, but also payor allowed amounts. Knowledge is power. Follow up with your insurance representative if the actual amounts paid do not agree with what you expected. This can give you leverage when negotiating payor contracts.

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Yearly Task Examples:• Run yearly reports. If you run your monthly reports,

reconciling and comparing to your yearly reports should be a breeze. Unsure of what to run? Ask your vendor for suggestions or collaborate with other users of your software or specialty

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Yearly Task Examples:• Clean up schedule templates. Your office workflow is determined upon

how your schedule is designed and how cohesive it is to patient and clinical flow. Your schedule template affects the amount of patients you see and how often, the number of claims sent as a result of the visits, and the volume of visits spent in A/R and collections. Setting a strategic schedule template will ensure smooth patient traffic and a consistent workflow and billing cycle. – Make a fresh start, get rid of the old templates, and replace them with organized

and clean ones.

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Yearly Task Examples:• Review system downtime plan. Do a fire drill. What is your plan if the

system goes down or your power goes out? Preparation is key. Review each department downtime policy and ensure all paper documents are up to date and available in the event of an emergency or if the PM/EMR goes down. – Test your plan with a “fire drill” and see how prepared your office is. – Make sure that your downtime plan includes a clear process for getting charges

entered in billing in a timely manner.

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Other Ongoing Tasks

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Optimize your software• Centricity offers several options for building and customizing its

structure as to accommodate your individual practice and specialty. Because of this variability, features are designed to maximize the software’s performance in many environments. During the initial software implementation, users are in “survival mode” learning how to use the basic functions of the software in order to perform their job. They tend to be overwhelmed with information overload or not really recognize how all the components will work together in the big picture.

• Also considering staff turnover, industry changes, software updates, lack of training, and changes in technology, it is easy to see how data can build up and new features not utilized.

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Improvement is a Continuous Process• Revisit your housekeeping list and update regularly. • Have staff “sign off” on important task lists stored on a shared location.

Ready

SetClean

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Closing

• If you discover a neglected task, keep calm and to not get overwhelmed. Just like spring cleaning, sometimes things need noticed before they can get clean and organized. Be grateful that you made the discovery and focus on the benefits ahead.

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Thank you!

[email protected]/company/hayes-management-consulting

You can also find us at:

Questions?

Hayes CHUG contact: Lorie Richardson, LPNDirector, Account ManagementPrincipal Healthcare [email protected]

Angela HunsbergerSenior Healthcare [email protected]

http://www.hayesmanagement.com

https://twitter.com/HayesManagement

https://www.linkedin.com/company/38915?trk=tyah

mailto:[email protected]

mailto:[email protected]

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Hayes Service Lines

• Optimize technology and improve operations efficiency

• Craft strategic and tactical plans specific to organizational needs

• Optimize/transform revenue cycle, reduce costs, streamline operations and eliminate waste

• Automates and streamlines auditing process

Clinical/IT Consulting

Revenue Cycle Consulting

Strategic Consulting

MDaudit Software

chug 2015 fall conference

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