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9/13/2013
1
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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