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Focusing an Organization on Financial Success 2015 Mollie Drake MBA, CPAM Senior Director, Corporate Access Management
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Focusing an Organization on Financial Success
2015
Mollie Drake MBA, CPAM
Senior Director, Corporate Access Management
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Today’s Agenda
About Scripps
Revenue Cycle Functions
A Focus on Measures
A Focus on Structure
A Focus on Training
Outcomes
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About Scripps
5 Hospitals on 4 Campuses located in San Diego Not for Profit More than 2600 Affiliated Physicians Two Level I Trauma Centers Extensive Ambulatory Care Network
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Revenue Cycle Functions
Scheduling / Access Management
Case Management
Charge Description Master
Outpatient Revenue Management
Health Information – Chart Management and Coding
Billing and Follow Up
Transactions / EDI
Self Pay Collections / Customer Service
Underpayment Audit and Collections
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What’s Measured
Cash Collections POS Collections DNFB – Bill Edits DNFB – User Holds AR Days Credit Balances AR Over 90 Days Bad Debt Write-offs Bad Debt Recoveries Charity Write-offs Gross Revenue Aged Accounts by Payer Cash as % of Charges Charge Errors
Contractual Adjustments Underpayment Collections Saved / Avoidable Days Medicare / Sr. HMO LOS Third Party Liens Interest Collections Appeals Denials IME Payments Late Charges RAC Audits One Day Stays Pre-admit Percentage Unapplied Cash
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The Reports
Daily Cash Collections
Semi-Weekly Cash Collections Adjustments AR Balances AR Days Average Daily Cash Average Daily Revenue Average Daily Adjustments
Monthly Revenue Cycle Summary PI Initiatives Revenue Management
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The Structure
Targets Set System Goals Individual Hospital Goals
Systemwide Steering Committee Meets Weekly Reviews Key Measures Reports on Current Initiatives Policy Review and Approval
Hospital Committees Meet Bi-Weekly Review Key Measures Report on Current Initiatives Identify Obstacles to Discharge
Accountability established at all levels for all goals.
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The Structure
EVP/CFOEVP/CFO
VP, Revenue CycleVP, Revenue Cycle
Revenue Cycle Steering Committee:PFS, Access, Case Mgt, HIM, Revenue Mgt, Payer Relations, Contracting,
Audit & Compliance, Finance, Accounting, Information Systems
Revenue Cycle Steering Committee:PFS, Access, Case Mgt, HIM, Revenue Mgt, Payer Relations, Contracting,
Audit & Compliance, Finance, Accounting, Information Systems
Mercy San DiegoMercy Chula Vista
Mercy San DiegoMercy Chula Vista EncinitasEncinitas La Jolla
Home Health
La JollaHome Health GreenGreen
Bi-Weekly Facility Subcommittees:Bi-Weekly Facility Subcommittees:
Scripps HealthBoard of Trustees
Scripps HealthBoard of Trustees
CEOCEO
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Reality
The PlanMeasuresStructureGoalsLeaders
The TeamHigh School EducationTrained on the JobRole SpecificFront End/Back End Conflict
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The Gap
How to bridge the gap?
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The Training
A three level structured training program Over 70 courses Front End to Back End Consistent Information Focused Delivery Dedicated Resources Advancement Opportunity
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The First Tier
Level I – Core Competencies 23 Courses All Revenue Cycle Line Staff Concepts and Mechanics Professional and Technical Fundamental Understanding
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Level I Courses
Billing Terminology
Commercial Carriers
Customer Service
Effective Communication
HMO 101
Hospital Billing Overview
Insurance Follow Up
Introduction to Capitation
Introduction to Medi-Cal
Patient Accounting
Patient Confidentiality
Patient Registration
Point of Service Collections
PPO Plans
Regulatory Bodies
Senior HMO Coverage
Telephone Skills
Tri-Care and You
Understanding COB and TPL
Understanding CMS
Welcome to Medicare
Workers’ Compensation
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Boot Camp
9 day programComprehensive workbookLecture, exercises, role playingHands on system practiceSecret shopperTour of CBOPre-test
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Core Competency Test
203 Questions 75 True/False 75 Multiple Choice 50 Fill-in The Blank 3 Insurance Cards
16 Subjects Passing Score 80%
Failure = Loss of Position
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Level II
Advanced Training 25 Courses Builds on Core
Competencies Patient Accounting
Certification
Apply the knowledge
and get the promotion!
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Level II Courses
Assigning Liens
Business Correspondence
Collection Techniques
Conducting an Inservice
Conflict Resolution
Dealing with Difficult People
Disproportionate Share
Effective Communications
Allscripts Reports
Follow Up Queues
Health Information Overview
Medical Terminology
Medicare Compliance
Medicare Cost Report
Patient Confidentiality
Payer Contracts
Risk Pools
Scheduling System
Secondary Systems
Self Pay Negotiations
System Troubleshooting
Unbilled Accounts
Understanding the ChargeMaster
Utilization Review
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Moving to Level II
Complete a Project Submit the work Blinded application Peer review Follow up review Promoted once
approved
Pass the CRCS Pay in advance Preparation courses Reimbursed once
passed Certificate presented
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Sample Projects
Break Schedule Disaster Preparedness Gastric Bypass Misdirected Checks Procedure Manuals Resource Books Automating Scheduling
Correct Posting Codes Reimbursement
Calculators Letter Library POS Collections Physician Outreach Insurance Directory
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Keeping Level II
One Inservice One Teambuilding Exercise Less Supervisory Assistance Assigned Complex Problems Mentor to New Employees
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Level III
27 Courses Builds Professional
Skills Develops Computer
Skills
Lead a Performance Improvement Project
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Level III Courses
Case Management
Cost/Benefit Analysis
Customer Service
Allscripts Reports II
Effective Presentations
Ethics in Business
Graphing Statistics
Leading an Effective Meeting
Medical Terminology
Medicare Compliance
Microsoft Excel; 1,2,3
Microsoft PowerPoint; 1,2,3
Microsoft Word; 1,2,3
Motivational Skills
Patient Confidentiality
Process Mapping
Project Management
Revenue Management
Technical Writing
Time Management Skills
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Moving to Level III
Propose a Performance Improvement Project Management Team Approves Mentor Assigned Present Final to Management Team Management Team Evaluates Promotion upon Approval
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Sample Projects
Cash Pricing Blue Cross Prefixes AR over 90 Boutique Program Guide Service Line Standardization Medi-Cal Billing Manual Interest Calculation and Collection Front End Work Queues Maternity Collections
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Keeping Level III
Represent Department on Committees Develop / Update Policies and Procedures Problem Resolution Mentor to Level II
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Outcomes
Staff Interaction
Cross Training
Conflict Replaced with Compassion
Role Recognition
Bench Strength
Joint Commission Compliance
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The Results
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The Results
Reduced monthly average from 74.4 to 70.8 days
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The Results
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The Results
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Last Thoughts
“Knowledge is power.” -- Francis Bacon
“Success in business requires training and discipline and hard work.”
--David Rockefeller
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Questions
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Fun With Training
