everyone has a role in managing the revenue cycle · 2018. 11. 2. · everyone has a role in...
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EVERYONE HAS A ROLE IN MANAGING THE REVENUE CYCLE
KPCA Fall Conference November 6, 2018
Day 1 TopicsAgenda•Welcome & Introductions•Review Learning Objectives•Why are we here?•Why does it matter?•Brief Overview of the Revenue Cycle•Group Activities
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FQHC Revenue Cycle Welcome & Introduction
• Why we are here
• Who’s in the audience?
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Learning Objectives
Describe critical steps & staff roles in FQHC Revenue
Cycle management
1
Analyze your health center’s
current Revenue Cycle workflows &
identify opportunities for
improvement
2
Review examples of revenue cycle
metrics
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FQHC Revenue Cycle Why are you here?
Take 5 min and answer the following questions individually:
•What do you think is going right with your HC’s Revenue Cycle?
•What do you think needs the most improvement with your HC’s Revenue Cycle?
•What questions are you trying to answer by coming to this session?
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FQHC Revenue Cycle Why are you here?
Report-Out
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FQHC Revenue Cycle Why does it matter?
Cash Flow!!
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FQHC Revenue Cycle Revenue Cycle Overview
The Healthcare Financial Management Association (HFMA) defines the revenue cycle as:
"All administrative and clinical functions that contribute to the capture, management, and
collection of patient service revenue."
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Revenue Cycle Overviewycl
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Revenue Cycle Overviewy
Let’s Decide on one!!
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Revenue Cycle Overviewycl
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FQHC Revenue Cycle
Revenue Cycle Overview
Major Steps in the Revenue Cycle
•Claims Preparation
•Claims Submission
•Claims Management
•Reporting12
FQHC Revenue Cycle Revenue Cycle Overview
Claim Preparation:• Patient Registration: the process of collecting a
comprehensive set of data elements about the patient including demographics, financial and clinical
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FQHC Revenue Cycle Revenue Cycle Overview
Claim Preparation (Cont.)•Patient Eligibility
• Verifying the Payer Source• Determining Sliding Fee Scale Eligibility • Obtaining Prior Authorization • Verifying Patient’s PCP
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FQHC Revenue Cycle Revenue Cycle Overview
Claims Submission (Cont.)•Charge Entry:
•Automated or manual?•Closing the encounter/visit
•Rules Engine: •Claim Edit/Claim Scrubbing
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FQHC Revenue Cycle Revenue Cycle Overview
Claims Submission (Cont.)
•Claims Transmission:• Billing Department to Clearinghouse• Clearinghouse to Payer
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FQHC Revenue Cycle Revenue Cycle Overview
Claims Management
•Accounts Receivable (A/R) Follow-Up•Payment Posting•Denial Management•Accounts Receivable (A/R) Follow-Up•Patient Balance Collections
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FQHC Revenue Cycle Revenue Cycle OverviewReporting• Reporting/Analytics, must be:
• Measurable• Timely• Transparent• Geared to the correct audience• Actionable
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FQHC Revenue Cycle Group Activity #1
•Revenue Cycle Management (RCM) Mapping•Instructions (Handout)
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FQHC Revenue Cycle Group Activity #1
•Review & Report Out
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FQHC Revenue Cycle Group Activity #2
•Roles & Responsibilities•Instructions (Handout)
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FQHC Revenue Cycle Group Activity #2
•Review & Report Out
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FQHC Revenue Cycle
The BOTTOM LINE is the Revenue Cycle is a detailed process
that has to be managed that is the responsibility of the entire HC team.
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FQHC Revenue Cycle
Questions?
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FQHC Revenue Cycle Contact Information
Martha Wooten
Cell: 505-947-3911
Sherri Goemmer
Cell: 505-228-984925