Tools to Strengthen Your Revenue Cycle. October 26, 2015
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1 Tools to Strengthen Your Revenue Cycle October 26, 2015
2 Daryn Eikner, MS Vice President Service Delivery Improvement National Family Planning & Reproductive Health Association 2
3 Increasing Revenue Strengthen the revenue cycle process Maximize provider productivity Increase operational efficiency and effectiveness
4 Today Introduce the revenue cycle assessment tool Introduce the revenue loss tool
5 Components of Revenue Cycle Front-end Operations Administrative Clinical Encounter Back-end Billing Functions 5
6 Components Barriers of the Revenue Cycle
7 The Revenue Barriers Cycle Assessment Tool
8 The Revenue Barriers Cycle Assessment Tool Revenue Cycle Assessment Staffing & Functions Barriers Reflection & Planning
9 The Revenue Barriers Cycle Assessment Section 1. Policies and Procedures Section 2. IT Systems Section 3. Front End Billing Processes Section 4. Clinical Billing Processes Section 5. Coding and Documentation
10 The Revenue Barriers Cycle Assessment Section 6. Section 7. Section 8. Section 9. Claims Submission Remittance Reconciliation Accounts Receivable Management Analysis Section 10. Third-Party Payer Contracts Section 11. Provider Credentialing
11 Section 3. Front End Billing Process Appointment scheduling Pre-registration & authorization Reminder calls Registration/check-in Eligibility verification Handling of cash Reconciliation Process
12 Section Barriers 9. Analysis HIPPA Privacy Protections HIPPA Security Protections KPIs Reports
13 Barriers Feedback Current Practice Recommendations Fee Schedules Fees are set to Medicaid reimbursement rates and rather than the cost of services. Last cost analysis was completed in Revise fee schedule to reflect the cost of the services being provided. Conduct a cost analysis. Cash There are no formal, documented processes for the handling of cash received from clients. Develop & document procedures for the handling of cash. Train staff on new procedures.
14 The Revenue Barriers Cycle Assessment Tool Rhonda Staley, MPH Title X Sterilization Manager and Revenue Cycle Evaluator South Carolina Dept. of Health & Environmental Control
15 Questions
16 Confidential & Covered: Revenue Loss Logic & Tool Funding for this project was provided by the Office of Population Affairs (Grant Number 1 FPRPA ). The views expressed by this project do not necessarily reflect the official policies of the Department of Health & Human Services; nor does mention of trade names, commercial practices, organizations imply official endorsement by the U.S. Government.
17 Revenue Logic Logic to analyze revenue data to determine unrealized revenue due to an inability to submit claims because of a client request confidentiality. Identify visits by patients confidential billing Access to relevant claims information for those visits Organizations adapted screening processes and retrained staff to implement
18 Revenue Loss Tool REPORT NAME: REPORT PERIOD: C&C SAMPLE REPORT 11/1/ /30/2015 Total Revenue $ Total number of visits made by clients Total number of visits made by clients who have insurance but request not to use it Total number of visits made by clients who have insurance and request not to use it due to need for confidential billing services GO TO TAB # CLAIM ID SERVICE MONTH TYPE OF INSURANCE OTHER INSURANCE TYPE ALL CHARGES (DOLLARS) SLIDING FEE SCALE? SLIDING FEE PLAN Amount Paid (Dollars) LOST REVENUE (DOLLARS ) CPT/HCPCS Code (1) CPT/HCPCS Charge (1) ICD-10 DIAGNOSIS CODE (1) ICD 10 DIAGNOSIS (1): DESCRIPTION PATIENT AGE PATIENT SEX
19 Revenue Loss: Illustration Peggy, a 19 year-old female, visits her family planning provider. Peggy lives with her parents and is covered by their insurance. Peggy does not want them to know that she was in the clinic today. Peggy wants to initiate contraceptives today but is not sure which method she wants. The clinician counsels her for 13 minutes on her options for contraceptive methods. Peggy decides to initiate oral contraceptives today and leaves the clinic with a 3 month supply of combined oral contraceptives. The clinician collects a specimen for a CT/GC screening and sends it to an outside lab. The entire visit was 18 minutes.
20 Revenue Loss Tool
21 Revenue Loss Tool
22 Evelyn Kieltyka Sr. Vice President of Program Services Rhonda Woodman Medical Billing Manager
23 Questions
24
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