strategies to improve practice cashflow

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Strategies to Improve Cash Flow

Secret Weapons that Can Improve Your Practice Revenue


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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.


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


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


Issues that Influence RCM Strategy

Meaningful Use

HIPAA Security Standards Accountable for Integrity Assure Accessibility

ACA Effect Higher Deductible Health Insurance Exchanges

“Cloning” Records


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


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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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


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


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


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


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


Agree on Operational Standards

Standards Based on EHR Features Product Use Payer/ACO Practice Services Doctors


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


RCM Checklist Items

Reconcile Charges Appointments Cancellations No Shows

Supporting Documentation for Clinically Significant Events

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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


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


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


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


RCM Checklist Items

Quality Assurance Documentation Standards Outlier Detection – Treatment and/or Management

Meaningful Use


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


RCM Reporting

Maintain Statistics to Prove Performance Payer Patient Population Provider Location

Report on Standards Performance Trends


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


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?


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?


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?


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?


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.)


QUESTIONS

ANSWERS


RONALD B. STERLING, CPASterling Solutions, Ltd.

[email protected](301)681-4247BLOG: Avoid-EHR-Disasters.com


Conventus Contact Information

Susan Lieberman, MBAVice President, Risk Management

Conventus Inter-Insurance Exchange877-444-0484, x466

www.conventusnj.com