AUGUST 9 11, 2016 Maximizing the Effectiveness of Your ... · 1. Health Catalyst, The Key to...

Maximizing the Effectiveness of

Your Practice's Revenue Cycle

and Business Operations

AUGUST 9 – 11, 2016

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 2

Agenda

• Market Trends

• Review the 3 main areas of the revenue cycle

–Front Office

–Mid Office

–Back Office

• Revenue Cycle Resources

Market Trends


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


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


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


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


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)


Allscripts PM: Data Validations


Allscripts PM: Automate Processes & Workflow


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


Revenue Cycle Overview: Mid Office

• Sources of Revenue Leakage

– Inefficient clinical documentation

– Incomplete charge capture

– Inaccurate code selection

– Missed charges


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.


Allscripts PM: Claims Scrubbing & Validations


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


AR Analysis: Lag Statistics

Back Office


T. T. W. W. A. D. I. That’s the way we’ve always done it


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

https://clientconnect.allscripts.com/community/toolbox/doc


Customizable Work Queues


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


Days in AR Trend


Denial Rate Trend by Payer

What if I need help with my

revenue cycle?


Allscripts RCM Services

Allscripts Practice

Management™

Allscripts

Payerpath®

Allscripts Practice

Performance™

Education

& Training

RCM Services

Client


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


Management Reports – RVU Metrics


Operational Reports – Denial Analysis


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


Questions

AUGUST 9 11, 2016 Maximizing the Effectiveness of Your ... · 1. Health Catalyst, The Key to...

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