Post on 27-May-2020
Maximizing the Effectiveness of
Your Practice's Revenue Cycle
and Business Operations
AUGUST 9 – 11, 2016
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Agenda
• Market Trends
• Review the 3 main areas of the revenue cycle
–Front Office
–Mid Office
–Back Office
• Revenue Cycle Resources
Market Trends
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42%
35%
10%
6% 5%3%
39% 38%
13%
1%
6%3%
35%
39%
16%
2%
6%
2%
0
5
10
15
20
25
30
35
40
45
Commercial Medicare Medicaid OtherGovernment
UncompensatedCare
Non-patient
1990 2000 2010
“The percentage of commercial
payers will shrink, while payer
types of lower reimbursement
rates will increase.”
A Changing Reimbursement Landscape
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Here’s the reality of the future
1. Health Catalyst, The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement, 2014
“The transition from FFS to
value-based reimbursement
is one that will occur over
many years. To meet value-
based goals, hospitals are
going to have to reduce
utilization among their
populations, which will
reduce their procedure
volume, which will reduce
their revenue.” 1
Costs
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The Growing Patient Responsibility
3%
-3%
4%
11%
4%
-5%
6%
22%
-5
0
5
10
15
20
25
Primary InsurancePayment
Co-Payments Co-Insurance Deductible Obligations
2013-2014 2014-2015
“Patient deductible obligations
are up 22% in the past two
years–while commercial
payments have grown only
4%.”
Front Office
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Revenue Cycle Overview: Front Office
• Sources of Revenue Leakage
– Poor registration accuracy
– Poor insurance verification
– Poor point-of-service collection
– Manual process for appointment reminders
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Revenue Cycle Overview: Front Office• Processes to Optimize
– Use automated process for appointment reminders
• iRemind
– Automate processes & workflow
• Office manager (C.A.O.)
– Use automated solutions to check eligibility
• Batch & real time eligibility
– Collect at check-in
• Patient Payment Assurance
– Configure data validation (demo & ins) in PM
• CSM (Validations)
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Allscripts PM: Data Validations
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Allscripts PM: Automate Processes & Workflow
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Front Office Revenue Cycle BenchmarksBenchmarks Measures
# of payors batch eligibility is verified prior to appointment Individual
Eligibility is verified with payor for scheduled services 98 percent
Claims edits and denials due to registration and referrals < 2 percent
# of insurance cards\driver license scanned > 95 percent
Time-of-service collections: co-pays 95 percent
Time-of-service collections: other > 75 percent
Mid Office
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Revenue Cycle Overview: Mid Office
• Sources of Revenue Leakage
– Inefficient clinical documentation
– Incomplete charge capture
– Inaccurate code selection
– Missed charges
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Revenue Cycle Overview: Mid Office
Processes to Optimize
– Charge capture can be streamlined via charge pass.
– In many cases this can be manual or a hybrid mix of forms and
other processes.
– To ensure compliance and coding accuracy, edits should be applied
prior to claims submission
• for Medical Necessity;
• Correct Coding Policy (CCP) bundling/unbundling;
• Medicare-specific front-end edits;
• and to identify ICD codes not at ultimate specificity;
• or those that do not support selected CPT code claim edits.
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Allscripts PM: Claims Scrubbing & Validations
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Mid Office Revenue Cycle BenchmarksBenchmarks Measures
Professional charges entered <2 business days 99 percent
Charges entered for out-of-office encounters > 7 days 0 percent
Claims with charge coding errors (per scrubber) <4.0 percent
Pending claims edits corrected < 1 business day 99 percent
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AR Analysis: Lag Statistics
Back Office
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T. T. W. W. A. D. I. That’s the way we’ve always done it
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Revenue Cycle Overview: Back Office• Processes to Optimize
– Leverage technology
– Office Manager
• Work queues
• http://www.wpc-edi.com/reference/codelists/healthcare/claim-
adjustment-reason-codes/
– Automated remit posting (alternatively match paper remits in PM)
– Credit balance management (Manage Credit Balances)
• https://clientconnect.allscripts.com/community/toolbox/doc
– Scan and index documents
– Automated statement process (Automated Self-Pay Collection Overview)
– Load contractual allowances
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Customizable Work Queues
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Back Office Revenue Cycle BenchmarksBenchmarks Measures
Net collection rate > 97 percent
Days in accounts receivable < 35 days
Percentage total accounts receivable > 120 days < 15% of total
AR
Self-pay accounts receivable > 90 days < 5% of total AR
Response to patient billing inquiries < 24 hours
Resolve credit balances Within 60 days
Denial rate on first time claims submission < 3.0%
Practice Performance
Analytics
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Days in AR Trend
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Denial Rate Trend by Payer
What if I need help with my
revenue cycle?
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Allscripts RCM Services
Allscripts Practice
Management™
Allscripts
Payerpath®
Allscripts Practice
Performance™
Education
& Training
RCM Services
Client
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How do we do it?
A unique and proven
combination of people,
process and technology
created to deliver
exceptional customer outcomes
CURVE
ANALYTICS
CLIENT
EXECUTIVE
CODING &
COMPLIANCE
EDI
SERVICES
WORKFLOW
OPTIMIZATION
DOCUMENT
MANAGEMENT
RECONCILIATION
& AUDITING
DATA
APPLICATIONS
SUPPORT
CENTER
OPTIMIZATION
& TRAINING
ACCOUNT MANAGER
CHARGE ENTRY | PAYMENT POSTING
PATIENT CALLS | FOLLOW-UP
APPEALS
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Management Reports – RVU Metrics
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Operational Reports – Denial Analysis
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Two Options To Fit the Client’s Needs
• Full service, comprehensive outsource – allows practice to virtually eliminate billing office and reduce/repurpose FTEs
• Includes services from master files maintenance to self-pay follow-up
• Provides piece of mind and easy scalability with end-to-end services bundle
• Transparency for all stakeholders
• Limited scope co-source services – allows practice to retain more control over revenue cycle
• Minimal change to practice staff count – focus on practice initiatives and patient care
• Clients can handle their own denial management and self-pay follow-up functions
• Transparency for all stakeholders
Full Services RCM Shared Services RCM
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Questions