Candice A. Powers, MBADirector of Revenue Cycle

Beaufort Memorial Hospital

Optimizing The Technologies That Your

Facility Has In Place

Scheduling Authori

zation

Registration

Encounter

Coding/HIMBilling

Posting

Financial Counseling

Collection

Denials and Audits

Traditional Revenue Cycle

Areas are often operated in Silos Lacking integration with bolt on

technologies As a result processes are fragmented People and their responsibilities get

lost in translation Results in lost productivity, increased

cost and underperformance

Nothing New

Scheduling

Auth

Registration

Encounter

Coding

Billing

Posting

Financial Counseling

Collection

Denials and Audits

Five Zone Strategy

HIS

Keep the analysis to the 5 zones initially

Searching for Gaps, hoping for no HOLES

Be sure to spend time with front line staff as well as managers and directors

Preparing the Gap Analysis

Technology Report:Technology

Primary FunctionSecondary/Tertiary

FunctionLocale in Rev Cycle

Costs

Process

2 questions: What works? What could work better?

HIS

Pre Encounter Financial

Counseling

BillingPosting

Financial Counselin

g

Collection

Denials/ Audits

Optimal state

Scheduling Authori

zation

Registration

Encounter

Coding/HIMBilling

Posting

Financial Counseling

Collection

Denials and Audits

Remember?

HIS

Pre Encounter Financial

Counseling

BillingPosting

Financial Counselin

g

Collection

Denials/ Audits

Optimal state

o Scheduling, Authorization, Registration, FC must become more blended, integrated

o Assess:o Financial clearance technologyo Eligibility o Batch eligibility verificationo Propensity Assistance o Med Nec Screening/Order

Levelo Quality Assurance technology

and/or processo Integrate

eligibility/propensity/Med Nec/QA info into the master HIS

Before Encounter

o Billing and Posting

o HIS capabilitieso CCIo Unit discrepancieso Plan code discrepancieso Facility misinformation o REPORT AND FOLLOW UP

o Claims Clearinghouseo Bridge routineso Productivity reportingo Take the time to eliminate the

paper (less than 5%)o Alias payers daily and report

backo Can you claim status?o What is your first pass yield

rate?o Cash Postingo Again NO PAPER

Post Encounter

Worklisting CATCH ALL LIST Review and trend aging monthly Reallocate resources in measurable

increments Post Encounter

Financial Counseling

What info do you have or can you get PRE ENCOUNTER?

Post encounter is a completely different ballgame

Essential for Non Profits USE the propensity information you have

now integrated Under 501R, presumption becomes

essential Connect advocacy resources within the

health system and community Automation??? Discounts at POS? SP?

Collections

Access and transparency Cut costs by collecting address information

and feed back to HIS Review the patient portal. How much

functionality is present? Ask questions of your partners and include

them in every process change discussion Using same propensity scoring for net 30

discount?

Collections

Denials/Audits

Denials

Full ANSI/Denial code review of your top 10

Strip the reporting directly from the 835 Standardize follow up procedure to

identify and use CAS codes when adjustment taken on non 835(less than 5% remember)

Feed HIS statuses of the progress Standardize reporting Underpayments ARE underhanded

denials Total Claim/Total Submitted Claim/Total

Denied/Net Reimbursement/Recovery

Audits

Standardize reporting Audits will provide the roadmap for

clinical improvement and administrative improvement

Are you capturing secondary denials info

As a hospital, do we have access to the physician owned practice clinical documentation???

Where should we develop

resources for success?

You are where you are because you are good. Without team support, your success will be minimal.

BE PROACTIVE

Provide opportunities for larger picture education

HFMA is an excellent resource for staff development

Evaluation process for technology holes Check HFMA for reputable

companies Ask around, do NOT use only

references provided Evaluate until you find a fit Do not settle Grading system with a

comment from each team member

Down to top three, more in depth review and rank

DO NOT DO THIS YOURSELF WITH ADMINISTRATION

INCLUDE A TEAM OF BOOTS AND

REV CYCLE RESOURCES

FROM AREA AND THE

TOUCHPOINTS

Simplify

Check the engine first

Ask the question to more than one person

Check the engine again

Speak upCREATE THIS CULTURE!!!!

HIS

Pre Encounter Financial

Counseling

BillingPosting

Financial Counselin

g

Collection

Denials/ Audits

The next few years/decade in

our industry