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ACTUAL FINDINGS

ACTUAL FINDINGS. HOSPITALS ACROSS THE STATE……WHAT IS HAPPENING?. DO YOU REALLY KNOW????. UPFRONT COLLECTIONS? BILL HOLD/ERROR? SECONDARY CLAIMS? RTP REPORTS? BILLERS REAL KNOWLEDGE? CONTRACTS? HOW TO READ YOUR AR SUMMARY AND DETAILS?. ACTUAL FINDINGS.

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ACTUAL FINDINGS

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  1. ACTUAL FINDINGS HOSPITALS ACROSS THE STATE……WHAT IS HAPPENING?

  2. DO YOU REALLY KNOW???? • UPFRONT COLLECTIONS? • BILL HOLD/ERROR? • SECONDARY CLAIMS? • RTP REPORTS? • BILLERS REAL KNOWLEDGE? • CONTRACTS? • HOW TO READ YOUR AR SUMMARY AND DETAILS?

  3. ACTUAL FINDINGS • ARE YOU REALLY GETTING THE REAL TRUTH FROM YOUR STAFF? • WHAT IS LOST IN THE BLACK HOLE? • WHAT DO WE DO NOW? • WHY DID WE GET HERE? • HOW DO WE GET OUT OF HERE?

  4. FINDINGS:NO UPFRONT CASH COLLECTIONS • $0.00 TO $1200.00 MONTHLY • WE DON’T KNOW HOW TO ASK FOR MONEY • OUR BOARD WILL NOT LET US ASK FOR MONEY • OUR PATIENTS WILL GO TO ANOTHER HOSPITAL • OUR PHYSICIANS GET MAD WHEN WE ASK OUR PATIENTS FOR MONEY

  5. UPFRONT COLLECTIONSHOW DO WE START? • EDUCATE PATIENTS/COMMUNITY • EDUCATE BOARD • EDUCATE PHYSICIANS • EDUCATE EMPLOYEES • NOT AN OPTION TO COLLECT • EVEN COLLECTED ON OLD BILLS • FROM $0.00 TO $64,000.00

  6. WHAT UPFRONT COLLECTIONSCAN DO FOR YOU • REDUCE BAD DEBT • REDUCE AR DAYS • INCREASE CASH FLOW • REDUCE THE COST OF DOING BUSINESS ON THE BACK END

  7. FINDINGS:BILL HOLD/ERROR • 60 BED HOSPITAL • APPROXIAMATELY 1500 OUTPATIENTS MONTHLY • APPROXIAMATELY 450 ER VISITS • APPROXIAMATELY 80 ADMISSIONS A MONTH • STAFF RUNNING REPORT FOR CFO AND “TWEEKING” THE REPORT BEFORE SENDING IT TO THE CFO

  8. Findings:BILL HOLD/ERROR • BILL HOLD FOR DIAGNOSIS NOT COMPLETE • BILL ON HOLD FOR “COMPUTER” ISSUES • BILL HOLD FOR CLAIMS ON HOLD FOR ERRORS • NO PRECERT ON CLAIM, OR EVER OBTAINED

  9. Findings:BILL HOLD/ERROR • MORE THAN $2,000,000.00 • SOME CLAIMS ON LIST WERE OVER 1 YEAR OLD • CLAIMS ON HOLD FOR “OTHER DEPARTMENT” INFORMATION

  10. How to correct:BILL HOLD/ERROR • WEEKLY STAFF MEETINGS • GOAL SETTING • PHYSICAN EDUCATION • BILLING EDUCATION • IDENTIFY AND CORRECT “COMPUTER” PROBLEMS • TRAINING • DEFINING WHO GETS AND WHEN TO GET A PRECERT

  11. Findings:SECONDARY CLAIMS • NOT FILED • OVER 650 MEDICAID CROSSOVERS NOT PAID • COMPUTER ISSUES • DID NOT KNOW HOW TO FILE A SECONDARY CLAIM

  12. How to correct:SECONDARY CLAIMS • DESIGN A PROCESS • MONITOR SECONDARY CLAIMS • EDUCATION FOR STAFF • CORRECTION OF COMPUTER PROBLEMS

  13. Findings:BILLERS KNOWLEDGE • DID NOT KNOW THE DIFFERENCE BETWEEN AN INPATIENT CLAIM AND AN OUTPATIENT CLAIM • DID KNOW WHAT A CONTRACT WAS OR WERE THEY WERE LOCATED • DID NOT KNOW WHAT THEY WERE SUPPOSED TO BE PAID ON A CLAIM • LIMITED KNOWLEDGE OF THE COMPUTER SYSTEM

  14. Findings:BILLERS KNOWLEDGE • LIMITED ACCESS TO WHAT THEY REALLY NEED IN THE COMPUTER SYSTEM • LIMITED OR NO UNDERSTANDING OF HCPC’S OR CPT’S • LIMITED OR NO UNDERSTANDING OF MODIFIERS • DID NOT EVEN KNOW WHAT AN APPEAL WAS

  15. Findings:BILLERS KNOWLEDGE • LIMITED ACCESS TO THE INTERNET • NO EDUCATION • NO TRAINING

  16. WHAT IS THE ANSWER??THE BILLERS KNOWLEDGE • WE SPEND ALL THE TIME WE CAN GENERATING REVENUE FOR OUR HOSPITAL • WE SPEND COUNTLESS $ ON COMPUTER SYSTEMS TO CAPTURE ALL THE INFORMATION WE CAN • WE SPEND COUNTLESS $ RECRUITING PHYSICIANS

  17. WHATS THE ANSWER??THE BILLERS KNOWLEDGE • WE SPEND LITTLE ON NO $ ON EDUCATING OUR BILLERS • WE HIRE AN EMPLOYEE BECAUSE THEY CAN USE EXCEL OR WORD • WE “PROMOTE” THEM BECAUSE THEY WERE NEXT IN LINE

  18. WHATS THE ANSWER??THE BILLERS KNOWLEDGE WHAT IS REALLY THE ANSWER? EDUCATION CONTINUING EDUCATION TRAINING MORE TRAINING YOU GET WHAT YOU PAY FOR EDUCATION AND TRAINING

  19. WHAT DO WE DO? • EDUCATE YOUR STAFF • EDUCATE YOUR “CUSTOMERS” • GIVE YOUR STAFF THE TOOLS THEY NEED • MEET WITH YOUR STAFF • EVALUATE YOUR STAFF • LEARN TO RUN AND READ YOUR REPORTS • IF YOU CAN’T “TRUST” A MEMBER ON YOUR “TEAM”, THEY USUALLY AREN’T A MEMBER OF YOUR “TEAM”.

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