Tools to Strengthen Your Revenue Cycle October 26, 2015
Daryn Eikner, MS Vice President Service Delivery Improvement National Family Planning & Reproductive Health Association 2
Increasing Revenue Strengthen the revenue cycle process Maximize provider productivity Increase operational efficiency and effectiveness
Today Introduce the revenue cycle assessment tool Introduce the revenue loss tool
Components of Revenue Cycle Front-end Operations Administrative Clinical Encounter Back-end Billing Functions 5
Components Barriers of the Revenue Cycle
The Revenue Barriers Cycle Assessment Tool
The Revenue Barriers Cycle Assessment Tool Revenue Cycle Assessment Staffing & Functions Barriers Reflection & Planning
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
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
Section 3. Front End Billing Process Appointment scheduling Pre-registration & authorization Reminder calls Registration/check-in Eligibility verification Handling of cash Reconciliation Process
Section Barriers 9. Analysis HIPPA Privacy Protections HIPPA Security Protections KPIs Reports
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 2010. 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.
The Revenue Barriers Cycle Assessment Tool Rhonda Staley, MPH Title X Sterilization Manager and Revenue Cycle Evaluator South Carolina Dept. of Health & Environmental Control
Questions
Confidential & Covered: Revenue Loss Logic & Tool Funding for this project was provided by the Office of Population Affairs (Grant Number 1 FPRPA006059-01-00). 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.
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
Revenue Loss Tool REPORT NAME: REPORT PERIOD: C&C SAMPLE REPORT 11/1/2015-11/30/2015 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 #2 29 6 5 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
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.
Revenue Loss Tool
Revenue Loss Tool
Evelyn Kieltyka Sr. Vice President of Program Services Rhonda Woodman Medical Billing Manager
Questions
www.nationalfamilyplanning.org
National Meeting March 5-8, 2017