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
Championship Revenue Cycle:
Passion & Purpose
Agenda
• Warm-Up / Introductions• Building Block Concepts• Competitive Events• Wrap-Up / Conclusions
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Championship Revenue Cycle:
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
Championship Revenue Cycle:
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• Ranked #5 in Vizient BOS 2016-17
Baystate I&T Systems / Vendors
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Championship Revenue Cycle:
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• 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
Championship Revenue Cycle:
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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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Championship Revenue Cycle:
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…?
Championship Revenue Cycle:
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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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Championship Revenue Cycle:
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Patient Keeper
ChargeLag
RC Metric:
Cerner
Championship Revenue Cycle:
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ChargeLag
RC Metric:
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Championship Revenue Cycle:
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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%
Championship Revenue Cycle:
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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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Championship Revenue Cycle:
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
Championship Revenue Cycle:
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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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Championship Revenue Cycle:
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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
Championship Revenue Cycle:
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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Championship Revenue Cycle:
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
Championship Revenue Cycle:
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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Championship Revenue Cycle:
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:
Championship Revenue Cycle:
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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Championship Revenue Cycle:
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%
Championship Revenue Cycle:
Passion & Purpose
PracticeRanking
RC Metric:
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Championship Revenue Cycle:
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%
Championship Revenue Cycle:
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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Championship Revenue Cycle:
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?
Championship Revenue Cycle:
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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Championship Revenue Cycle:
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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
Championship Revenue Cycle:
Passion & Purpose
Welcome To Slack
• Sharing info without a ‘sales pitch’
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Championship Revenue Cycle:
Passion & Purpose
Questions?
Contact Info:[email protected];[email protected];