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Presentation hosted by Conventus outlining specific strategies for adapting to new quality-based payment plans to boost revenue and cash flow. Features Ron Sterling of Sterling Solutions
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Sterling Solutions, Ltd.
Strategies to Improve Cash Flow
Secret Weapons that Can Improve Your Practice Revenue
Sterling Solutions, Ltd.
Technical Assistance
Technical Assistance Telephone Number: 732-822-9948
Question Submission for Q&A Session: Type your question into the Questions drop down on
your screen.
(PLEASE JOT DOWN THIS INFORMATION))
Sterling Solutions, Ltd.
Conventus Risk Management
Advances in Practice Operations Series• “Streamlining Your Practice for Profitability & Success”• “Revenue Cycle Management & EHRs”• “Quality Driven Healthcare & EHRs”• “Patient Flow & the Bottom Line”
Onsite Services• C.A.R.E. Certification Program• Office Risk Assessments• EHR Risk Consultations
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E-Publications
Sterling Solutions, Ltd.
Today’s Expert
Ronald B. Sterling, CEO of Sterling Solutions, Ltd., is a nationally-recognized thought leader on leveraging EHRs to boost practice revenue through smart selection and implementation of electronic health record and practice management systems.
Ron has advised healthcare organizations and practices across the country. Ron has analyzed software from over 150 vendors.
Ron publishes the popular EHR Blog, Avoid-EHR-Disasters.com and authored the HIMSS Book of the Year Award winning Keys to EHR/EHR Success - Selecting and Implementing an Electronic Medical Record. Ron has contributed hundreds of articles to a wide range of publications including the widely used Marketing Your Clinical Practice.
Sterling Solutions, Ltd.
RCM Issues
Revenue Sources Changing Fee-For-Service Decreasing Increasing
- Shared Savings- Accountable Care Organizations- eVisits- Patient Portal Services- Patient Service
Performance/Results Oriented Payments
Sterling Solutions, Ltd.
RCM Focus Changes toSupport Evolving Payment Models
From - E&M Charge Capture
To - Maintaining Quality and Performance Patient Service Proving Quality Patient Centered Specialty Practice Patient Centered Medical Home
Sterling Solutions, Ltd.
Issues that Influence RCM Strategy
Meaningful Use
HIPAA Security Standards Accountable for Integrity Assure Accessibility
ACA Effect Higher Deductible Health Insurance Exchanges
“Cloning” Records
Sterling Solutions, Ltd.
Preserve Information to Support RCM Notes New Service Documentation Tools
- Clinical Messaging- Patient Remote Patient Monitoring Systems
Patient Quality and Service Objectives- Coordinate Patient Populations- Track Patient Care
Performance Standards- Quality Improvement
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RCM Support Is Complicated
Sterling Solutions, Ltd.
RCM Support Is Complicated
Payers/ACOs May Vary
Sustain an Audit of Supporting Documentation Requests for Documents Examination of EHR Based Records
- Computer Assisted Review Tools- Review of Audit Trails- Review Context of Care
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Sterling Solutions, Ltd.
Evolving RCM is Complicated
EHR May Not Accommodate Tracking of Key RCM Measures Relevant Status Over Activities
May Require Changes to EHR Use Activities Measures Documentation to Trigger RCM Requirements
Sterling Solutions, Ltd.
May Require Additional Documentation Meaningful Use Like Attestation Global Reporting Performance Tracking
Payment May Not Be Associated with a Patient Quality Incentive “SGR Fix” Payments
Evolving RCM is Complicated
Sterling Solutions, Ltd.
EHR Records are Vulnerable
Payer Patient Service Expectations First Response Final Resolution/Recommendation
Due Diligence to Protect Patient Records Avoid Degradation Maintain Accuracy and Consistencyy
EHR Challenges Related to RCM
Sterling Solutions, Ltd.
EHR Challenges Related to RCM
ICD10 Starts October 1, 2015 Not Just About Coding
- Clinical Decision Support (MU)- Health Maintenance Items- Classification of Plans, Visits and More
ICD10 Specificity- Site- Laterality- Visit Type- More
Sterling Solutions, Ltd.
Clinical RCM Objectives
Verify Record Standards
Maintain Integrity of Patient Records
Protect Against Unsubstantiated Services Quality Lapses Claim Fraud
Support Contractual, Professional and Industry Standards
Sterling Solutions, Ltd.
Agree on Operational Standards
Standards Based on EHR Features Product Use Payer/ACO Practice Services Doctors
Sterling Solutions, Ltd.
RCM Checklist Items
Notes Signed Within X Hours/Days Regular Office Visits eVisits Evolving Activities (Ex. ACO
Support)
EHR Interface with PMS/Billing Accuracy Timeliness ICD9/10 Coding Changes Substantiation
Sterling Solutions, Ltd.
RCM Checklist Items
Reconcile Charges Appointments Cancellations No Shows
Supporting Documentation for Clinically Significant Events
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Sterling Solutions, Ltd.
RCM Checklist Items
Patient Portal Traffic
Patient Submission of Information- New Patients- Follow Up
Turnaround Time Follow Up on Undelivered Messages Documentation Supports Care Standards
Sterling Solutions, Ltd.
EHRPatient Portal
Patient Request
Response
Information
Messages – Sent to Inbox and Information Entered into EHR.Information Accepted – Information Flagged and Posted to Patient Chart.
Patient Portal
Sterling Solutions, Ltd.
RCM Checklist Items
Outgoing and Incoming Electronic Traffic Check Rx Transition of Care Lab Results Patient Orders Other Results
Workflow Management Patient Appointments Cleared and Completed To-dos and Messages Completed
Sterling Solutions, Ltd.
RCM Checklist Items
Internal Messaging Part of Patient Service Strategy Status and Response by Type Workflow Issues
Incoming Documents/Images Status of Items to be Indexed Routing of Indexed Items Documentation of Decisions Changes to Care Plan Document Patient Notification
Sterling Solutions, Ltd.
RCM Checklist Items
Quality Assurance Documentation Standards Outlier Detection – Treatment and/or Management
Meaningful Use
Sterling Solutions, Ltd.
RCM Checklist Items
Quality Patient Services Test Results Follow Up Procedure/Surgery Follow Up Referral Follow Up Reminder Transmission Reminder Follow Up Health Maintenance Items Outstanding Orders Obsolete Orders
Sterling Solutions, Ltd.
RCM Reporting
Maintain Statistics to Prove Performance Payer Patient Population Provider Location
Report on Standards Performance Trends
Sterling Solutions, Ltd.
Supporting Claims and Collections
In addition to copy of notes to match E&M code with documentation…. Includes proving care standards Depends on operational
performance Requires timely and accurate
records
Meaningful Use reporting and Clinical Quality Measures are a window into the future of RCM
Sterling Solutions, Ltd.
RCM and EHR Cases
PMS receives charges for office visits from EHR but EHR does not post transactions for patient advice, RPMS monitoring and other activities that are billed/paid under a quality initiative. What are the RCM issues? What are the RCM problems in light of an ACO
environment? What is a workaround to maintain financial information?
Sterling Solutions, Ltd.
RCM and EHR Cases
Practice receives a quality incentive payment for managing an at risk patient population. The PMS only posts fee for service charges. How and where should the payment be posted? Can the payment be posted directly to the
accounting system and bypass the PMS? How will realization reports be affected?
Sterling Solutions, Ltd.
RCM and EHR Cases
EHR Vendor advises practice to not sign patient notes in case the doctor wants to change the document. What are the fee for service issues? What are the professional liability
issues? What are the RCM problems in light of
an ACO environment?
Sterling Solutions, Ltd.
RCM and EHR Cases
EHR Messages are not included as part of the patient record according to the EHR design. How does this design complicate quality
patient care? What are the operational accommodations
needed to support quality care based RCM?
Sterling Solutions, Ltd.
Go Forward Plan
Monitor EHR Vendor tools to support RCM under evolving payment and performance systems Meaningful Use as a Start
Maintain EHR Documentation and Performance Standards to take advantage of EHR and align your practice with evolving revenue models (ACO, Shared Savings, PCSP, etc.)
Sterling Solutions, Ltd.
QUESTIONS
ANSWERS
Sterling Solutions, Ltd.
RONALD B. STERLING, CPASterling Solutions, Ltd.
[email protected](301)681-4247BLOG: Avoid-EHR-Disasters.com
Sterling Solutions, Ltd.
Conventus Contact Information
Susan Lieberman, MBAVice President, Risk Management
Conventus Inter-Insurance Exchange877-444-0484, x466
www.conventusnj.com