The Revenue Cycle and the Electronic Health Record

1. Presented By Suzanne Adolphson, MSW, MHA The Revenue Cycle and the Electronic Health Record

2. Western University of Health Sciences College of Dental Medicine • Located in Pomona, California • 1st class graduates in 2013 • Use a paperless system

3. Objectives: • Define the revenue cycle • Use the EHR to improve your revenue cycle • Use the EHR to track improvements

4. Improve your revenue cycle rather than relying on cutting expenses.‘…find the holes in your revenue cycle and then plug them...’

5. Defining Your Revenue Cycle • 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.

6. Organizing Your Thoughts: Systems Theory: Revenue Cycle

7. Using the EHR What is the EHR? • EHR = Electronic Health Record • Fully integrated EHR = all functions are interconnected and do not stand alone.

8. Each Area Impacts The Revenue Cycle • Treatment Plan • Lack of treatment plan=lack of communication • Communicates cost of treatment to patient • A sequenced treatment plan facilitates scheduling • Tracks potential revenue

9. Each Area Impacts The Revenue Cycle • 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

10. Each Area Impacts The Revenue Cycle • 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?

11. Each Area Impacts The Revenue Cycle • 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

12. Each Area Impacts The Revenue Cycle • Claims Processing • Treatment Plan = accurate coding = accurate claims • Accurate claims = faster reimbursement • Electronic Claims and electronic attachments = faster • reimbursement • Real time processing information

13. Each Area Impacts The Revenue Cycle • 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

14. Each Area Impacts The Revenue Cycle • A/R Management • Accurate demographics = fewerreturned 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

15. Each Area Impacts The Revenue Cycle • 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

16. Each Area Impacts The Revenue Cycle • 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

17. Improvement? • 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

18. Benchmarks • 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%

19. Questions?

20. References Quist, 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.