eight strategies to get paid - revenue cycle management
DESCRIPTION
Join revenue cycle management expert Elizabeth Woodcock & James Muir to dissect the eight strategies for surviving and thriving in today’s turbulent reimbursement environment. This webinar will empower you with solutions to make your practice a top performer. In addition, attendees of this live webinar can quality for CEU credits.* After this session, you’ll be able to: Evaluate payer contracting opportunities and pitfalls Determine contract management procedures to ensure appropriate payment Implement effective methods of setting patient’s expectations for payment – before the visit Apply time-of-service collections techniques Develop denial prevention and management procedures Assess technologies to support efficient revenue cycle management Identify staffing needs for successful revenue cycle management Differentiate the elements of reporting key performance indicators for revenue cycle managementTRANSCRIPT
Welcome to the Webinar
8 Strategies to Get Paid Every Dollar You Deserve
We’ll begin in a few moments.
Before we get started there are a few
housekeeping items
• This webinar is being recorded
• For an uninterrupted presentation, lines will be
muted for the duration of the webinar
• We will address questions at the end of the
presentation via the chat function
• Feel free to submit questions via chat throughout
the presentation
• Details on getting your CEU credits will be covered
at the end of the presentation
• Handouts from today’s presentation will be emailed
to you within 24 hours
MBA, The Wharton School of Business, University of Pennsylvania
BA, Duke University Fellow, American College of Medical Practice
Executives Certified Professional Coder Author, 12 textbooks and more than 500
Articles Founder and Principal, Woodcock & Associates Former Consultant, Medical Group
Management Association; Group Practice Services Administrator, University of Virginia Health Services Foundation; Senior Associate, The Advisory Board Company
25+ Years in Revenue Cycle Management & Billing Service Administration
BA, Brigham Young University Author, 2 books, hundreds of articles including
articles for the MGMA Connexion and Advance For Health Information Executives
Educator for many organizations including various MGMA chapters and Metro managers groups.
Certifications from IBM, 3Com, Miller-Heiman, Franklin Covey and JES.
Longstanding active participant with MGMA & HFMA
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Elizabeth W. Woodcock, MBA, FACMPE, CPC Speaker, Author, Trainer www.elizabethwoodcock.com
James M Muir VP Revenue Cycle Management NextGen Healthcare Speaker, Author, Educator www.linkedin.com/in/puremuir/
8 Strategies to Get Paid Every Dollar You
Deserve
Elizabeth W. Woodcock, MBA, FACMPE, CPC
© 2014
1. Payer contracting 2. Payment monitoring 3. Pre-visit collections 4. Time-of-service collections 5. Denial management 6. Staffing 7. KPI reporting 8. Technology
6
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Terms
• Timely filing: “reliant on the beneficiary”
• Recoupments
• Termination
• Process for appeals
• Changes, in writing
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8
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Contracted Fee Schedule Match Rate On what percentage of claim lines does the payer’s allowed amount equal the contracted fee schedule rate excluding
the application of claim edits and payment rules (rules that adjust the fee schedule amount)
70.78%
62.08%
66.23%
84.20%
85.21%
61.55%
74.34%
99.95%
85.76%
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2014
• Submit list of frequently used CPT® codes – and get prices (“allowables”) at the line item level
• Determine modification of reimbursement for modifiers, multiple procedures and advanced practice providers
• Request disclosure re: service charges
10
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Insurance Coverage
Benefits Eligibility
Financial Responsibility
1 2 3
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Initial scheduling call
Appointment confirmation
When patient presents
“Arrival Time”
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Provide patients
• Insurance confirmation and benefits summary, including unmet deductible
• Explanation of benefits
• Price estimation from the payer
• Initial patient statement/ledger
• Financial agreement for scheduled procedures and surgeries
Reference “Discount” v. “Contractual Adjustment”
© 2014
• Offer payment options
• Lead with: “How much more time do you need, Ms. Woodcock?”
• Encourage payment options based on your cost to collect • Capture the best rate
• Pre-establish parameters of a payment plan • Maximum time (e.g., 6 months)
• Minimum payments (e.g., $25)
• Offer “credit card on file” option
• Identify a separate payer category for payment plans
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www.metrosources.com
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2014
“Reason Code” 15 - The authorization number is missing, invalid, or does not apply to the billed services or provider.
1 - Deductible Amount
“Soft” Denial “Hard” Denial
15
PR CO
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Protocols
Action and timeframe
Initial, subsequent
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Is it worth your time? Need Thresholds! – Effort & Money
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2014
Reason Code
Payer
Action
Worklist
CO18 – Exact Duplicate Claim / Service
PeachCare
Post $0 Payment; Put Claim on Hold
Biller-Medicaid
© 2014
Prevention is the “best medicine”
• Provider enrollment and credentialing
• Accurate registration information, backed by financial clearance
• Non-office services
• Accurate time-of-service payments
• Accurate, timely procedure and diagnosis coding, with appropriate modifiers, linkages and places of service charge editing system
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Complex, elaborate
work
Compulsive, Type A
workforce
Customers never
grateful Corbis.com
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2014
Per day Per hour
Coding
- Evaluation and Management codes n/a 15 to 20
- Surgeries and procedures n/a 6 to 12
Charge entry line items
- Without registration 375 to 525 55 to 75
- With registration 280 to 395 40 to 55
Payment and adjustment transactions posted manually 525 to 875 75 to 125
Refunds researched and processed 60 to 80 8 to 10
Insurance account follow-up
- Research correspondence and resolve by telephone n/a 6 to 12
- Research correspondence and resolve by appeal n/a 3 to 4
- Check status of claim (telephone or online) and rebill n/a 12 to 60
Self-pay account follow-up 70 to 90 10 to 13
Self-pay correspondence processed and resolved 90 to 105 13 to 15
Guarantor billing inquiries (by phone or correspondence) 56 to 84 8 to 12
20
. © Walker, Woodcock, Larch, 2009 (forthcoming 2015), as published in The Physician Billing Process by MGMA
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2014
72 Hours
50 to 70
Daily
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Key Performance Indicator Your
Practice High
Performers Expected
Range
Days in Receivables Outstanding 27.49 35 to 45
Percent of Receivables Over 120 Days 9.84% 12 to 25%
Adjusted Collection Rate 99.16% 95 to 98%
Cash $? $?
22
Source for “High Performers”: MGMA Performance & Practices of Successful Medical Groups, 2013, median data
for multispecialty practices.
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2014 23
To properly identify the adjustment:
1. Implement and use adjustment codes
2. Train payment posting and follow-up staff
3. Monitor appropriate use via audits
Important: Examine report on all 100% contractual adjustments
on a line item level
© 2014
Hardware Management information systems Insurance coverage and benefits eligibility Kiosk Charge capture; editing Coding/reimbursement support Payment monitoring Electronic remittance/funds transfer Analysis and reporting business intelligence 24
Outsourcing Options
What Exactly Does RCM Services Offer?
NextGen RCM Services helps clients address these challenges & others via:
• Account Management & Oversight
• A Tailored Solution
• Access to the Full Suite of NextGen® solutions
How NextGen Healthcare Helps you Address Top
Challenges
Self-pay Collections
Rising operating cost
Preparing for new
reimbursement models
Optimizing an existing EHR
Self-Pay Collections
Get the support of RCM experts who collect more efficiently & at a
lower cost — optimizing your workflow, back office functions, and
bottom-line, while eliminating strain on your time, money & internal
resources.
We deliver the staff training, best practices, process enhancements,
technology & professional resources to connect with a higher volume
of patients more efficiently and get every dollar you have earned.
Our unified clinical & financial management solutions are built to
manage & anticipate change with functionality for ACOs &
risk-based models.
Our HIT experts configure your systems to take full advantage of
technology to drive revenue to its fullest potential & improve
your staff productivity.
End to End Revenue Cycle Management
(Typical Deployment)
SYSTEM ADMINISTRATION, PM DATABASE CONFIGURATION, WORKLOG MANAGER, TRAINING, CLIENT CUSTOMER SERVICE
CHARGE
ENTRY
INBOUND SERVICE
AUTHORIZATION
SCHEDULING
CHECK-IN REGISTRATION
POS COLLECTIONS
ASSIST WITH
CHARGE CAPTURE
ACCOUNT
MANAGEMENT/
OVERSIGHT
PRE-SERVICE POINT OF
SERVICE POST-SERVICE
CLAIM
RECONCILIATION
BILLING &
COLLECTIONS
REFERRAL
MANAGEMENT
INSURANCE ELIGIBILITY
VERIFICATION
ANALYSIS
PATIENT STATEMENTS
& CORRESPONDENCE
CODING SERVICES
CLAIM SCRUBBING
CLEARINGHOUSE
EDITS
CLAIM SUBMISSION
EDI & PAPER
PAYMENT
POSTING ERA
& PAPER
CLAIM
RESOLUTION
PATIENT
CUSTOMER SERVICE
A/R MANAGEMENT
INSURANCE
FOLLOW-UP
DENIAL MANAGEMENT
& RESOLUTION
APPEALS
MANAGEMENT
REFUNDS &
OVERPAYMENTS
A/R FOLLOW-UP
DELINQUENT ACCOUNTS
CONTRACT
MANAGEMENT
FINANCIAL
RECONCILIATION TO
BALANCE MONTH/DAY
PERFORMANCE
REPORTING
DASHBOARDS
DATA WAREHOUSE REPORTING
INSIGHT
REPORTING
TRANSITION TO
EXTERNAL COLLECTIONS
CODING AUDITS
CREDENTIALING/
PROVIDER ENROLLMENT
= RCM Services
= Client
= 3rd Party Vendor
CARE
MANAGEMENT
CLINICAL DATA
MANAGEMENT
VIRTUAL CLINICAL
DOCUMENTATION
ENHANCED CARE
DELIVERY
CARE
COORDINATION
End to End Revenue Cycle Management
(Tailored Deployment)
SYSTEM ADMINISTRATION, PM DATABASE CONFIGURATION, WORKLOG MANAGER, TRAINING, CLIENT CUSTOMER SERVICE
CHARGE
ENTRY
INBOUND SERVICE
AUTHORIZATION
SCHEDULING
CHECK-IN REGISTRATION
POS COLLECTIONS
ASSIST WITH
CHARGE CAPTURE
ACCOUNT
MANAGEMENT/
OVERSIGHT
PRE-SERVICE POINT OF
SERVICE POST-SERVICE
CLAIM
RECONCILIATION
BILLING &
COLLECTIONS
REFERRAL
MANAGEMENT
INSURANCE ELIGIBILITY
VERIFICATION
ANALYSIS
PATIENT STATEMENTS
& CORRESPONDENCE
CODING SERVICES
CLAIM SCRUBBING
CLEARINGHOUSE
EDITS
CLAIM SUBMISSION
EDI & PAPER
PAYMENT
POSTING ERA
& PAPER
CLAIM
RESOLUTION
PATIENT
CUSTOMER SERVICE
A/R MANAGEMENT
INSURANCE
FOLLOW-UP
DENIAL MANAGEMENT
& RESOLUTION
APPEALS
MANAGEMENT
REFUNDS &
OVERPAYMENTS
A/R FOLLOW-UP
DELINQUENT ACCOUNTS
CONTRACT
MANAGEMENT
FINANCIAL
RECONCILIATION TO
BALANCE MONTH/DAY
PERFORMANCE
REPORTING
DASHBOARDS
DATA WAREHOUSE REPORTING
INSIGHT
REPORTING
TRANSITION TO
EXTERNAL COLLECTIONS
CODING AUDITS
CREDENTIALING/
PROVIDER ENROLLMENT
= RCM Services
= Client
= 3rd Party Vendor
CARE
MANAGEMENT
CLINICAL DATA
MANAGEMENT
VIRTUAL CLINICAL
DOCUMENTATION
ENHANCED CARE
DELIVERY
CARE
COORDINATION
Your NextGen RCM Account Manager:
• Is your Client Liaison for all issues & resolutions
• Is responsible for monitoring the overall
performance of your account (oversight)
• Will explain & help you understand all KPIs &
Reports discussed in your regularly scheduled
meetings.
• Has access to specialist teams & resources
within NextGen to evaluate & resolve any
specific issues.
Account Manager Functions Can Be Broken
Down Into Four Areas
1. Oversight – Financial Performance
– Operations
– Best Practices
2. Guidance – Establishing Practice Goals
– Addressing Outstanding & New Items/Issues
– Addressing Items Impacting Revenue
3. Education – Call Center Statistics
– Training
– Policy & Procedures
– Payer Notifications
4. Ongoing Support – Systems & Software
– Integration & Technical
– Changes in practice environment
Getting Your Complimentary RCM Assessment
Attendees of this Webex are
eligible for a free consultation
with their NextGen Healthcare
Director of Revenue Cycle
Management to learn how they
can qualify for a free RCM
assessment valued at $3,500.
Email Jill Ryan to set up your
appointment:
Panelists Q&A
Elizabeth W. Woodcock,
MBA, FACMPE, CPC Speaker, Author, Trainer
www.elizabethwoodcock.com
James M Muir VP Revenue Cycle Management
Speaker, Author, Educator
www.linkedin.com/in/puremuir/
Getting Your AAPC CEU Credit (1.0 CEUs)
Attendees of this Webex are eligible for AAPC CEU Credits!*
Email Jill Ryan to receive the documentation for your AAPC
CEU Credits:
* This program has the prior approval of AAPC for 1.0 CEUs of continuing education hours. Granting of prior
approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. AAPC
accepts credit hours for the live webcast of this presentation. Recorded sessions are not eligible for credit.
Getting your ACMPE Credit Hours (1.0 CEU) Here are the instructions for viewing your transcript on line and entering your
ACMPE credit hours:
• Go to http://www.mgma.com/myTranscript/
• Log in with your membership ID and password.
• Follow the instructions and the CEUs will appear up on your Transcript in 24-
48 hours*
• For the Credit hour calculation add the total number of clock hours for the
duration of the program.
* Note: ACMPE accepts credit hours for the live webcast of this presentation. Recorded sessions are not
eligible for credit.
Thank you Contact information for any additional questions:
James Muir
Vice President RCM
[email protected] www.linkedin.com/in/puremuir/
Elizabeth W. Woodcock, MBA,
FACMPE, CPC
Speaker, Author, Trainer