integrating care coordination in the revenue cycle
DESCRIPTION
West Jefferson Medical Center expert, Darlene Gondrella, reviews strategic initiatives for hospitals to integrate care coordination and revenue cycle teams for better outcomes across the organization. •Engage care coordination in the revenue cycle process •Integrate clinical and revenue cycle teams •Bridge communication gaps across the organization •Reduce readmissions through an integrated approach to patient discharge and follow-upTRANSCRIPT
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TraceCommunication.com
“Integrating Care Coordinationin the Revenue Cycle”
May 6, 2014 | 1pm ET, 10 am PT
Thank you for joining today’s webinar. The presentation will begin at 1pm EST.
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TraceCommunication.com
“Integrating Care Coordinationin the Revenue Cycle”
May 6, 2014 | 1pm ET, 10 am PT
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Today’s Webinar Agenda
• Housekeeping Items• Introduction of Speakers and Presentation• Q&A Session
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Housekeeping Items
• Welcome to Today’s Webinar!– Phone lines will be muted– For technical support, please contact:
WebEx Technical Support 866-229-3239 or [email protected]
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Webinar Playback
• Today’s presentation will be recorded.• View past recordings on our website:
TraceCommunication.com/Webinars
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Asking Questions
• Submit questions at any time using Q&A box in the bottom right hand panel
• Questions will be addressed at the end of the presentation
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TraceCommunication.com
“Integrating Care Coordinationin the Revenue Cycle”
Darlene GondrellaVP of Care Coordination
West Jefferson Medical Center
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Today’s Presenter
Darlene Gondrella, RN, BSN, CCMVice President, Care Coordination
West Jefferson Medical Center
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Today’s Agenda
Engaging care coordination in the revenue cycle
Integrating clinical & revenue cycle teams
Bridging communication gaps
Reducing admissions
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Care Coordination Strategies for Improved Performance
Care Coordination at WJMCIntegration with the Revenue Cycle
Processes to Improve Rev Cycle Performance
Darlene Gondrella
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West Jefferson Medical Center
427-bed, not-for-profit community hospital in Marrero,
LA, close to New Orleans
Medical staff of more than 400 and employee/volunteer base of
1900
National awards for clinical excellence across many of our
subspecialties
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Care Coordination at WJMC
• Case managers• Social workers• Discharge planners• Discharge expeditor
Inpatient
• Case managersOutpatient
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Care Coordination in the Revenue Cycle
Chief Administrative Officer• Patient Access• Case Management (Inpatient and Outpatient)• Patient Business Services• Health Information Management• Physician Clinics• Hospitalists• Cardiac/Neuro/Oncology /Palliative Care Service Lines• Marketing• Retail
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Integration with Care Coordination
Bridging communication gaps
Decrease unnecessary denials
Reduce readmissions to prevent reduction in pay penalties
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Revenue Cycle Team
• Patient Access Services• Case Management• Patient Business Services• Health Information Management• Service Line Development
Meets monthly with CAO
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Revenue Cycle Team
Coding
Denials
Trends
RAC audits
Training needs
New CMS rules and regs
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Bridging Communication Gaps
Monthly meetings
Education, Education, Education
Access to transparent,
timely patient information
and data
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Education
Physician office lunch & learn sessions
Monthly hospitalist meetings
Articles in physician newsletters re: upcoming regs/changes that affect the Medical Staff
Interdisciplinary team meetings for new service line development
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CM in Relation to the Revenue Cycle
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CM Challenges
•Number of days approved, level of care•Lack of clinical
Medical Necessity Denials
•Inaccurate or incomplete documentation•Missing information
Documentation Failures
•Rework, inefficiency•Payment delays, underpayment
Time Constraints
•Duplication•Manual, paper-based process
Medicaid Notification
•Time intensive•Back and forth
Discharge Planning
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Technology Implementation
Real-time recording of all conversations
Ability to send transcripts of recordings to insurance companies
Reduced denials, less time spent preparing
appeals
Complete record of information coming in
and going out
Improved workflow and time savings
Savings in paper record storage
Capture and save information in a single
click
Less time spent printing, scanning and
filing
Reduced medical necessity denials
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Patient View
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Coordinate daily CM activities
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CM in Relation to the Revenue Cycle
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Pre-Admission
Patient class for ED Admissions
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Admission
Document clinical reviews for urgent/emergent
admissionsRecord admission
notification
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Concurrent
Record concurrent review calls with payers
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Discharge
Blast fax discharge placement
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Post-Discharge
Insurance logs/denial letters
Patient Follow-up
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Denial Appeals Follow-up
More efficient use of time • Proof of authorization• Proof of notification• Proof of clinical info sent
Proof of authorization lead to decreased denials
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Initial Outcomes
Avoided initial denials from payers by showing documented proof of calls
Improved turnaround time on claims payments by 30 – 60 days
Increased percentage of medical necessity denials overturned from 56 percent to nearly 83 percent
Reduced number of medical necessity denials
Allowed case manager previously handling appeals to take on full case load
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Patient Follow-up
Outpatient Care Coordination•Phone calls post discharge – recorded•Early identification of symptoms – early intervention•Review calls for quality•Teachback•Customer service•Complaints
•OP can resend information that was previously sent to HH agency with click of a button
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Reduce Readmissions
CTC Clinic•Free service – appt in 24-48hrs.•Assists PCP when they do their follow up visit in 3-5 days
Dispo codes for planned readmits – CM
working with HIM to ensure correct coding
Dispo codes for AMA
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Conclusion
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Questions?
Please submit questions using the Q&A section in the participant panel.
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Thank you!
Blair WrightThe White Stone Group, [email protected]
Darlene GondrellaWest Jefferson Medical Center