shelly guffey making the most of your revenue cycle management technology 11.15.12

SHELLY GUFFEY

MAKING THE MOST OF YOUR REVENUE

CYCLE MANAGEMENT TECHNOLOGY11.15.12

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• Identify key questions

• Prepare your staff to fully leverage technology

• Create written policies

OBJECTIVES

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• Declining Medicare reimbursements

• Growing patient responsibility for payments

• Industry transitions will impact revenue flow

STATE OF THE HEALTH CARE INDUSTRY

Source: American Health Information Management Association

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MANAGING YOUR REVENUE CYCLE

Source: MGMA’s Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid, 2nd ed.

• Many medical practices report a gross collection rate of 60% or less– For every $1.00 billed, physicians are

only reimbursed $0.60

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IMPACT OF USING TECHNOLOGY

• Practices who use revenue cycle management technology consistently outperform their peers– Cost

– Revenue

REVENUE CYCLE MANAGEMENT TECHNOLOGY

Source: LarsonAllen study, 2010

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IMPACT OF RCM TECHNOLOGY

• Technology adopters collected more than 50% of outstanding receivables in 15 days or less

– Providers who did not use technology efficiently collected only 9%

REVENUE CYCLE MANAGEMENT TECHNOLOGY

Source: LarsonAllen study, 2010

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REVENUE CYCLE MANAGEMENT TECHNOLOGY

How can you make the most of your revenue cycle

management technology?

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INTEGRATE TECHNOLOGY SEAMLESSLY

• Minimize disruptions to staff during integration

• Break integration into phases

• Consider how tools will fit within other systems

MAKING THE MOST OF YOUR TECHNOLOGY

FIT WITHIN YOUR

EXISTING WORKFLOW

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ENSURE VENDOR OFFERS SUPPORT

• How will they provide support?

• How often are their tools updated to keep current?

• How will the tool work within your existing systems?

• How will they train your staff?

• Do they offer user group meetings or webcasts?

• Can you call client references?

MAKING THE MOST OF YOUR TECHNOLOGY

QUESTIONS TO ASK

VENDORS ABOUT THEIR

SUPPORT

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TEST TECHNOLOGY TOOLS WITH STAFF

• Involve several staff members in testing

• Take staff feedback into consideration when selecting a tool

MAKING THE MOST OF YOUR TECHNOLOGY

TEST OPTIONS

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PREPARE YOUR STAFF TO USE TOOLS

• Determine who needs to interact with new system

• Hold training sessions

• Inform clinical staff how their work may impact the practice’s revenue cycle

• Involve staff in continued education and professional organizations

MAKING THE MOST OF YOUR TECHNOLOGY

TRAIN STAFF TO USE NEW

TECHNOLOGY

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CREATE POLICIES FOR TECHNOLOGY USE

• Create standards for billing processes

• Record policies in writing

MAKING THE MOST OF YOUR TECHNOLOGY

ESTABLISH POLICIES TO

IMPROVE EFFICIENCY

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UTILIZE REPORTING FEATURES

• Track how quickly claims are submitted

• Analyze frequent errors and denials

• Monitor days in A/R

• Benchmark to improve performance

MAKING THE MOST OF YOUR TECHNOLOGY

UTILIZE REPORTS

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CORRECT CLAIMS REJECTIONS

• On average, it costs practices $40 in staff time to rework a denied claim

• Correct claims rejections within 48 hours of submitting the claim

• Develop a process to identify and address common rejections

MAKING THE MOST OF YOUR TECHNOLOGY

CORRECT CLAIMS

REJECTIONS

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IDENTIFY FREQUENT REJECTIONS

• Identify the top rejection for your practice

• Educate your staff on correct coding for that rejection

• Continue to eliminate common rejections that have the most impact on your practice

MAKING THE MOST OF YOUR TECHNOLOGY

IDENTIFY FREQUENT

REJECTIONS

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CHECK PATIENT ELIGIBILITY

• Only 79% of practices check patient eligibility

• Only 24% of practices check patient eligibility at every visit

• Use eligibility tools to quickly verify patient eligibility prior to the appointment

MAKING THE MOST OF YOUR TECHNOLOGY

CHECK PATIENT

ELIGIBILITY

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EDUCATE PATIENTS ABOUT PAYMENTS

• Talk with patients in advance about expected payment owed

• Collect patient payment at time of service

• Offer financing options

MAKING THE MOST OF YOUR TECHNOLOGY

EDUCATE YOUR

PATIENTS ABOUT

PAYMENTS OWED

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COLLECT PATIENT PAYMENTS

• Patient eligibility checks and other tools can help you calculate patient payment

• Enable multiple payment options (cash, checks, credit cards) to collect at time of service

• Create installment plan payment options

MAKING THE MOST OF YOUR TECHNOLOGY

COLLECT PATIENT

PAYMENTS

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OFFER ELECTRONIC PAYMENT OPTIONS

• Enable off-hours patient payments

• Create online payment portal for easy access

MAKING THE MOST OF YOUR TECHNOLOGY

OFFER ELECTRONIC

PAYMENT OPTIONS

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SELECT TECHNOLOGY THAT CAN GROW

• Choose products that allow for expansion and upgrades

• For example, Epic and Gateway EDI are always adding features and upgrades to keep up with industry changes

MAKING THE MOST OF YOUR TECHNOLOGY

SELECT TECHNOLOGY THAT GROWS

WITH YOU

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TO MANAGE YOUR REVENUE CYCLE, ALWAYS:

• Identify one staff member to review insurance payments for accuracy

• Review EOBs and ERAs to address delays, denials and reductions

• Analyze reason and remark codes on payment adjustments

• Verify patient insurance eligibility prior to each visit

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TO MANAGE YOUR REVENUE CYCLE, ALWAYS:

• Keep copies of fee schedules and health insurer contracts

• Create a plan to upgrade electronic transactions for ICD-10

• Meet with your claims processing team regularly to evaluate workflow for ways to improve efficiency

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TO MANAGE YOUR REVENUE CYCLE, DAILY:

• Submit claims and statements

• Receive remittance advice files and reports

• Balance claims files against totals from your Practice Management System

• Manage primary and secondary rejections

• Post remits in your Practice Management System

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TO MANAGE YOUR REVENUE CYCLE, WEEKLY:

• Verify that rejected claims have been corrected and resubmitted

• Analyze claims rejections to spot and correct common errors

• Ensure all claims have reached appropriate payers

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TO MANAGE YOUR REVENUE CYCLE, MONTHLY:• Balance claims statistics to create a snapshot

of your office’s performance

• Compare your office’s performance to industry benchmarks

• Share news on industry trends and changes with your staff

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KEY TAKEAWAYS

• Practices who use revenue cycle management technology see positive results

• Training staff to utilize technology helps you collect more revenue and reduce staff time

• Establishing clear policies for posting claims and collecting patient payments helps manage your revenue cycle more efficiently

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Q + A

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SHELLY GUFFEY800.969.3666 EXT 1450SGUFFEY@GATEWAYEDI.COM

THANK YOU.

THE BEDSIDE MANNER YOUR

REVENUE DESERVES™

11.15.12