FY07 EMCF “Game Plan” Specific Action Steps to Improve Collections

•Document Imaging–Faster AR follow up vs. paper retrieval–Scan charges from encounter forms

•Eligibility–Extend beyond 60 day GHS interface

•Charge Scanning–Complete ED project

•MedEx–Reviewing use for portion of EMCF patients

•Call To Action–Continued emphasis on correction batches –Error reduction to avoid TES –Studying TES for improvement ideas

•Fee Schedule–Capitalize on “EHC updraft” for UHC? (3%)

•More TES Edits for CMOs

Re-Route EMCF Staff to Edits & Denials

Reduce Claim Error Count

More access to info for direct dept. engagement

FY07 EMCF “Game Plan” Specific Action Steps to Improve Collections

•Missing Revenue–Correction Batches – any opportunities?–How to tell if docs are not submitting?

•TES Edits – reduce the volume–Medicaid Location of Service–Medicaid Category of Service–Missing Diagnosis

•Non-Billable Report–Published by K Cook

•Charge Lag–What are your expectations?–TES impact?

•Volunteer Physician Issue–Still $350k tied up here – but dying

•MVA Project expansion–Proceeds beginning to come in

Re-Route EMCF Staff to Edits & Denials

Reduce Claim Error Count

Find revenue opportunities

Cause & Effect: EMCF

• Low Revenues:

• Missed Revenues:

• Other:

• Charge Lag• TES – which edits

and why?• How to correct?• Correction Batch

clues

• TES edits: – Provider #s

• Non-billables Rpt.• Volunteer Faculty• Credentialing Rpt

• Scan-able forms project

• Chief engagement on issues

Weekly / Monthly

Reports

Direct Mgt. engagement

More CMO TES edits are coming: so we need to have a plan of attack

Appendix

EMCF Budgeted Monthly Charges: $9.8M

Average Monthly Charges Hitting TES Edits: $1.8M (18%)

*Equivalent of $14M of TEC’s monthly

charges hitting TES*

TES Snapshot: EMCF vs. TECRevenue held in edits – requiring work

TES Edits by Category6 Month Trend

Peds Self Pay

EMCF Precerts

EMCF Clerical

Grady

Departments

42.71% Dx Not Coded

9.13% Missing Dx/ Procedure

2.65% Missing Referring Phys

2.07% Missing Medicare/ Medicaid Provider Numbers

The majority of EMCF revenue requires correction of billing-dependent data

What do these edits mean?

• Diagnosis Not Coded –– encounters received with written diagnosis instead of code

• Takes coders approx 7 days to code and confirm• Are physicians missing a box to check?• Are forms needing to have more codes based upon MD utilization?• Correction batch sent back to departments – “can’t read” the handwriting

• Missing Diagnosis/Procedure Code – – encounters received without a diagnosis and/or procedure indicated

• An essential item required to bill anyone and maintain compliance• “Nothing on the form” – correction batches sent back to departments

• Invalid Diagnosis/Procedure Code – – encounters received with an invalid diagnosis and/or procedure code

• Handwritten / outdated codes • Is there a training need here? Are physicians aware of these issues?• Requires a correction batch (internal to billing office) to fix

• Missing Referring Physician –

– encounters received without a referring physician where the payer is Medicaid, Medicare or Blue Cross/Blue Shield

• An essential item required to bill these payers and maintain compliance• Have to fill item in on form to get paid