Best Practices in Revenue Cycle Management San Diego County Medical Society
Presented by:
Ron Anderson, CHMB Solutions www.chmbsolutions.com
CHMB Solutions Founded in 1995, CHMB provides physicians, clinics, and multi-specialty organizations with outsourced business services including billing and revenue cycle management consulting. CHMB expertise includes a wide range of surgical, primary care, and internal medicine specialties for over 500 providers throughout California. www.chmbsolutions.com
Ron Anderson CHMB Director of Business Development a CHMB shareholder, has worked in healthcare since 1990. In addition to overseeing sales and marketing for CHMB, Mr. Anderson is responsible for client information system connectivity, and Internet based solutions.
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Expertise – Revenue Cycle Management – Reimbursement Analytics – Healthcare Information Systems (HIS)
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Certifications – CPHIT – Certified Professional Healthcare Information Technology – CPEHR – Certified Professional Electronic Health Records
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Healthcare Industry Participation: – – – – –
Co-Chair MGMA Information Technology Advisory Panel (since 2002) CAMGMA liaison to the California Medical Association (since 2004) CAMGMA Webmaster (since 2005) Past President of the California MGMA – CAMGMA (2003-2004) Past President of San Diego MGMA (2001 & 2002)
Revenue Cycle Where does it start? Where does it end? •
Front Office $ Reception and Scheduling
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Back Office $ Billing and Collections
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Reporting and Analytics $ Gather Data, Analyze, Take Action
Revenue Cycle Where does it start? Where does it end? •
Front Office $ Reception and Scheduling
•
Back Office $ Billing and Collections
•
Reporting and Analytics $ Gather Data, Analyze, Take Action
Revenue Cycle Key Areas of Concern • • • • • • • •
Gathering & Verifying Quality Data Point of Service Collections Audit Revenue Capture Accounts Receivable Metrics Monitoring Cash Flow Denials/Underpayments Measuring Productivity Analyzing Payer Contracts
Front Office Patient Eligibility & Insurance Verification • Eligibility – Does you practice verify eligibility and obtain pre-authorization/referral for all appropriate patient services? • Patient Registration – Does your practice have (and monitor) basic data which is captured, verified and entered prior to or at the time of service?
Front Office Data Quality & Time of Service Collections • Are you incorporating verified eligibility info to front office check-in staff? • How often do you update patient demographic information? • What percentage of patient co-pays are collected at time of service? • When are patients with outstanding balances being informed and/or requested to pay?
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Family Family Practice Practice Associates Associates
That which gets measured‌ gets done
$10,000 $ 7,500 $ 5,000 $ 2,500 - 0 -
Contests / Challenges with incentives & rewards
Front Office to Back Office Transfer Charge Capture Verification • Are you auditing the capture of all provided services? • Do you reconcile your days superbills against the appointment book? • Do you reconcile inputted charges against surgery logs (IP and OP)?
The Cost of Missing Superbills‌ A leak in your revenue cycle! Average Charge per patient/encounter Average Collections Rate Missing/Lost Superbills Annual Lost Revenue per provider* * Assuming 25 patient encounters per day
$ 200 55 % 1% $5,280