Practice Management 101Cycle of Service Assessment

May 19th, 2011

WhoPaul Casey, President and CEO

– 20+ years in Practice Management– Founded MD Solutions in 2000– Vision – Maximize Organizations Investment in Technology– Proficient with a multitude of PMS Technologies– Revenue Cycle Expertise– Former Reimbursement and IT Leader

• Mt. Auburn Hospital – Professional Services• Cancer Center of Boston• Various roles with Brigham Beth Israel Hospital

Today’s Goals

• Understand “Cycle of Service”• Ability to evaluate “Cycle”• Ability to Identify “Opportunity”• Ability to manage “Change”

1st Contact

Visit/Arrival

ArrivalTreatment

Check Out

Paid in Full

Final Thoughts

• Evaluate• Identify Opportunity• Prioritize your focus• Work on top “3” priorities• Measure your change• Make this an ongoing process, keep

challenging yourself and your organization

Pre-Registration/Registration/Re-Registration

• How is each these patient contacts handled? • What information is obtained during this initial contact?• Financial expectations set?• Do you send a pre-visit letter/brochure/practice guide?• Is the insurance information obtained at this time?

– If so, acceptable plan?– Full Registration vs. Phone

• Is eligibility verified at this point?• Do you qualify ability to pay prior to services?

Scheduling

• How do you schedule? WFE/PUI?• Auto/Resource/Provider?• Do you use appointment datasets?• Do you know how staff is booking appointments?

– Auto vs. Manual?• Are you using the wait bump cancel list?• Are you reserving add on slots?• Tracking No-Shows?• What is your patient retention strategy?

Pre-Visit Preparation

• Check patient eligibility prior to patient visit? Explain?• Ensure referrals are in place prior to patient visits? Explain?• Practice patient reminder strategy? Explain?

– Another opportunity to set expectations (Visit/Financial)• Do you review pending appointments for patient/collection

balances?• Online patient portal strategy?

– Do patients have ability to complete required forms online…

Patient Check-In

• Automated Check-In (Kiosk)?• Traditional Check-In? Arrive in system? Encounter Forms?• Eligibility? If change in coverage, verified?• Co-pay at check-In? (If so, what accounting controls?)• Staff trained to collect money due from patients?• Do you attempt to collect past due amounts?• Do you post payment to system at this point? OTC?• Do you use a system generated face sheet?• Copies of Drivers License and Insurance Cards?• Appropriate signage in practice?

Charge Documents/Capture

• Paper/Electronic?• How often are these updated?• Utilizing forms manager?• Are you doing out of office services?• How are you ensuring all billable revenue is captured?

Patient Check-Out

• How do charges get into system and when?– Manual– Interface from EMR– Interface from Third Party

• How are you ensuring all billable revenue is captured?• How long between DOS and Post date?• Do you reconcile to schedule?• Do you reconcile cash collections at TOS?• Do you utilize a TOS Receipt?• Do you use a “NEXT DAY” report?

Patient Check-Out Cont.

• Do you collect co-pays, prior balances?• Do you accept credit/debit cards?• If unsuccessful, what expectations are set at this time?

– Send patient home with TOS statement and return envelope?• Patient retention strategy? Do you use some type of recall

listing? Explain?

Claims Production/Management

• What clearinghouse are you using?• What percentage of claims are being sent electronically?• What pre-claim edit reports are utilized prior to

submission?• Are you utilizing Ingenix? Hosted?• Do you utilize a log to track submissions and successful

receipt?• Are you familiar with “CLMRPT”?• How often are claims produced?• Are you using cross practice claims utility?

Claims Production/Management cont.

• Are you or have you considered automating this process?• How do you manage clearinghouse rejections?• Are you using Task Manager to manage edits, clearinghouse

and payor rejections? Explain?• Do you have oversight in place to ensure completeness of

this process? Explain?• Are you sending secondary claims electronically?• Are you claims programmed to send COB_A Info? Formerly

referenced as medigap?

eRemit

• Are you automating your posting process?• What percentage of transactions posted this way?

– Run reports to validate percentages, could be a surprise!• What plans are you posting?• What challenges exist?• When denials received, posting appropriately?• Are you posting patient payments electronically?

Payment/Denial Processing

• Do you use a lock box services?• From receipt date, how many days to post? (24 Hours?)• Does cash posting handle denials?• How are EOB’s stored for retrieval?• How is each batch reconciled back to the deposits?• How is this maintained throughout the month?• How do you measure staff productivity and quality?

Statement Process

• Do you currently use a statement vendor? If yes, who?• What is the current cost per statement?• What is included in the cost?• Do you send return envelope with your statements?• What is your statement interval set at?• How often do you run statements?• Do you have a statement that patients understand?• Can you accept payments online?• Have you considered electronic bill pay/presentment?• Does your vendor have ability to customize your output?

Follow-up (No Response)

• At what point does insurance follow-up begin?• What tools do you use to manage this process?

– Task Management? Reporting? Other?• If TM, what challenges are you facing?• If reporting, why not TM?• Do you use auto adjust/rebill programs? Explain?• Have you used custrebill?• How do you measure productivity and quality of staff?

Appeals (Denied/Posted)

• Describe how your practice manages denials/appeals?• What tools are used in this process?• Do you set dollar limits on appeals?• What is the largest/most common denial types?

– eCommerce – Denial Reports by Transaction Category

• Do you incorporate TM into this process?• How do you measure productivity and quality of staff?

Paid in Full/WriteOff

• What is your practice bad debt write off policy?• Do you use collections plus? • Do you use outside collection agency? Are they effective?• How many statements prior to write off/placement?• Do you make calls prior to write off/placement?• If account transferred to collection, is there indication on

account? How is chart notated?• How do you handle hardship?• Do you use an early in/early out program?• Is your in-house collection efforts profitable?

Final Thoughts

• Evaluate• Identify Opportunity• Prioritize your focus• Work on top “3” priorities• Measure your change• Make this an ongoing process, keep

challenging yourself and your organization