robin bradbury 800-355-0410 [email protected] “top ten questions”
TRANSCRIPT
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Time and EnergyTime and Energy
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When performance is measured, performance improves.
Revenue Cycle 101Revenue Cycle 101
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Objective measures are always better than subjective measures.
Revenue Cycle 102Revenue Cycle 102
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PreviewPreview
Metrics Sharing with Staff
Cost to Collect Expectations
Self Pay Charge Capture
DNFB Contract payments
Denials Meetings
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What are the “key” measures for the Revenue Cycle?
Question # 1Question # 1
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• Days in Revenue Outstanding
• Cash Collections
• Cost to Collect
• Cash as a % of Net Revenue
• Write-offs as a % of Revenue
• Aged AR Greater than 90 Days
• Days in Discharge to Final Bill
• Up-front Cash Collections
Key MeasuresKey Measures
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Benchmark Data Benchmark Data
• HARA report
• HFMA MAPS
• Zimmerman
• Regional Groups
• Your facility
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Free Benchmark StudyFree Benchmark Studyhttp://www.ereso.com
Sample Information:
Facility Bed Size: 122
Average Daily Census: 38
Total Accounts Receivable: $8,000,000
Cash Receipts per Month $900,000
Gross Revenue per Month: $2,000,000
A/R Over 90 Days: $3,500,000
Monthly Cost of BO: $45,000
Write Offs per Month: $150,000
Number of Open Accounts: 19,000
Number of FTE's in BO: 12
Percent A/R in Self Pay: 40%
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Value PropositionValue PropositionActual Example
Hospital Peer Group DifferenceCash
Opportunity
AR Days Reduction 82 43 39 $1,476,815
Days over 90 Reduction31.7% 24.4% 7.3%
$217,374
DNFB Reduction
24.2
7.2 17.04 $652,439
Cost to Collect Reduction $ 0.027
$ 0.025 $ 0.002
$33,356
Bad Debt Write off Reduction 8.9% 2.3% 6.6%
$855,290
Charity Write off Reduction 1.9% 6.9% -5.0%
NA
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How do you document and share this information with the
Revenue Cycle staff?
Question #2Question #2
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• Monthly Dashboard
• Posted key measures in Revenue Cycle areas
• Monthly team meetings
• Incentives
• End of Month flurry to meet goal
Key MeasuresKey Measures
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Incentive PlansIncentive Plans
• 96% of other industries have incentive plans for employees
• Healthcare – less than 50%
• Be creative with incentives
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What is our cost to
collect a dollar?
Question #3Question #3
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• Good comparative measure (common definition)
• Important consideration when evaluating investment in resources – more cash intake may be worth it
• National average for hospitals is $.03 per dollar collected
• Smaller and Critical Access hospitals closer to $.05 to $.10 per dollar collected
BenchmarksBenchmarks
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Do we have expectations and performance standards for our
Revenue Cycle staff and …..
Question #4Question #4
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…do we monitor performance and
provide incentives for excellence?
Question #4 Question #4 (continued)(continued)
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• Measure metrics and behaviors
• Front end, middle and back office resources
• Raise performance level awareness
• Align goals
• Creates healthy competition
• Cream will rise to the top
Expectations and Expectations and Performance StandardsPerformance Standards
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ExpectationsExpectations
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Changing the ParadigmChanging the Paradigm
• How do we measure effective follow up?
• Touch as many accounts as possible?
• Dollars in the door?
• Cost to collect?
• Use technology to reduce touches, increase effectiveness and reduce costs.
• Example of large hospital versus small hospital and eligibility.
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re|discoverre|discover
Proprietary technology
Focus on discovery quickly of outstanding issues
Focus on dollars resolved not touches
Paradigm shift
Reduced human intervention
Used in our cash acceleration, insource and wind down projects
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Wildly Important GoalWildly Important Goal11
• Teams need to be engaged in pursuit of the goal
• Teams should be involved in goal setting based on higher level plan developed
• Where do you want to go and what do you want to be and how do you want to perform and be recognized in the industry?
1 Drawn from text The 4 Disciplines of Execution by McChesney, Covey and Huling
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Lead & Lag MeasuresLead & Lag Measures11
• Lead Measures– Those measures that are impacted and measured
on a daily basis that impact the Lag Measures• Quantity of calls made, quantity of accounts or
credits resolved, promises to pay, etc
• Lag Measures– Measures that occur after the fact
• Gross Days, Cash, Net Days, % of AR > 90 days, etc
1 – Drawn from text The 4 Disciplines of Execution by McChesney, Covey and Huling
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How are we managing the
patient-responsible dollar?
Question #5Question #5
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The Process..…The Process..…
Payer Contract
Claim
Cash Self-PayAdjustments
Patient Data
Other Payers Cash Bad Debt
ChargesRegistration
Billing
Payment
Collection
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Institute for Health Care Revenue Cycle Research - A Division of Zimmerman, LLC. National Pledge to Reform Uncompensated Care Reform Underway: Adopting Best Practices to Reduce Uncompensated Care and Improve the Patient Experience. a special supplement to PATIENT PAYMENT BLUEPRINT™
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When Respondents Who Had Received When Respondents Who Had Received Recent Medical Care Learned the Recent Medical Care Learned the
Cost of their TreatmentCost of their Treatment
63% don’t know the treatment
costs until the medical bill arrives; 10% never know
the cost.
Source: Great-West Healthcare 2005 Consumer attitude toward healthcare survey
15%7%
63%
10%2% 3%
Before thetreatment
At the time ofthe treatment
After thetreatment
Never Still intreatment/still
having medicalproblems
Not sure
When did you learn what the total cost of the treatment would be, including the amount that the insurance company would pay?
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Estimate, Validate, and Estimate, Validate, and AdvocateAdvocate
• Estimate Charges, insurance coverage and patient portion
• Validate the information
• Advocate for the patient to deal with the obligation
– Cash, Check or Credit Card
– Payment plan
– Medicaid Eligibility
– Charity Care
– Reschedule?
• Software is available to do this
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Cascading questionsCascading questions
• Will you be paying cash, check or credit card?
• Do you have a card on file with us? If, no…would you like to?
• Do you want to take advantage of our multiple payment plan options including interest free payment arrangements?
• Do you want us to help you qualify for Medicaid?
• Do you want us to help you qualify for our charity care program?
• Should we reschedule this procedure?
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Emergency RoomEmergency Room
• 1/3 of ER patients have no insurance
• 29% national average collect in ER
• Discharge collection process
– Need centralized exit point
– Keep license
– Train staff to bring back to discharge
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TechnologyTechnology
Charge Estimators
Multiple point of service collection points
Eligibility Verification
Stratification tools
Payer Search tools
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Self Pay StrategySelf Pay Strategy
Platform Deliverables
Estimated Charges
Eligibility Verification
Estimated Income
Charity Recommendation
Maximum Payment Recommendation
Payment Propensity
Work-Flow Management
Patient Demographic Data and Diagnosis
Financial Data
Financial Assessment Algorithm
Client Specific Payment History
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ResultsResults
Reduced placements of self pay accounts to collection agencies by nearly 50% within first six months
2
3
Increased cash receipts on self pay accounts by over 22% during first 90 days
4
1
Measurable Results from Presumptive Charity Policy and Self Pay Stratification
Reduced FTE allocation for follow up on self pay accounts by 25%
Reallocated 60% of FTE staff previously assigned to charity application processing
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Capture all of the charges for the services that your providers perform.
Insure that you are billing all parties that are responsible for payment
Collect all cash up front for all scheduled surgeries and all co pays from non scheduled services
Segregate self pay into charity, other payers and accounts with a propensity to pay.
Send the rest to collection.
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Has a Chargemaster and charge capture review and assessment
been performed recently?
Question #6Question #6
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DRGCoding
APCCoding
InpatientTreatment
OutpatientTreatment
APCAPCAPCDRG Payment
XRAY
XRAY L
abLab
EKG
EKG
XRAY
EKG
Lab
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• Outpatient revenues are significant particularly in rural/community hospitals
• CMS indicates a 50% underpayment
• Better performers have these common aspects: Dedicated ownership of process (75%)
Supported by technology (47%)
Independent reviews (46%)
• Marshalltown example
Charge Capture ReviewCharge Capture Review
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Effective Charge Capture Effective Charge Capture Review Review ProgramProgram
• Quarterly review of outpatient payments compared to charts
• Utilize a Nurse Auditor
• Change processes to capture all charges
• Retroactively re-bill when appropriate
• Improve reimbursement
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What are our days in
Discharge to Final Bill?
Question #7Question #7
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• Indicator of effective front end, charge capture and coding process
• Clients have wide range from 3–25 days
• Break into parts
• Sample accounts
• Determine where the bottlenecks are
Doctors sign-off
Coding
Daily billing
Days from Discharge toDays from Discharge toFinal BillFinal Bill
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Potential SolutionsPotential Solutions
• Outsource some of the Coding
• Use Super Coders on an as needed basis – train staff
• Set goals and expectations
• Monitor top ten DNFB accounts
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Are we getting paid what we should be paid for services
performed?
Question #8Question #8
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• EOB review – sampling
• Compare to net revenue calculation
• Use of software to monitor payment
• Outside review on contingency fee
• Payer report cards and payer meetings
• Most hospitals are leaving 2% to 5% on the table of non-government reimbursement if not using a contract management service
Reimbursement % by PayerReimbursement % by Payer
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Do we have an unpaid claims tracking mechanism?
Question #9Question #9
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• Monitoring
• Trends
• Improve the front end processes
• Unpaid claims versus denial tracking
• Should take a systemic view - unbilled and denials
Unpaid Claims TrackingUnpaid Claims Tracking
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Unpaid Claims Measurement ToolUnpaid Claims Measurement Tool
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Do revenue cycle stakeholders regularly engage in clearing
open items and process improvement meetings?
Question #10Question #10
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• Collaboration between multiple functions, backgrounds, and skill sets
• Focus on large dollars – use a top ten concept
• Recurring errors
• Open communication and no finger pointing
• May require senior management involvement
Regular Clearing MeetingsRegular Clearing Meetings
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• Discuss these questions with Revenue Cycle leader or key stakeholders
• Perform Benchmark Indicator Analysis (BIA)
• As a Revenue Cycle team, review the results
• Set realistic goals and expectations and achieve them
Next StepsNext Steps
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Same ServicesSame ServicesMore DollarsMore Dollars
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“Learn from the mistakes of others – you can't make them
all yourself.”
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Questions?Questions?
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Robin [email protected]