maximizing relationships within the revenue cycle · history/background of pfs • the industrial...

Maximizing Relationships within the Revenue Cycle

Chris Johnson CHFP Senior Revenue Cycle Consultant Trubridge, LLC

Agenda

• History/Background

• Roles and Responsibilities

• A walk through the Revenue Cycle

• Revenue Cycle Steering Committee

Look familiar?

HIM Director PFS Director

Is this how you see your PFS Director?

HIM Director PFS Director

Is this how your PFS Director sees you?

Let’s end the feud

History/Background

History/Background of HIM • Medical Record’s roots stemmed from early

Astrologers in the 14th century • Hospitals began keeping Medical Records in the late

1700’s • 3 categories of early medical records:

– Rudimentary (Europe): • Lists the names of clients and their payments for

treatment

– Narratives of Cure (Greece): • Recorded advice to patients about diet, recipes, and

lessons for surgeons

– Early Modern (England): • Name, date, complaint, history, diagnosis,

remedy/therapy and payment

History/Background of PFS

• The Industrial Age resulted in mills and factories seeing an increase in work related injuries

• Doctors charged what they felt patients could afford on a case-by-case basis

• No standard payment system

• In the 1920s, individual hospitals began offering services on a pre-paid plan (i.e. Insurance)

• Great Depression caused hospital administrators to face a choice of federal funding for the poor

Now let’s talk about roles

No…not that kind of rolls

Roles and Responsibilities

Roles:

• Health Information Management (HIM) – the practice of acquiring, analyzing, and protecting

medical information vital to providing quality patient care. It is a combination of business, science, and information technology.

• Patient Financial Services (PFS) – administrative functions that contribute to the capture,

management, and collection of patient services revenue

HIM

• Paper Chart

• Electronic Record

• Collecting Documentation

• Coding

• Queries

• ROI

Responsibilities:

PFS

• Patient Access

• Revenue Capture

• Claims Submission

• Claims Follow-Up

• Rejections/Denials

• Reimbursement

Always a Balancing Actct

PFS

Dollars

Collect monies due, timely

Data

Always start with the Why?

Data vs.

• Disease Management

• Record of Documentation

• Claims Submission

Dollars

• Provides Capital for

• Equipment

• Facilities

• PAYROLL

• Both employ the same basic skills

– Eye for detail

– Knowledge of medical terminology

– Knowledge of HIPAA

– Proper completion of medical forms

• The best coders have knowledge in billing

• The best billers have knowledge in coding

• Comparable salaries and a high expected employment growth

A walk through the Revenue Cycle

The Revenue Cycle Insanity

DENIAL &

APPEAL

MANAGEMENT SCHEDULING

PRE-REG &

PRE-CERT

INSURANCE

VERIFICATION

FINANCIAL

COUNSELING

REGISTRATION

CHARGE

CAPTURE

& ENTRY

MEDICAL

MANAGEMENT CLAIMS

SUBMISSION

THIRD PARTY

FOLLOW-UP

PAYMENT

POSTING

CONTRACT

NEGOTIATION /

ADMIN.

REJECTION

PROCESSING

MEDICAL

RECORDS &

CODING

PATIENT

Revenue

Information

Systems

The Revenue Cycle Simplified

Patient Access

Data Processing

HIM Insurance

Collections

Patient Access

Scheduling Pre-Reg Registration

Data Processing

Charge Capture

Receipting Closing

A/R Days

HIM Chart Prep Deficiencies Coding

Insurance Billing Edits Claims

Submission Claims

Follow-Up

Collections Financial Counselors

Patient Statements

Bad Debt Write-Offs

Step-by-Step

The Revenue Cycle Simplified

Revenue

Reg. Scheduling/ Pre-Reg

Charge Capture

Coding Accuracy

Billing Edits

Rejection/ Denials

Appeals/ Underpays

Data Analysis

Clinical Documentation

1. Do We Have a Leaky Pipe? 2. Where are the Leaks? 3. Collaborate to Plug the Leaks.

Revenue Cycle Steering Committee

– To ensure effective communication, involvement of key senior management personnel is critical.

– Establish mechanisms to facilitate formal and informal communication with key hospital members.

– This committee should continue indefinitely, while evolving and growing to meet the facility’s needs.

Revenue Cycle Steering Committee

Revenue Cycle Steering Committee

• Steps to begin:

– Meeting charter

• Compliance and Collections

• Participants and their roles

• Recurring location, date, time

– Report Card

– Action Plan

– Subcommittees

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Chris Johnson CHFP Senior Revenue Cycle Consultant Trubridge, LLC