Practice Pulse
RCM Analysis and E.H.R. HealthCheck
Angela Jarrett, CPC, CMPA
Senior Professional Services Consultant
RCM Analysis Overview
Increase productivity, increase staff
knowledge, increase revenue, modify
workflows, increase staff measurements
and outcomes
• Analysis
• Professional Consulting
• Living RCM
RCM Analysis Agenda
• Overview
• Revenue Cycle Management Analysis
Report
• System Work Flow Analysis and
Design
• Professional Consulting and Support
• Goal
Revenue Cycle
Management Analysis
This information is intended to provide the staff
with an analysis of overall system status as well as a
review of system usage and overall performance.
 Administration – Exclusive Review of specific
Admin Tables
 Financial Performance
 System Maintenance
 Management Goals and Outcomes,
Measurements and Expectations
A Peek Behind The Curtain
$ Squeezing the Sponge $
Stay In the Bell Curve
HRSA Top 5 Financial Classes:
Medicare, Medicaid, Slide Fee, Self Pay
and Commercial. Are the providers
coding ALL patients the SAME way?
With the RCM ANALYSIS Report…
you will know!
Workflow, workflow, workflow!
A workflow consists of
an orchestrated and
repeatable pattern of
business activity
enabled by the
systematic organization
of resources into
processes that
transform materials,
provide services, or
process information.
System Workflow
Analysis and Design
Identify workflow, system functional
weaknesses and staff competency
 Front Desk Staff Observation
 Billing Department Staff Observation
 EDI Database Review
 Development of Optimized Workflows Plan
Professional Services
Consulting and Support
Identify required maintenance, staff re-training
and overall optimization RCM to “Living RCM
Standards’
 Administration Training
 System Training
 Billing/Patient Financial Services Training
 Payment Entry - Insurance/Patient
 Reports Training
 Closing Date Procedures Training
RCM ANALYSIS
Tier 1, 2, 3 and beyond
Visualutions Revenue Cycle Management Consulting Services
Tier 1
Tier 2
Tier 3
X
X
X
Financial Performance - Report and Dashboards Created
X
X
X
System Maintenance
X
X
X
Management Goals and Outcomes, Measurements and Recommendations
X
X
X
Staff Observation and Discussion End User- Registration, Scheduling, Pre/Post Payment
Collections, etc.
X
X
Billing/Patient Financial Services- Charge Entry, charges management, processing, EDI
Sub/Resp., Claims management, follow-up, payment posting
X
X
EDI Database Review
x
x
X
X
Implementation
System Work Flow Analysis and Design
Revenue Cycle Management Analysis
Administration – Exclusive Review of specific Admin Tables
Development of Optimized Workflows Plan
Administration Training
X
System Training (Super/End User Training)- Include Gap areas, UDS deep dive, etc.
x
Billing/Patient Financial Services Training- All aspects of billing, training adding EDI
Transmission and Response refresher
X
Name
Plan Duration Assigned
Total Hours
Revenue Cycle Management Analysis
Financial Performance - Report and
Dashboards Created
Day 1
Day 2
2hrs
Online
2
Administration – Exclusive Review of specific
Admin Tables
4hrs
Onsite
4
System Maintenance
4hrs
Onsite
4
Management Goals and Outcomes,
Measurements and Expectations
2hrs
Onsite
2
System Work Flow Analysis and Design
Observation Front Desk
4hrs
Onsite
4
4hrs
4hrs
Onsite
Onsite
4
4
4hrs
Implementation and Post implementation Support
Onsite
4
Observation Billing/Patient Financial Services
EDI Database Review
Day 3
Development Optimized Workflows Plan
Admin Follow Up Training
System Training (Super/End User Training)
Billing Training
Payment Entry - Insurance/Patient
Beyond
Reports Training
Reports Training Follow Up/Scoping
Closing Date Procedures Training
Collections Training
2 Days
Onsite Training
16
2 Days
Onsite Training
16
16hrs
Onsite Training
16
4hrs
Remote Training
4
4hrs
Remote Training
4
2hrs
Remote Training
2
2hrs
Remote Training
2
4hrs
Remote Training
4
Our Goal
WHAT IS… The E.H.R.
HealthCheck
The objective of this program is to assist customers that find
themselves still struggling with how to implement the
changes required by CMS, Government etc…
The overall goal is to help practices change their concept and
thought process regarding the software by accepting change
in their workflow.
The key initiatives for this service are:
 Analyze our customers’ workflow
 Fabricate a systematic workflow process
 Create benchmarks for each process
 Ultimately generate revenue
PROCESS FOCUS
1.
2.
3.
4.
5.
Evaluation – Evaluate the overall office processes to include the
current roles of the staff and utilization of EHR system during the daytoday operations.
Analysis – Analyze the efficiency of the tools within the EHR system
as it relates to the client's EHR vendors best practices.
Recommendations – Consultation on the discoveries found during
the analysis as to find mitigation on broken processes.
Implementation – Based on the recommendations agreed upon, we
will incorporate the needed workflows as well as introduce new
products and functionalities to move towards Meaningful Use
compliance. (i.e. Patient portal, HL7 interfaces, etc...)
Evaluation – Perform a post-evaluation of the overall office processes
to include the current roles of the staff and utilization of the EHR
system during daily operations as comparison to your initial
evaluation.
Benchmarking Examples
Check-In Process
•
Has check in lag time improved?
•
Is the end user capturing all necessary MU Information at Registration?
•
Are demographics being updated?
•
Decrease in No Show Rate?
Clinical Process
•
IIs the Clinical Support Staff managing the encounter types, scheduled visit and LOC correctly?
•
Did the clinical staff capture the Meaningful Use data?
•
Is tasking/orders tracking used correctly?
•
Lag Time Improvement
•
Services and referral follow-up lag time improvement.
Provider Process
•
Are providers documenting HPI and CPOE A@P thoroughly for ICD-10 standards.
•
Are providers completing note during the visit, after the patient leaves or later?
•
% of On Hold, In Progress, Completed Orders.
•
Are all charges captured.
•
Are the providers creating an Append and documenting this correctly?
•
Are providers completing prescriptions, ordering labs and x-rays procedures?
•
Are providers scheduling the patient’s next appointment?
What to Expect When We Arrive
1st
2nd
3rd
4th
5th
• We will examine and analyze your front office, clinical staff, and provider processes.
• Based on our findings, we will deliver a strategy that will allow your agency to employ Best
Practices based to assure your success.
• We will help you modify your workflows, as needed, and introduce you to any new product
functionality that has been evolved since your implementation.
• We will conduct an Exit Interview to discuss finding and recommendations.
• A written evaluation and recommendations will be provided for future improvements. We would
like to keep track of your progress with a follow up call 30 to 60 days from the Check-up visit.
CRITICAL CLINICAL ASSESSMENT AREAS:
EHR Implementation Team Workflow Design
Appointment
Scheduling
Patient
Check In
Clinical
Check In
Provider
Process
Orders/E-Rx
/Referral/Pt
Education
Clinical
Check Out
Office Check
Out
Billing
Investment
There’s an investment on the client’s part for
this to be successful:
• Time – The practice has to invest in the time
to learn.
• Adjustment – To the changing times and
regulations of CMS
• Attitude – How you react will affect your staff
• Concepts – We need to be open to new ideas
• Workflow – A re-training or new workflows
and concepts
Who is our target audience?
• Our Customers
• Our clinical support staff
• Our providers
YOU!
DECIDE…..
COMMITT….
ACHIEVE!
Questions and Answers
Thank you.
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