Maximizing Relationships within the Revenue Cycle. Chris Johnson CHFP Senior Revenue Cycle Consultant Trubridge, LLC

Transcription

1 Maximizing Relationships within the Revenue Cycle Chris Johnson CHFP Senior Revenue Cycle Consultant Trubridge, LLC

2 Agenda History/Background Roles and Responsibilities A walk through the Revenue Cycle Revenue Cycle Steering Committee

3 Look familiar? HIM Director PFS Director

4 Is this how you see your PFS Director? Is this how your PFS Director sees you? HIM Director PFS Director

5 Let s end the feud

6 History/Background

7 History/Background of HIM Medical Record s roots stemmed from early Astrologers in the 14 th century Hospitals began keeping Medical Records in the late 1700 s 3 categories of early medical records: Rudimentary (Europe): Lists the names of clients and their payments for treatment Narratives of Cure (Greece): Recorded advice to patients about diet, recipes, and lessons for surgeons Early Modern (England): Name, date, complaint, history, diagnosis, remedy/therapy and payment

8 History/Background of PFS The Industrial Age resulted in mills and factories seeing an increase in work related injuries Doctors charged what they felt patients could afford on a case-by-case basis No standard payment system In the 1920s, individual hospitals began offering services on a pre-paid plan (i.e. Insurance) Great Depression caused hospital administrators to face a choice of federal funding for the poor

9 Now let s talk about roles No not that kind of rolls

10 Roles and Responsibilities

11 Roles: Health Information Management (HIM) the practice of acquiring, analyzing, and protecting medical information vital to providing quality patient care. It is a combination of business, science, and information technology. Patient Financial Services (PFS) administrative functions that contribute to the capture, management, and collection of patient services revenue

12 Responsibilities: HIM PFS Paper Chart Electronic Record Collecting Documentation Coding Queries ROI Patient Access Revenue Capture Claims Submission Claims Follow-Up Rejections/Denials Reimbursement

13 Always a Balancing Actct PFS Collect monies due, timely Data Dollars

14 Always start with the Why? Data vs. Disease Management Record of Documentation Claims Submission Dollars Provides Capital for Equipment Facilities PAYROLL

15 Both employ the same basic skills Eye for detail Knowledge of medical terminology Knowledge of HIPAA Proper completion of medical forms The best coders have knowledge in billing The best billers have knowledge in coding Comparable salaries and a high expected employment growth

16 A walk through the Revenue Cycle

17 The Revenue Cycle Insanity CHARGE CAPTURE & ENTRY MEDICAL MANAGEMENT Information Systems MEDICAL RECORDS & CODING CLAIMS SUBMISSION REGISTRATION THIRD PARTY FOLLOW-UP FINANCIAL COUNSELING PATIENT PAYMENT POSTING INSURANCE VERIFICATION PRE-REG & PRE-CERT SCHEDULING Revenue CONTRACT NEGOTIATION / ADMIN. DENIAL & APPEAL MANAGEMENT REJECTION PROCESSING

18 The Revenue Cycle Simplified Patient Access Collections Data Processing Insurance HIM

19 Patient Access Step-by-Step Scheduling Pre-Reg Registration Data Processing Charge Capture Receipting Closing A/R Days HIM Chart Prep Deficiencies Coding Insurance Billing Edits Claims Submission Claims Follow-Up Collections Financial Counselors Patient Statements Bad Debt Write-Offs

20 1. Do We Have a Leaky Pipe? 2. Where are the Leaks? 3. Collaborate to Plug the Leaks. The Revenue Cycle Simplified Revenue Scheduling / Pre-Reg Reg. Charge Capture Clinical Documentation Coding Accuracy Billing Edits Rejection/ Denials Appeals/ Underpays Data Analysis

21 Revenue Cycle Steering Committee

22 Revenue Cycle Steering Committee To ensure effective communication, involvement of key senior management personnel is critical. Establish mechanisms to facilitate formal and informal communication with key hospital members. This committee should continue indefinitely, while evolving and growing to meet the facility s needs.

23 Revenue Cycle Steering Committee Steps to begin: Meeting charter Compliance and Collections Participants and their roles Recurring location, date, time Report Card Action Plan Subcommittees

24 Chris Johnson CHFP Senior Revenue Cycle Consultant Trubridge, LLC Keyword TruBridge facebook.com/trubridgese rvices