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Tools to Maximize Efficiency and Effectiveness in Your Billing

Department

Presented by: Charitie Horsley, CPC

All Rights Reserved

Introduction

• Who am I?

• Who are you?

• What are your goals for the session?

Agenda

• What are my tools or resources?

• What are some of the best resources available?

• How to use all of your resources to maximize Efficiency and Effectiveness (E&E).

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The Billing Department

What does the typical Billing Department Look Like?

What are your Resources?

Hardware

Software Data

People

Hardware / Office Equipment

• Office Equipment and Space Design

– Letter opener

– Letter stuffer/sealer

– Copy machine and printers

• Access

• Placement

• Computer Access & Speed

– Stall or slow speed

– Shared files

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Software

• Automation

• Practice Management System

• Clearinghouse

• Internet

• Microsoft Office Suite

Automation is Step 1

Don’t underestimate the value of 1 minute.

Total Minutes

Time per Day Day Week Month Year

Total Hours

1 minute 1 5 20 260 4.3

5 minutes 5 25 100 1300 21.7

10 minutes 10 50 200 2600 43.3

Practice Management System

• Eligibility

• Claim Status

• Referrals

• Payment Posting

• Voice and Text Reminder Systems

– Appointments

– Account Balance Notifications (ABN’s)

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The research shows…

Source: An Ounce of Prevention: Automation and the Patient Protection and Affordable Care Act Article – ©TeleVox Software found at www.televox.com

88% of patients want to receive digital reminders for preventive or follow up care.

More than 35% of patients who don’t follow treatment plans exactly said they would be more likely to do so if they received e-mail, voicemail, or text reminders.

85% of Patients said that E-Communications are more helpful than in-person or phone conversations.

45

Day

s O

ld (

DP

R)

Automated Collection Letter

ABN Call 15 Days Later

75

Day

s O

ld (

DP

R)

Automated Collection Letter

ABN Call 15 Days Later

90

Day

s O

ld (

DP

R)

PAR Account Review

• Ensure Letters & ABN Calls were successful

• Place Personal Call (Over $x.xx)

• Pre-List Account

10

5 D

ays

Old

(D

PR

)

Account Pre-Listed for

Placement with an Agency

Automated Patient Collections Process

Clearinghouse

• Denial Corrections

• Appeal Solutions

• Analysis Tools

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Internet Freebies

• Google • YouTube

– CMS Medlearn Channel – Strengths Based Leadership – Customer Service – Microsoft Training – Software Training

• World Health Organization ICD-10 Training – http://www.who.int/classifications/icd/en/

• American Medical Association CPT RVU Lookup – https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do

• CMS.gov – Physician Fee Schedule Lookup

• http://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

Microsoft Office Suite

– Outlook

• Shared Calendars

• Task Lists and Assignments

– Word

• Labels

– Excel

• Pivotables

Data

• Knowledge is power!

• What is measured improves!

• Distribution

• Prioritization

• Analytics

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Knowledge is Power!

• Stay Up To Date!

– CMS

– AMA

– MGMA

– AAPC

– Specialty Association

– Coding Rules

– Payer Rules

What is Measured Improves!

• Key Indicators

– Tracking

– Trending

– Setting Goals

• Using Graphics

• Benchmarking

Sample Key Indicators

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Using Graphics

Benchmarking

• Why benchmark?

• How to create your own benchmarks

• Where to find other benchmarks

– MGMA Cost Survey = #1

– Associations

– Government

Charitie’s Benchmarks

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More Benchmarks

Work function Per day Per hour Per

transaction

Coding of evaluation and management codes n/a 15 to 20 claims 3 to 4 minutes

Coding of procedures and surgeries n/a 6 to 12 5 to 10 minutes

Charge entry line items without registration 375-525 55-75

Charge entry line items with registration 280-395 40-55

Payment and adjustment transactions posted manually 525-875 75-125

Insurance account follow-up, research and resolution by phone n/a 6-12

Insurance account follow-up, research and resolution by appeal n/a 3-4

Insurance account follow-up, claim-status verification and re-billing n/a 12-60

Patient account follow-up 70-90 10-13

Source: MGMA Book, The Physician Billing Process: 12 Potholes in the Road to Getting Paid

MGMA Benchmarks Table 67.2: for All Orthopedic Surgery Practices Accounts Receivable Data, Collection Percentages, and Financial Ratios

Practice Count Mean Stdev 25%tile Median 75%tile 90%tile

Total AR/physician 109 $331,797 $154,061 $212,123 $304,792 $435,761 $547,541 Total AR/provider 89 $228,347 $112,881 $149,461 $206,839 $270,078 $377,579 0-30 days in AR 112 52.26% 15.44% 42.52% 55.84% 61.64% 69.47% 31-60 days in AR 112 14.42% 4.97% 11.36% 13.83% 17.08% 21.23% 61-90 days in AR 112 7.42% 3.65% 5.61% 6.84% 8.42% 10.75% 91-120 days in AR 112 5.42% 3.42% 3.56% 4.77% 6.05% 8.76% 120+ days in AR 112 20.48% 15.62% 11.89% 16.82% 25.15% 36.59% Re-aged: 0-30 days in AR 26 51.60% 12.31% 49.00% 53.32% 60.80% 63.64% Re-aged: 31-60 days in AR 26 14.39% 5.21% 10.55% 13.09% 16.97% 22.72% Re-aged: 61-90 days in AR 26 7.21% 1.73% 5.92% 6.98% 8.21% 9.90% Re-aged: 91-120 days in AR 26 5.19% 1.83% 3.84% 5.33% 6.20% 7.70% Re-aged: 120+ days in AR 26 21.61% 14.33% 13.06% 16.95% 23.73% 44.92%

Not re-aged: 0-30 days in AR 64 57.71% 12.49% 48.71% 59.46% 65.23% 73.65%

Not re-aged: 31-60 days in AR 64 14.29% 4.08% 11.39% 13.86% 16.89% 19.95%

Not re-aged: 61-90 days in AR 64 7.07% 3.24% 5.31% 6.62% 8.00% 10.01%

Not re-aged: 91-120 days in AR 64 4.79% 3.28% 3.14% 4.19% 5.32% 8.08%

Not re-aged: 120+ days in AR 64 16.14% 10.22% 9.31% 15.03% 21.15% 29.14%

Months gross FFS charges in AR 111 1.71 1.24 1.08 1.39 1.82 2.82

Days gross FFS charges in AR 111 51.94 37.80 32.99 42.28 55.43 85.86 Gross FFS collection % 115 42.54% 10.44% 37.21% 41.35% 46.54% 53.05% Adjusted FFS collection % 115 92.84% 17.81% 93.69% 97.22% 100.00% 103.47%

Gross FFS + cap collection % 2 * * * * * * Net cap rev % of gross cap 2 * * * * * *

© 2003-2012 Medical Group Management Association ® All Rights Reserved

Distribution of Work

• Billing Department Work Distribution

– Strength Based!

• “When done right, strengths based A/R work models can greatly increase production and improve morale at the same time.”

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Data - Prioritization • First By Strength and Skill • Then by Workflow

– Claim Edits – Claim Denials – Correspondence

• Then by Aging Bucket – ALWAYS by Dollar!!!

• 1 - $1,000 account or encounter worked in 20 minutes

VS. • 10 - $100 accounts worked in 60

minutes

Data - Analytics

• “Newer” Industry

• All of your Key Financial Information at a glance.

TITAN- a real-time, web-based application that provides comparative healthcare analytics on reimbursement, utilization and productivity for practices, service providers and health systems. www.remitdata.com

Dashboard “Insight Board”

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Denial Management

Instantaneous E&M Utilization with Analysis

Clearinghouse Analysis

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People

# 1 MOST IMPORTANT RESOURCE!!

Hire the Right People

• Pre-Employment Skills Assessments • Writing

• Spelling

• Basic Math

• Keyboard (www.learn2type.com)

• 10-Key (www.learn2type.com)

• Special Skills Tests – Patient Account Rep

– Coding

Get the right people on the Bus!

• Know the benchmarks and appropriate staffing ratios!

• Strength Based Interviewing

• Networking

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Sample Strengths Based Interview Questions

• What are you good at? • What comes easily to you? • What do you learn quickly? • What things give you energy? • How would a close friend/previous boss describe

you? • Describe a successful day you have had. • When did you achieve something you are really

proud of? • What things are always left on your to-do list?

Retain Good Staff

• Pay them Right – Performance-Based Pay

• Production

• Quality Assurance

• Attendance

• Reward them for work done well – Small rewards regularly

– Larger rewards when warranted

– Extrinsic rewards like association memberships and conferences

Using All Your Resources

Hardware

Software Data

People

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Questions

Charitie Horsley, CPC CKHorsley@ThinkManagementGroup.com