Jump Start Your Year in the Revenue Cycle Edna Buffington Senior Director of Patient Financial Services Unbilled • Review and work your unbilled reports daily • Identify areas of opportunity in your Charge Master to prevent accounts from holding on your Unbilled Report • Identify possible Registration issues • Look at your billing system and accounts that error out – identify if these errors are related to Registration, Charge Master, edits that can be put in your Host system that would prevent claims from billing with errors to your billing system • Hold weekly unbilled meetings to discuss why claims error out, discuss payers that are getting close to timely filing and put together a plan to reduce your unbilled days Unbilled • Unbilled meetings – Include HIM – Include Case Management – Other Departments as needed – Remember it is a Team Effort in reducing unbilled at every facility HIM Requests • Have a process to track HIM requests from payers • Review to ensure that these request are processed timely – remember a lot of payers have time lines of when these requests are due back to them • If you are using an outside vendor for HIM requests review their logs to make sure they are current Late Charges/Incorrect Charging • Another way to jump start the year is to track and monitor Late Charges/Incorrect Charging from Departments • Identify your areas that you have opportunity in to reduce these types of issues • Have Late Charge Meetings with your departments and discuss the impact of having to rebill accounts to payers, discuss the impact on the RAC Audits. Remember that your documentation in your Medical Record should match your charges and what you bill to payers Electronic Billing • Review your electronic billing rate to see if there are payers that you are billing manually that can go electronically. Normally if a claim is billed electronically it is processed faster than a manual claim. • Review denials on claims that passed your electronic billing edits as a clean claim. Review to see if you can write edits in your billing system to prevent claims from denying at the payers. The goal is to bill each claim clean so that you get reimbursed quicker. • If there are payers that require Medical Records to go with their claims, research to see if your billing system has the capability of attaching the records electronically. Secondary Billing • Review to ensure that you have Medicare accounts with secondary insurance crossing over to payers electronically when possible • Look at manual secondary billing and identify areas that can assist in keeping this current, i.e. PBX or 3rd shift registration areas that have down time during the night • You should look to see if your billing system has the capability of accelerated secondary billing modules Medicare Remote System • Make sure that staff is working claims in the return to provider status daily for Medicare accounts • Identify the reasons for claims that are not passing the Medicare edits and identify areas that you can correct in your Host or Billing systems to prevent this issue Denials • Track Denials • Develop a Denial Task Force that meets and reviews the Denials for the month • Identify the reasons for your denials – – – – – Is it a Registration issue not verifying insurance coverage Is it a Medical Necessity Issue Is it a Charge Master issue Is it a Pre-authorization issue Are these denials related to off site entities • Develop a plan to correct the denials • Provide education and feedback to staff – Registration – Clinical Areas – Physician Offices Payer Issues • Review your accounts by payer and identify any issues with payers • Look for payers that are not paying timely or according to contract • Schedule on site meetings with payers for resolutions • Contact your payer reps for assistance • Stay in “The Know” on any new changes with 5010 billing, system issues/upgrades or contract changes in order to eliminate any accounts not paying timely Summary Aging • Review your summary aging weekly and identify any financial class aging opportunities • Review your past due follow up by collector and see if there are issues with productivity • Review your account assignments and see if you need to make adjustments for the new year – sometimes volumes change and you need to reassign accounts by collector • Identify your particular payer issues or service line issues that you need to be addressed Vendors • Hold your vendors accountable • Review the line of business they are doing for you and see if accounts are noted appropriately • Review their reports and hold monthly calls to discuss their performance • Audit their invoices to ensure they are billing you correctly Self Pay Screening Vendor • Review their close and return reports to see if you agree with how they handled your accounts • Review the services they are screening for and make sure they are screening for all services, i.e. PCIP, any Minor Child coverage your state may provide, etc. • Ask them to provide a Home Visit Report to you so you can see if they are making home visits to patients • Review their hours of operation to see if they are covering your areas during peek times • Hold monthly calls to go over their performance, issues and or concerns Self Pay and Self Pay After Insurance • Look at your Point of Service Plan • Develop tools/scripts to assist your staff in collecting Point of Service • Educate, Train and Monitor Point of Service Collections • Develop goals for staff and provide feedback • You may want to consider adding point of service to your yearly review of staff Registration • Develop a good training program for new hires in Registration • Review your Central Scheduling Area to ensure all services are scheduled that can be scheduled in advance • Make sure you are pre-registering accounts 3-5 days in advance, preferably 10 to 14 days, completing insurance verification, and medical necessity checks prior to the date of service • Develop a good QA program and provide feedback on issues/errors to staff • Remember that everything that registration does affects the entire facility- this is the start of your revenue cycle. Conclusion • • • • • • • Be Proactive and not reactive Hold staff accountable Know your payers and issues Review your Summary Aging for areas of opportunity Look at your systems and implement processes to be more efficient Reduce your denials Educate and give feedback to all departments that impact your revenue cycle • Revenue Cycle is a Team effort from all areas that begins with Registration – to Clinical Departments – Charging – Billing and then account resolution. It takes everyone to have a successful Revenue Cycle.