fri presentation - moss and guerci - decathlon · 2019. 3. 27. · 1 championship revenue cycle:...

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Championship Revenue Cycle:

Passion & Purpose

GREATNESS: By GoodnessThe Revenue Cycle Decathlon

Friday, January 19th, 2018Gillette Stadium Clubhouse

Jonathan Moss, MBA DirectorJoseph Guerci Manager

Physician Billing OfficeBaystate Medical Practices


Passion & Purpose

Agenda

• Warm-Up / Introductions• Building Block Concepts• Competitive Events• Wrap-Up / Conclusions

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Passion & Purpose

• Largest employer in Western MA• Network of 5 hospitals, >85 practice/service

locations, almost 1K providers • UMass Medical School affiliation• BMP’s Professional Billing Office of 65 FTEs,

generating 1.4M claims, $180M NPR• Ranked #5 in Vizient BOS FY2016

Baystate Team


Passion & Purpose

• Ranked #5 in Vizient BOS 2016-17

Baystate I&T Systems / Vendors

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Passion & Purpose

• Vizient – Annual Billing Office Survey– Cost Adjusted (‘16 Medicare Labor Index)

• 10%: Cost (PA + IT) per Claim (14)• 15%: Cost (PA only) per Claim (10)

– 20%: FFS Days in AR; net credits; 365 (5)– 10%: Pt Collection Efficiency (16)– 20%: Matched NCR (24)– 12.5%: % Line Items Denied 1st Pass (16)– 12.5%: Terminal Denial Rate (14)

*Note: (Weight) (BMP Rank)

Annual Survey Ranking


Passion & Purpose

Performance Concepts (cont’d)

Managing the Revenue Cycle is like competing in a _______ ?

RANKING comes from across-the-board competence and incremental improvement (“goodness”) not greatness or massive leaps of improvement in one or two areas!

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Passion & Purpose

A Decathlon

• Combined Track & Field Event– 4 Runs: 100m, 400m, 110m hurdles*

&1500m– 3 Jumps: Long, High & Pole Vault– 3 Throws: Shot Put, Discus & Javelin

• Traditionally, “Worlds Greatest Athlete”• World’s Greatest Revenue Cycle…?


Passion & Purpose

Event: 100mSkillset: It’s all about speed and quickness!(Master the start position, power through and lunge for the finish)

Charge Lag

RC Metric:– Electronic charge capture– Clinician-centric workflow– Training, training, training– Steadfast resolve– Integration with clinical and

financial systems

Oct’17: 9.5

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Passion & Purpose

Patient Keeper

ChargeLag

RC Metric:

Cerner


Passion & Purpose

ChargeLag

RC Metric:

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Passion & Purpose

Event: 1500m

Skillset: Requires persistence & grit!(Relax, maintain steady pace, full sprint at the end)

PatientCollections

RC Metric:– Tools with integration to billing– Holistic view of health system– POS scripting/practice support– Dialer & Customer Service Calls– Persistence

FY17: 63%


Passion & Purpose

Collect% on Current Balance

Collect% on Prior Balance

TotalCollection%

FY17 75.18% 7.25% 23.59%

FY17-High Qtr 77.37% (Q3) 7.31% (Q3) 24.65% (Q2)

FY17-Low Qtr 73.31% (Q1) 7.19% (Q2) 22.22% (Q4)

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Balance Amounts “Walked Out of Practices”*:FY17: $15,034,607 or $1,252,884 / month

* Uncollected prior balances are susceptible to double-counting if patient returns.

PatientCollections

RC Metric:

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Passion & Purpose

Event: 110m Hurdles

Skillset: Overcoming payer obstacles…(Count steps, don’t slow down at hurdles, if you hit ‘em, keep going)

A/R Days& Aging

RC Metric: – Worklisting & Task Mgmt (ETM)– Productivity Standards– Focus on workflow, # “touches”– Denial mitigation– Claim Sub redesign (Enrollment)– Payer Relations

• Joint Operating Committee mtgs

Nov’17: 31.6 Days


Passion & Purpose

A/R Days& Aging

RC Metric:

BMP PHYSICIAN BILLING OFFICE

ETM PRODUCTIVITY - LAST 5 DAYS

10/30/2017

# ETM Task Outcomes Grand Days Avg Daily AVG Hourly Productivity, LAST FIVE Business Days

DATE: 10/23/17 10/24/17 10/25/17 10/26/17 10/27/17 Total Wrkd Outcomes 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM

ACCOUNTS RECEIVABLE

ATKINS, SANDRA 147 126 179 103 165 720 5 144.0 - 29.0 25.6 21.8 18.4 17.6 0.4 26.0 2.6 2.8 - -

BRITANY, CAROL 148 185 278 45 145 801 5 160.2 - 5.5 4.8 21.8 26.6 15.8 1.8 24.2 22.6 37.4 - -

DOWN, PAMELA 103 144 78 46 371 4 92.8 1.2 16.5 13.3 12.0 15.3 14.5 - 0.5 1.2 9.0 9.2 -

GOLMAN, CINDY 38 40 31 34 143 4 35.8 2.0 2.8 10.5 5.5 1.0 0.8 1.0 1.8 1.5 1.5 - -

HOWE, MELISSA 42 36 42 50 18 188 5 37.6 2.8 6.6 7.2 4.4 2.4 2.4 0.8 - 1.6 5.0 2.4 2.0

HARRIS, LINDA 6 9 24 119 158 4 39.5 0.3 8.3 3.3 1.0 3.5 0.5 2.8 7.5 5.8 6.8 - -

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Passion & Purpose

Sep-17 34.2

79.0 73.4

60.1 54.7

48.4 47.0

37.6 38.7 36.8 38.3 33.1

36.6 33.0 31.8 34.2

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30

40

50

60

70

80

90

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Fiscal Year

Billing Procedure Dvlmt

Clearing-house

Change

Automated $ Posting

PCS Redesign

Claim Form / Edit

Redesign

Flowcast Upgrade

Dashboard & Scorecard Reporting

Contract Mgmt

Coding Editor

System Intense Process Intense

Elig: File Automation

2ndary: EDI

eCode

Phone System

PK

Dialer

POS Collections

ETM

A/R Days

& Aging

RC Metric:

Claim Sub Design


Passion & Purpose

Event: Javelin Toss

Skillset: Master the process, don’t skip a step!(Grip, position, form, transition, delivery)

MissingCharges

RC Metric:– Data integrity– Arrived vs. Billed– Professional vs. Technical– Identification & reporting– (Anticipated) Notes Interface

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Passion & Purpose

MissingCharges

RC Metric:

• Missing Charges – a patient was scheduled and arrived in Centricity Business but there is no corresponding charge in PatientKeeper (PK)

• Incomplete Charges – issues identified by the coders in processing their day-to-day charges; charges now in the PK Holding Bin

• Missing Documentation – documentation that has not been completed for patients who were scheduled and arrived in Centricity Business.

• Lost Charges - NO ACTION – charges that are now past file time and cannot be billed. This will inform you of the amount of gross revenue being lost.

MISSING CHARGE REPORT

DETAILS FOR MISSING CHARGES FROM PATIENTKEEPER WITHIN FILE TIME as of 11/15/2017

SERVICE LINE SCHEDULING PROVIDER

MISSING CHARGE

WITHIN 30 DAYS

MISSING CHARGE

GREATER THAN 30 DAYS

ABARE MD,NATHAN Total 2 0AGUILLON MD,ARTURO Total 1 0AHMAD MD,MUNIR S Total 0 1AJELLO MD,ROBERT R Total 30 25AL-AZIZI MD,KARIM Total 0 2ALBERT PA,GRACE Total 0 13ALOUIDOR MD,REGINALD Total 0 3ALROUMI MD,FAHAD Total 4 2AMPADI MD,THAMPI Total 2 0ANGELIDES GASTRO PITTSFIELD, Total 1 0AQUADRO NP,MARIA A Total 0 2ARRHYTHMIA NORTHAMPTON, Total 15 0AZIZ MD,HANY Total 10 7BACH MD,NEIL Total 9 15


Passion & Purpose

Event: Discus Throw

Skillset: Become a Spin Master…(Spinning of the person and the discus the key)

CreditBalances

RC Metric:

– Identification– Task routing– Automation– Reporting

Nov’17: 3.6%

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Passion & Purpose

STAGE SUMMARY REPORT: CREDIT BALANCESColumn Labels

1-60 61-120 121-180 >181 Total Count Total Balance Row Labels Count Balance Count Balance Count Balance Count BalanceCredit Balance

Charge Corrected Credit 206 -$72,471.22 731 -$176,878.45 608 -$124,229.11 1,794 -$328,654.89 3,339 -$702,233.67

Credit Balance 3 -$6,171.69 2 -$6,149.99 3 -$580.73 8 -$12,902.41

Credit w/ Ins Adjustment 102 -$2,580.97 129 -$9,068.59 96 -$6,212.44 441 -$42,415.93 768 -$60,277.93

Credit w/ Pat Adjustment 4 -$84.16 23 -$6,220.47 16 -$1,069.51 277 -$30,006.53 320 -$37,380.67

IVF Global 13 -$43,741.84 6 -$15,806.00 3 -$4,394.13 1 -$224.00 23 -$64,165.97

Multiple Ins Payments 21 -$1,064.46 181 -$17,588.48 188 -$16,726.92 1,082 -$102,097.24 1,472 -$137,477.10

Pat Pay and No Charges 581 -$29,392.19 322 -$19,296.03 221 -$8,971.00 244 -$18,531.25 1,368 -$76,190.47

Pat Pay and TES Charges Exist 61 -$2,221.00 30 -$865.00 8 -$210.00 13 -$305.00 112 -$3,601.00

Pat Pay exceeds Credit 33 -$756.00 4 -$547.00 4 -$704.40 8 -$739.00 49 -$2,746.40

Pat Pay exceeds Credit w/ Ins Pay 1,353 -$33,993.33 1,296 -$33,885.50 975 -$27,593.43 967 -$36,889.10 4,591 -$132,361.36

Post Op 113 -$3,633.00 88 -$3,083.68 35 -$2,628.27 57 -$5,181.20 293 -$14,526.15

Redundant Ins Payments 2 -$221.88 44 -$7,676.69 42 -$14,927.37 206 -$26,274.04 294 -$49,099.98

Well Visit 94 -$3,811.15 198 -$12,571.76 118 -$5,755.76 322 -$27,165.36 732 -$49,304.03

Credit Balance Total 2,583 -$193,971.20 3,055 -$309,659.34 2,316 -$219,572.33 5,415 -$619,064.27 13,369 -$1,342,267.14

CreditBalances

RC Metric:


Passion & Purpose

Event: High Jump

Skillset: Form follows function!(Reaching for the top)

PracticeRanking

RC Metric: – “Heatmap” of Revenue Cycle metrics for each practice

– Internal benchmarking– Cooperative improvement– Encourage progress– Client Service

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Passion & Purpose

PracticeRanking

RC Metric:

BMP Revenue Management - Practice Performance MeasuresAs of September 2017

Key: 4th Quartile High performer - processes recommended to be emulated by similar practices

3rd Quartile Above Average performer - attention to frequency/timeliness and consistency of processes could move practice to the High Performer rating

2nd Quartile Average performer - processes likely need to be reviewed, responsibilities assigned and measurements monitored

1st Quartile Low performer - processes need to be scrutinized, responsibilities assigned/reassigned and measurements tightly monitored

Fiscal Year to Date As of Month End Month Totals

BA PRIMARY CARE Overall Write-Offs DenialsPK

Holding TES Charge ARDavincia

n POS CollectionsNum Billing Area Name Ranking NCR Bad Debt Eligibility Ref/Auth Overall Eligibility Ref/Auth Bin Edits Lag Days Alerts Current Prior

1001 PRIMARY CARE #15 1 98.06% 1.68% 0.00% 0.16% 5.31% 1.35% 0.50% 0.00% 0.00% 4.2 24.3 4.3%

1114 PRIMARY CARE #11 2 99.19% 0.76% 0.00% 0.00% 7.26% 1.33% 0.04% 0.00% 40.00% 10.2 24.9 4.8% 83.3% 3.8%

1115 PRIMARY CARE #13 3 97.47% 1.84% 0.06% 0.01% 5.25% 1.42% 0.09% 0.00% 0.00% 9.2 27.7 0.8% 62.2% 7.6%

1116 PRIMARY CARE #14 4 97.20% 2.43% 0.04% 0.04% 5.85% 1.75% 0.09% 1.35% 0.00% 5.2 23.7 26.4% 85.6% 0.4%

1400 PRIMARY CARE #10 5 99.02% 0.90% 0.00% 0.06% 5.52% 1.76% 0.31% 0.86% 5.88% 11.4 25.6 2.0% 80.3% 0.7%

1801 PRIMARY CARE #7 6 97.90% 1.50% 0.05% 0.12% 6.01% 1.87% 0.14% 2.90% 16.67% 7.3 27.4 13.0% 81.3% 8.8%

1802 PRIMARY CARE #4 7 97.77% 1.73% 0.05% 0.17% 5.72% 1.70% 0.24% 1.06% 0.00% 8.1 28.5 0.5% 54.2% 0.4%

1803 PRIMARY CARE #6 8 96.28% 2.84% 0.08% 0.08% 4.95% 2.07% 0.17% 1.68% 9.30% 7.5 25.7 31.3% 75.3% 0.6%

1804 PRIMARY CARE #3 9 97.83% 1.62% 0.03% 0.24% 7.54% 2.85% 0.26% 26.83% 0.00% 4.7 26.5 73.8%

1805 PRIMARY CARE #12 10 94.43% 4.95% 0.10% 0.39% 4.38% 3.09% 0.19% 2.29% 37.50% 6.6 24.5 17.0% 100.0% 13.5%

1806 PRIMARY CARE #16 11 95.78% 3.95% 0.11% -0.24% 5.65% 1.73% 0.22% 5.43% 28.57% 10.3 27.7 3.4% 95.8% 0.3%


Passion & Purpose

PracticeRanking

RC Metric:

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Passion & Purpose

Event: Pole Vault

Skillset: Use every asset to reach new heights…

NCR

RC Metric: • High profile event– Budget reconciliation strategy– Cross department accountability

• Revenue Management Oversight Group (RMOG)

– Visibility / reporting

Nov’17: 94.5%


Passion & Purpose

87.6% 88.1%89.3%

90.7%

91.8%92.9% 93.7%

94.2%94.7%

93.8%94.4% 95.1% 94.8% 95.1%

82.0%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

Sep-04 Sep-05 Sep-06 Sep-07 Sep-08 Sep-09 Sep-10 Sep-11 Sep-12 Sep-13 Sep-14 Sep-15 Sep-16 Sep-17

Fiscal Year

13yr Improved Rate ~ $9.1M in FY17Cumulative Improved Collections ~ $80.5M

~$80.5M

NCR

RC Metric:

Bad Debt: 3.52%Other: 1.35%

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Passion & Purpose

Last 3 “Events”

• SHOT PUT “Heavy Lift”: • Coding Edits & Contract management

• 400M “Balance of Speed & Endurance”: • Staff appreciation

• LONG JUMP “Take the Leap”:• Teaching – future providers cost-conscious care

• What’s the price tag?


Passion & Purpose

Wrap Up / Conclusions

• Avoid statistical deception– Understanding reverse effect metrics– Incremental improvement across the board

• Benchmark performance– Various well regarded surveys

• Focus on areas of weakness• Share ideas……

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Passion & Purpose

Share With Peers

• “Ad-Free” networking opportunities• Revenue Cycle Network of Peers

– Previously, Yahoo Group “Revenue Cycle Council”

• Interact with SLACK.com app– Workspace URL:

revenuecyclecouncil.slack.com


Passion & Purpose

Welcome To Slack

• Sharing info without a ‘sales pitch’

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Passion & Purpose

Questions?

Contact Info:[email protected];[email protected];

fri presentation - moss and guerci - decathlon · 2019. 3. 27. · 1 championship revenue cycle:...

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