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Candice A. Powers, MBADirector of Revenue Cycle
Beaufort Memorial Hospital
Optimizing The Technologies That Your
Facility Has In Place
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Scheduling Authori
zation
Registration
Encounter
Coding/HIMBilling
Posting
Financial Counseling
Collection
Denials and Audits
Traditional Revenue Cycle
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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
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Scheduling
Auth
Registration
Encounter
Coding
Billing
Posting
Financial Counseling
Collection
Denials and Audits
Five Zone Strategy
HIS
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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
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Technology Report:Technology
Primary FunctionSecondary/Tertiary
FunctionLocale in Rev Cycle
Costs
Process
2 questions: What works? What could work better?
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HIS
Pre Encounter Financial
Counseling
BillingPosting
Financial Counselin
g
Collection
Denials/ Audits
Optimal state
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Scheduling Authori
zation
Registration
Encounter
Coding/HIMBilling
Posting
Financial Counseling
Collection
Denials and Audits
Remember?
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HIS
Pre Encounter Financial
Counseling
BillingPosting
Financial Counselin
g
Collection
Denials/ Audits
Optimal state
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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
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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
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Worklisting CATCH ALL LIST Review and trend aging monthly Reallocate resources in measurable
increments Post Encounter
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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
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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???
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Where should we develop
resources for success?
You are where you are because you are good. Without team support, your success will be minimal.
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BE PROACTIVE
Provide opportunities for larger picture education
HFMA is an excellent resource for staff development
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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
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Simplify
Check the engine first
Ask the question to more than one person
Check the engine again
Speak upCREATE THIS CULTURE!!!!
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HIS
Pre Encounter Financial
Counseling
BillingPosting
Financial Counselin
g
Collection
Denials/ Audits
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The next few years/decade in
our industry