Treatment
Planning
Tracking
Progress
Accurate
Scheduling
AR
Management
Patient Checkin/Out
Coding and
documentation
Payment
Posting
Denial
Management
Claims
Processing
Presented By Suzanne Adolphson, MSW, MHA
•
Located in Pomona, California
•
1st class graduates in 2013
•
Use a paperless system
•
Define the revenue cycle
•
Use the EHR to improve your revenue cycle
•
Use the EHR to track improvements
Improve your revenue cycle rather
than relying on cutting expenses.
‘…find the holes in your revenue
cycle and then plug them...’
•
More than just billing and collecting
•
Includes all processes and procedures that
have potential to impact the revenue
•
Ex: treatment planning, scheduling,
accounts, patient check-in/out, all things AR,
etc.
ORGANIZING YOUR THOUGHTS:
SYSTEMS THEORY:
Treatment
Planning
Tracking
Progress
Accurate
Scheduling
EHR
AR
Management
Patient Checkin/Out
EHR
REVENUE CYCLE
Payment
Posting
EHR
Coding and
documentation
EHR
Denial
Management
Claims
Processing
USING THE EHR
WHAT IS THE EHR?
•
EHR = Electronic Health Record
•
Fully integrated EHR = all functions are
interconnected and do not stand alone.
TREATMENT PLAN
• Lack of treatment plan=lack of communication
• Communicates cost of treatment to patient
• A sequenced treatment plan facilitates scheduling
• Tracks potential revenue
SCHEDULING
• Need to know clinic activity.
• Using the Treatment Plan = staff knows what to collect
• Track patients who habitual fail or cancel = stable
patient base
• Tracks chair utilization
• Digital format allows for use of outside vendor for
confirmation of appointments
PATIENT CHECK-IN
• Treatment plan and accurate scheduling =
patient check-in process
• Ensures collection or verification of patient demographics
• Allows for collection of payment before treatment
• Do you want to manage credit or debt?
CODING AND DOCUMENTATION
• Treatment Plan = accurate coding
• Inaccurate coding = slower reimbursement from 3rd
party payers
• No codes = missing charges and/or reduced
productivity/revenue
• Use EHR to track missing charges (codes) daily
CLAIMS PROCESSING
• Treatment Plan = accurate coding = accurate claims
• Accurate claims = faster reimbursement
• Electronic Claims and electronic attachments = faster
reimbursement
• Real time processing information
DENIAL MANAGEMENT
• EHR flags incomplete claims.
• Electronic claims allows for real time management.
• Real time management = faster claim correction = faster
reimbursement
• Reduces the amount of time staff spends on the phone
with 3rd party payers
A/R MANAGEMENT
• Accurate demographics = fewer returned statements
• Digital format provides for sending file to 3rd party
vendors for statement processing.
• Allows staff to use time in more productive manner
• Reports that assist staff in claims and outstanding
balance follow-up
PAYMENT POSTING
• Tracks the amount of time from check posting in the
system to allocation to individual claim
• Future: 3rd party payers will send electronic files that
download payments automatically
• Staff will only have to look at the payments with
exceptions
PATIENT COLLECTIONS
• Report generation for outstanding
claims/patient balances
• Ease of working with collection agencies
• Collection agency can access files and
download information into their system.
• Streamlines process and reduce staff
involvement
TRACKING IMPROVEMENTS
• Determine which benchmarks to use to gauge
improvement
• Apply a simple pre-test/post-test method to determine
improvement
• Use the data your EHR collects to
determine improvements
• Determine which intervals to check for
improvements
CERTAIN BENCHMARKS CAN BE USED TO TRACK PROGRESS:
• Average days in A/R
<50 days
•
<20%
% of A/R over 90 day
• % of A/R over 120 days
• Billing turn-around
<10%
within 5 days of treatment
• Payer turn-around
Electronic claims
Paper claims
10-15 days
<45 days
•
<2%
Bad debt expense (% of net revenue)
QUESTIONS?
REFERENCES
Quist, Jim & Robertson, Brian. (2004). Key Revenue Cycle Metrics.
Healthcare Financial Management, 58 (9), 71-72.
Palmer, Diane. (2004). Key Tools For Turning Receivables Into Cash.
Healthcare Financial Management, 58 (2), 62-67.
Hammer, David. (2007). The Next Generation Of Revenue Cycle
Management. Healthcare Financial Management, 61 (7), 49-57.
Amatayakul, Margaret. (2005). Are You Using The EHR-Really?.
Healthcare Financial Management, 59 (11), 126-128.