2010 UBO/UBU Conference

Health Budgets & Financial Policy Briefing: Strategic Plans for UBO

Date: 24 March 2010

Time: 0800–0850

2010 UBO/UBU ConferenceTurning Knowledge Into Action Overview

MHS Mission Statement Strategic Planning MHS Revenue Cycle Measuring Program Success UBO Success Factors

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2010 UBO/UBU ConferenceTurning Knowledge Into Action MHS Mission

Military Health System Mission– Provide optimal Health Services in support of our

nation’s military mission – anytime, anywhere. How does UBO tie in to the mission? Are meeting or exceeding mission goals? What is your plan?

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Strategic Planning

Strategic planning is an organization’s process of defining its strategy, or direction, and making decisions on allocating it resources to pursue this strategy.– “What do we do?”– “For whom do we do it?”– “How do we excel?”

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2010 UBO/UBU ConferenceTurning Knowledge Into Action

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The Big Picture ~ MHS Revenue Cycle

The Revenue Cycle is made of administrative functions that contribute to creation of billable events, submission of bills, collection, payment and posting. The revenue cycle is paramount for the success of UBO. We must minimize the leaks.

An interdependency exists among all MTF staff from the registration clerk (for collection and confirmation of OHI) to the provider (for accurate documentation), to the coder and biller. All phases are interconnected to make the UBO Program successful.

Data quality is critical! Why? Every phase of the revenue cycle is dependent on the completeness and accuracy of the data collected. Starting from the beginning of the revenue cycle, every data point is passed along to the next phase and ultimately affects reimbursement for the MTF. An error in one part can affect the whole cycle.

2010 UBO/UBU ConferenceTurning Knowledge Into Action

SchedulingPre-registration

PatientCheck-in

Ins Verif &Auth

DenialManagement

Coding

AccountFollow-up

ClaimsSubmissions

EncounterDocumentation

PaymentPosting

Appeals

Patient Accounting Cycle“Revenue Cycle”

MHS Revenue Cycle

Results are increased resourcing with reliable outcomes in the form of usable data

Improved patient access, records documentation and coding accuracy

Data quality Management Controls are the driving force and conduit for ensuring effective and efficient operations

Visual review for validating and streamlining major clinical business and resource management processes

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Do You Have a Compliance Plan?

Why have a compliance plan?– Not an option – you must have one– Establish a culture to ensure compliance with DoD

policy & guidelines, private payer requirements, state & federal law

An effective compliance program…– defines or redefines behavioral objectives– ensures support flows from top management– is compatible with corporate culture– satisfies legal requirements in form and substance– is implemented with serious commitment of resources

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Measuring Program Success

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Quarterly TPC reporting done via the DD 2570, Third Party Collection Program, Report on Program Results

Metrics derived from the reported data– Observed OHI Rate – Collected to Billed Ratio– Adjustments and Write-offs vs. Amount Billed – Total Collections– Cost to Collection Ratio– Net Revenue

Must have benchmark for improving collections and decreasing costs

2010 UBO/UBU ConferenceTurning Knowledge Into Action Measuring Program Success

Monthly review of Accounts Receivable (AR)– Review dollar amounts for all outstanding accounts– Reasonable goal all accounts in AR are < 60 days– Must follow-up and either close or transfer accounts

to DFAS Reconcile monthly with FSO or Budget Offices Ensure rates are updated at start of FY

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2010 UBO/UBU ConferenceTurning Knowledge Into Action UBO Success Factors

MTF Revenue Cycle– Team Effort (not the just the UBO’s challenge)– Patient/Staff Education & Training

Patient targeted marketing and staff training ensure collection of OHI information

Need to explain benefits of programs to patients Each OHI not gathered is a “missed opportunity” for billing

Leadership Involvement– Brief them on UBO Performance (e.g., OHI Capture, Billings &

Collections for TPCP, MSA & MAC)– MTF senior leadership’s involvement and aggressiveness are

the keys to a successful UBO Program Think like a business – sometimes you have to spend money

to make money (aka return on investment (ROI)

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Summary

Set Goals Obtain Leadership Buy-in Review the Performance of the Entire Revenue Cycle

Team Establish Priorities Invest in Your People Gather and use Performance Metrics to Evaluate

Progress

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