Quarterly Education & IRCTC Check-In

Transcription

1 Welcome to the HOMETOWN HEALTH Quarterly Education & IRCTC Check-In A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO IOWA SHIP GRANT.

2 Webinar Etiquette All attendees are in Listen Only mode Questions or comments? - Open Questions pane in dashboard - Type in comments or questions - Comments will be monitored through out webinar. - Questions will be addressed at end of the webinar.

3 Webinar Resources This webinar will be recorded and posted for you to share with others on your team Handouts are available for download in the Handouts pane, and will also be ed out to attendees after the webinar.

4 Agenda Quarterly IRCTC Education & Check-In Welcome Results of Pre-Assessment Survey AGENDA Building a Revenue Cycle Team for Change Iowa Medicaid Check-in Making Education Meaningful - Roll out School of Revenue Cycle Management & School of Coding/Documentation Next Steps Jennie Price Annie Lee Sallee Sandy Sage Meghan Williams Jennie Price

5 Kristy Thomson Pre-Assessment Results Annie Lee Sallee, Revenue Cycle Education Specialist HomeTown Health

6 Annie Lee Sallee, MBA, RHIT, CPC, CPMA Revenue Cycle Education Specialist HomeTown Health Annie Lee has worked in healthcare since 2005 and has been with HomeTown Health for the past 3 years. Develops revenue cycle education for HTHU as well as participates in the various HTH grant programs including leading HTH s ICD-10 program for physicians and hospitals. Past experience includes working with the Medical University of South Carolina as a clinical revenue manager as well as a revenue cycle project manager. She has experience working with revenue enhancement projects related to both facility and professional billing.

7 Areas within the Revenue Cycle where you feel your hospital is above average: Our Starting Point

8 Areas within the Revenue Cycle where assistance is most needed (select your top 5) Our Starting Point

9 Our Starting Point What areas of staff training or development would you identify as your top three needs?

10 Our Starting Point Our hospital has a dedicated Revenue Cycle leadership team that meets and monitors denials and finances at least on a monthly basis.

11 Our Starting Point On a scale from 1 to 10, (1 being "inexperienced", 10 being "high level"), how would you rate the tenure of the Business Office staff at your hospital?

12 Our Starting Point On a scale from 1 to 10, how would you rate your confidence in your hospital team's ability to keep up with changes and updates from CMS and payers? (1 being no confidence, 10 being incredibly confident)

13 Our Starting Point Where do you feel you are currently struggling the most in Coding Overall? Injections and Infusions 66.7% Modifiers 51.5% Emergency Room Coding 39.4% Surgical CPT Coding 33.3% Other 30.3% Observation Coding 27.3% Inpatient PCS Coding 18.2% Diagnosis coding in ICD-10-CM 15.2%

14 Our Starting Point Where you feel you or your coders need remedial coding education, specifically in ICD-10? 84.8% 87.9% 63.6% 12.1% 18.2% 18.2% 6.1% Anatomy and Physiology remedial education Basics on ICD- 10-CM (Diagnosis) Complex Scenarios in ICD-10-CM (Diagnosis) Basics on ICD- 10-PCS (Procedure Coding Inpatients) Complex Scenarios in ICD-10-PCS (Procedures) Ask the expert (support for when questions arise) Other

15 Our Starting Point 63.6% What you identified as your ongoing needs from a coding perspective 57.6% 54.5% 60.6% 6.1% 3.0% 6.1% Annual Updates October ICD-10 Annual Updates January CPT OPPS Updates IPPS Updates AHA Coding Clinic Quarterly reviews CPT Assistant Quarterly reviews Other

16 Our Starting Point Do you feel your coders are pending excessively for queries, impacting productivity?

17 Our Starting Point Does your hospital perform internal quality audits regularly? Unsure, 6.1% No, 33.3% Yes, 60.6%

18 Our Starting Point Has your coding department had an audit internally or externally post ICD-10 Go Live?

19 Our Starting Point Does your hospital have an established Clinical Documentation Improvement (CDI) Program in place?

20 Our Starting Point Which best defines your CDI staff?

21 Our Starting Point What areas would you like additional education on in relation to CDI?

22 Our Goals What you hope your hospital gains by participation?

23 Our Goals The areas of education you would like provided:

24 Our Goals At the end of this program, how will HomeTown Health and the IRCTC team know that we have been successful in helping improve Revenue Cycle Management and ICD-10 coding practices in Iowa hospitals?

25 Kristy Building Thomson Your Revenue Cycle Team Sandy Sage, RN Revenue Analyst and Trainer HomeTown Health

26 Sandy Sage, RN Revenue Cycle Instructor/Trainer HomeTown Health University Project Leader for the SHIP grant programs: REV UP Your Revenue Cycle and Managed Care Consortium Most recently, she served as a Revenue Cycle Manager for Dodge County Hospital in Georgia She has been a Registered Nurse since 1990 She has been a Nurse Manager in the ED & Med/Surg, Case Manager, clinical liaison between medical and accounting, Revenue Analyst, Quality Coordinator, and BO staff trainer

27 Building Your Revenue Cycle Team Sandy Sage RN, Revenue Analyst

28 Learning Objectives Understand who is in the Revenue Cycle Define the purpose of the Revenue Cycle team List the staff who the team should include Understand how to get your team started

29 What is the Revenue Cycle?

30 We Asked You Does your hospital have a dedicated Revenue Cycle leadership team that meets and monitors denials and finances at least on a monthly basis?

31 Does your RC look like this?

32 TEAM PURPOSE To bring all areas of the hospital together to enable communication between departments, with an ultimate goal of maintaining the integrity of the revenue cycle and improving performance.

33 THE TEAM C-Suite Representative C = Culture, setting the tone Organizational Drive Removes obstacles Allows flexibility with team timing Promotes and understands the importance of the Revenue Cycle Team

34 THE TEAM C-Suite Representative Patient Access Case Management HIM Nursing Ancillary Services Billing Collections

35 The Role of the C-Suite and Role of the RC Leadership At a Glance: Roles in a High-Performance Revenue Cycle From HFMA s Strategies for a High-Performance Revenue Cycle, Nov. 2009

36 Starting Point Identify your goals as a team Process improvements Increased cash flow Decreased discharge to bill times Charging compliance (late charges, reconciliation) Denial management Patient satisfaction Policy management and enforcement Contract negotiation and compliance

37 Other Agenda Items Suggestions for other Agenda Items Each Month: High-priority projects Staff and People Resources Reimbursements /Payor Mix (margins/costs) Significant market changes Ideas to optimize revenue cycle processes

38 COLLABORATION Clinical and Financial staff should educate each other on the different areas. Nurse Auditors can help with understanding the care process and translating it financially Gain an understanding of how each area affects the others

39 THEN WHAT? Get to work! Begin to track data (denials, billing edits, missing charges, upfront collections, contract compliance) Bring data to your meetings for the team to review and evaluate Work together to create solutions for improvement Decide what your focus will be and allow that to evolve

40 Tracking and Reporting

41 Make it your own!! You are on the front lines You know what will work You know what staff can manage Start small or big, your choice Just Make it Work!

42 Solution Focused Focus on weaknesses in the cycle Help with solutions to improve efficiency Encourage department participation in the solution Engage staff in collecting data for reporting and evaluation

43 TEAM TIPS Don t focus on the people, focus on the process Create an atmosphere of change that is positive not punitive Continue to expand your reach into all areas Encourage staff participation for increased buy in

44 Rev Up Your Revenue Cycle HomeTown Health is working with the SORH through the FLEX grant to provide a program that will help your Revenue Cycle Team Rev Up Your Revenue Cycle gives you benchmarks for each area of your revenue cycle Sign up is happening now!!

45 QUESTIONS?

46 Iowa Medicaid Updates Sandy Sage, RN Revenue Analyst and Trainer HomeTown Health

47 IOWA MEDICAID UPDATES

48 REIMBURSEMENT If a patient is a member of a Managed Care Organization and the provider is NOT enrolled with that MCO, the provider can decide to either not see the patient or accept an Out-Of-Network rate. The patient cannot be asked to pay for the service! Members can only be charged for not medically necessary services or non-covered services

49 REIMBURSEMENT Iowa Administrative Code 79.9(4) "Recipients must be informed before the service is provided that the recipient will be responsible for the bill if a non-covered service is provided."

50 Prior Authorizations Prior Authorization Summary by Plan The Iowa Medicaid Enterprise (IME) has put together a prior authorization (PA) summary by plan. Providers can quickly view and compare PA requirements for each plan with this easy-to-use chart. This chart has been updated with the most current requirements for each Managed Care Organization (MCO). The link to find the chart is below orization%20requirements_rollup_v1.0.pdf

51 ELIGIBILITY The Eligibility and Verification Information System (ELVS) line is very busy during the first of the month. The ELVS web portal is another option for providers in lieu of calling the ELVS line but each provider must enroll through the Electronic Data Interchange Support Services (EDISS). The ELVS web portal allows for multiple eligibility checks and batch submission, where as the ELVS phone system only allows for one at a time. Login ID and password may be obtained through EDISS by submitting the Access Request Form to EDISS or calling EDISS at

52 Provider Enrollment ACA requirement Needed to stay active with Iowa Medicaid Enterprise (IME) Includes providers that were previously enrolled with Magellan and ones who recently enrolled with the IME Deadline 12/31/ D_%20Reminder_Provider_Enrollment_Renewal.pdf

53 Corrections Updating or Correcting a Member's Information: Providers who become aware of changes to, or errors in, a member's information should advise them to contact the Department of Human Services (DHS) Customer Service Call Center at , Monday - Friday; 7 a.m. to 6 p.m. Member's can report changes/corrections such as: New Address Incorrect Birth Date Birth of a Child Employment Starts or Ends

54 Kristy Making Thomson the Most of your Revenue Cycle Education Meghan Williams Customer Relations Coordinator - HomeTown Health

55 Meghan Williams Customer Relations Coordinator HomeTown Health Meghan joined the HTHU staff in May 2012 Coordinates social media for HomeTown Health & HTHU, website development and maintenance Education reporting for HTHU subscribers, education course review, as well as coordination of sales/marketing/retention for HTHU Completed a B.A. in Speech Communications from the University of Georgia Meghan s career in healthcare began as a Human Resources Director in southwest Georgia where she was responsible for all aspects of employee relations, payroll/benefits, workers compensation, annual education development and training, as well as serving as the HIPAA Compliance Officer. She also served as an active member of the hospital authority s volunteer group.

56 EDUCATION: MAKING THE MOST OF YOUR REVENUE CYCLE EDUCATION THROUGH IRCTC Meghan Williams, Customer Relations Coordinator, HomeTown Health University

57 EDUCATION: WHY IT MATTERS Education is key to successful, productive and effective employees. Education is one of the largest contributors to culture. Education reduces legal risk related to regulatory and compliance-based audits. Education empowers employees in their position and boosts their confidence. Education eliminates silos and broadens team awareness. Education is mandatory.

58 EDUCATION: SUCCESSFUL INTEGRATION Build education requirements into Job Descriptions as well as P&P documents. Establish and utilize Disciplinary Action for Non-compliance. Education as standard of Employee Evaluation Education as an investment not a consequence. Evidenced-based Education Creative & Adaptive Scheduling

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60 You will need to create an account and register with your organization to gain access. If you already have an account, use the login button

61 SCHOOL OF REVENUE CYCLE MANAGEMENT On Demand Training Medicare Webinars & Industry Updates PFS/Business Office Certifications Patient Access, Billing, Financial Counselor & Healthcare Hospitality Computer Courses Hospital Office Education Accounting Facility Compliance Management & Leadership

62 PFS/BUSINESS OFFICE CERTIFICATIONS Patient Access Certification Patient Access Specialist Annual Recertification Billing Pre- Requisite Billing Certification Billing Specialist Certification Annual Recertification Financial Counselor Certification Annual Recertification Certified Healthcare Hospitality Specialist Annual Recertification

63 SCHOOL OF CODING & DOCUMENTATION Coding & Documentation ICD-10 Foundation Courses Clinical Documentation Improvement ICD-10 Business Office Education ICD-10 History & Basics ICD-10 Fundamentals ICD-10 Physician Series

64 Kristy Next Steps Thomson Jennie Price, Director of Business Development - HomeTown Health

65 IRCTC Calendar Medicare Update Quarterly Training Other: October Transformation Check-In School of RCM Courses & Coding Courses November CAH Webinar December Coding/ICD-10 January 2017 Transformation Check-In February CAH Webinar March Coding/ICD-10 Live Meeting in Des Moines April Transformation Check-In May CAH Webinar, Closing Webinar Post-Assessment June Bonus: Coding/ICD-10 Results: Year Two begins!

66 Live ITC Meeting Tentative Dates: March 15-16, 2017 Courtyard in Des Moines Ankeny A live 2-day workshop with other participating hospitals will provide education in the area of Quality Grant will provide for one attendee registration from each hospital, plus stipend for hotel for 2 nights Additional attendees can attend for a small fee

67 Access Your Online Education We recommend having your IRCTC Team leaders complete or review the Course or Certification first, and then decide as a team who in your facility should take the program Available for your entire staff to utilize Instructions for creating a log in are on your User Login Instruction Handouts and on your Dashboard

68 Cross-Training Education Monthly Quality/ HCAHPS Education Third Thursday of the month at 1 pm Central Coming up This Thursday, October 20: Transparency and Public Reporting, and HCAHPS: Communication with Nurses and Doctors Monthly Telemedicine Education First Friday of each month at 10 am Central Coming up Friday, November 4 th Telehealth Equipment Selection and Purchasing

69 Program Dashboard *password protected* *revenue*

70 Contact the Team

71 Questions?

72 Your Feedback is Important! A very brief survey (5 questions) will pop up after this webinar closes: please take a moment to tell us how we did & how we could better serve you!