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Practice Management 101 Cycle of Service Assessment

Practice Management 101 Cycle of Service Assessment. May 19 th , 2011. Who. Paul Casey, President and CEO 20+ years in Practice Management Founded MD Solutions in 2000 Vision – Maximize Organizations Investment in Technology Proficient with a multitude of PMS Technologies

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Practice Management 101 Cycle of Service Assessment

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  1. Practice Management 101Cycle of Service Assessment May 19th, 2011

  2. Who Paul Casey, President and CEO • 20+ years in Practice Management • Founded MD Solutions in 2000 • Vision – Maximize Organizations Investment in Technology • Proficient with a multitude of PMS Technologies • Revenue Cycle Expertise • Former Reimbursement and IT Leader • Mt. Auburn Hospital – Professional Services • Cancer Center of Boston • Various roles with Brigham Beth Israel Hospital

  3. Today’s Goals • Understand “Cycle of Service” • Ability to evaluate “Cycle” • Ability to Identify “Opportunity” • Ability to manage “Change”

  4. Final Thoughts • Evaluate • Identify Opportunity • Prioritize your focus • Work on top “3” priorities • Measure your change • Make this an ongoing process, keep challenging yourself and your organization

  5. Pre-Registration/Registration/Re-Registration • How is each these patient contacts handled? • What information is obtained during this initial contact? • Financial expectations set? • Do you send a pre-visit letter/brochure/practice guide? • Is the insurance information obtained at this time? • If so, acceptable plan? • Full Registration vs. Phone • Is eligibility verified at this point? • Do you qualify ability to pay prior to services?

  6. Scheduling • How do you schedule? WFE/PUI? • Auto/Resource/Provider? • Do you use appointment datasets? • Do you know how staff is booking appointments? • Auto vs. Manual? • Are you using the wait bump cancel list? • Are you reserving add on slots? • Tracking No-Shows? • What is your patient retention strategy?

  7. Pre-Visit Preparation • Check patient eligibility prior to patient visit? Explain? • Ensure referrals are in place prior to patient visits? Explain? • Practice patient reminder strategy? Explain? • Another opportunity to set expectations (Visit/Financial) • Do you review pending appointments for patient/collection balances? • Online patient portal strategy? • Do patients have ability to complete required forms online…

  8. Patient Check-In • Automated Check-In (Kiosk)? • Traditional Check-In? Arrive in system? Encounter Forms? • Eligibility? If change in coverage, verified? • Co-pay at check-In? (If so, what accounting controls?) • Staff trained to collect money due from patients? • Do you attempt to collect past due amounts? • Do you post payment to system at this point? OTC? • Do you use a system generated face sheet? • Copies of Drivers License and Insurance Cards? • Appropriate signage in practice?

  9. Charge Documents/Capture • Paper/Electronic? • How often are these updated? • Utilizing forms manager? • Are you doing out of office services? • How are you ensuring all billable revenue is captured?

  10. Patient Check-Out • How do charges get into system and when? • Manual • Interface from EMR • Interface from Third Party • How are you ensuring all billable revenue is captured? • How long between DOS and Post date? • Do you reconcile to schedule? • Do you reconcile cash collections at TOS? • Do you utilize a TOS Receipt? • Do you use a “NEXT DAY” report?

  11. Patient Check-Out Cont. • Do you collect co-pays, prior balances? • Do you accept credit/debit cards? • If unsuccessful, what expectations are set at this time? • Send patient home with TOS statement and return envelope? • Patient retention strategy? Do you use some type of recall listing? Explain?

  12. Claims Production/Management • What clearinghouse are you using? • What percentage of claims are being sent electronically? • What pre-claim edit reports are utilized prior to submission? • Are you utilizing Ingenix? Hosted? • Do you utilize a log to track submissions and successful receipt? • Are you familiar with “CLMRPT”? • How often are claims produced? • Are you using cross practice claims utility?

  13. Claims Production/Management cont. • Are you or have you considered automating this process? • How do you manage clearinghouse rejections? • Are you using Task Manager to manage edits, clearinghouse and payor rejections? Explain? • Do you have oversight in place to ensure completeness of this process? Explain? • Are you sending secondary claims electronically? • Are you claims programmed to send COB_A Info? Formerly referenced as medigap?

  14. eRemit • Are you automating your posting process? • What percentage of transactions posted this way? • Run reports to validate percentages, could be a surprise! • What plans are you posting? • What challenges exist? • When denials received, posting appropriately? • Are you posting patient payments electronically?

  15. Payment/Denial Processing • Do you use a lock box services? • From receipt date, how many days to post? (24 Hours?) • Does cash posting handle denials? • How are EOB’s stored for retrieval? • How is each batch reconciled back to the deposits? • How is this maintained throughout the month? • How do you measure staff productivity and quality?

  16. Statement Process • Do you currently use a statement vendor? If yes, who? • What is the current cost per statement? • What is included in the cost? • Do you send return envelope with your statements? • What is your statement interval set at? • How often do you run statements? • Do you have a statement that patients understand? • Can you accept payments online? • Have you considered electronic bill pay/presentment? • Does your vendor have ability to customize your output?

  17. Follow-up (No Response) • At what point does insurance follow-up begin? • What tools do you use to manage this process? • Task Management? Reporting? Other? • If TM, what challenges are you facing? • If reporting, why not TM? • Do you use auto adjust/rebill programs? Explain? • Have you used custrebill? • How do you measure productivity and quality of staff?

  18. Appeals (Denied/Posted) • Describe how your practice manages denials/appeals? • What tools are used in this process? • Do you set dollar limits on appeals? • What is the largest/most common denial types? • eCommerce • Denial Reports by Transaction Category • Do you incorporate TM into this process? • How do you measure productivity and quality of staff?

  19. Paid in Full/WriteOff • What is your practice bad debt write off policy? • Do you use collections plus? • Do you use outside collection agency? Are they effective? • How many statements prior to write off/placement? • Do you make calls prior to write off/placement? • If account transferred to collection, is there indication on account? How is chart notated? • How do you handle hardship? • Do you use an early in/early out program? • Is your in-house collection efforts profitable?

  20. Final Thoughts • Evaluate • Identify Opportunity • Prioritize your focus • Work on top “3” priorities • Measure your change • Make this an ongoing process, keep challenging yourself and your organization

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