Presented By Suzanne Adolphson, MSW, MHA

• Located in Pomona, California

• 1st class graduates in 2013

• Use a paperless system

• Define the revenue cycle

• Use the EHR to improve your revenue cycle

• Use the EHR to track improvements

Improve your revenue cycle rather than relying on cutting

expenses.

‘…find the holes in your revenue cycle and then plug

them...’

• More than just billing and collecting

• Includes all processes and procedures that have potential to impact the revenue

• Ex: treatment planning, scheduling, accounts, patient check-in/out, all things AR, etc.

ORGANIZING YOUR THOUGHTS: SYSTEMS

THEORY:

REVENUE CYCLE

USING THE EHR

WHAT IS THE EHR?

• EHR = Electronic Health Record

• Fully integrated EHR = all functions are

interconnected and do not stand alone.

TREATMENT PLAN

• Lack of treatment plan=lack of communication

• Communicates cost of treatment to patient

• A sequenced treatment plan facilitates scheduling

• Tracks potential revenue

SCHEDULING

• Need to know clinic activity.

• Using the Treatment Plan = staff knows what to collect

• Track patients who habitual fail or cancel = stable patient base

• Tracks chair utilization

• Digital format allows for use of outside vendor for confirmation of appointments

PATIENT CHECK-IN

• Treatment plan and accurate scheduling = patient check-in process

• Ensures collection or verification of patient demographics

• Allows for collection of payment before treatment • Do you want to manage credit or debt?

CODING AND DOCUMENTATION

• Treatment Plan = accurate coding

• Inaccurate coding = slower reimbursement from 3rd

party payers

• No codes = missing charges and/or reduced productivity/revenue

• Use EHR to track missing charges (codes) daily

CLAIMS PROCESSING

• Treatment Plan = accurate coding = accurate claims

• Accurate claims = faster reimbursement

• Electronic Claims and electronic attachments = faster reimbursement

• Real time processing information

DENIAL MANAGEMENT

• EHR flags incomplete claims.

• Electronic claims allows for real time management.

• Real time management = faster claim correction = faster reimbursement

• Reduces the amount of time staff spends on the phone with 3rd party payers

A/R MANAGEMENT

• Accurate demographics = fewer returned statements

• Digital format provides for sending file to 3rd party vendors for statement processing.

• Allows staff to use time in more productive manner

• Reports that assist staff in claims and outstanding balance follow-up

PAYMENT POSTING

• Tracks the amount of time from check posting in the system to allocation to individual claim

• Future: 3rd party payers will send electronic files that download payments automatically

• Staff will only have to look at the payments with exceptions

PATIENT COLLECTIONS

• Report generation for outstanding claims/patient balances

• Ease of working with collection agencies

• Collection agency can access files and download information into their system.

• Streamlines process and reduce staff involvement

TRACKING IMPROVEMENTS

• Determine which benchmarks to use to gauge improvement

• Apply a simple pre-test/post-test method to determine improvement

• Use the data your EHR collects to determine improvements

• Determine which intervals to check for improvements

CERTAIN BENCHMARKS CAN BE USED TO TRACK PROGRESS:

• Average days in A/R <50 days

• % of A/R over 90 day <20%

•% of A/R over 120 days <10%

•Billing turn-around within 5 days of treatment

•Payer turn-around Electronic claims 10-15 days Paper claims <45 days

• Bad debt expense (% of net revenue) <2%

QUESTIONS?

REFERENCESQuist, Jim & Robertson, Brian. (2004). Key Revenue Cycle Metrics. Healthcare Financial Management, 58 (9), 71-72.

Palmer, Diane. (2004). Key Tools For Turning Receivables Into Cash.

Healthcare Financial Management, 58 (2), 62-67.

Hammer, David. (2007). The Next Generation Of Revenue Cycle

Management. Healthcare Financial Management, 61 (7), 49-57.

Amatayakul, Margaret. (2005). Are You Using The EHR-Really?.

Healthcare Financial Management, 59 (11), 126-128.