Tools to Strengthen Your Revenue Cycle
October 26, 2015
Daryn Eikner, MS
Vice President Service Delivery Improvement
National Family Planning &Reproductive Health Association
2
Increasing Revenue
Strengthen the revenue cycle process
Maximize provider productivity
Increase operational efficiency and effectiveness
Today
Introduce the revenue cycle assessment tool
Introduce the revenue loss tool
Front-end Operations
Clinical Encounter
Back-end Billing Functions
Administrative
Components of Revenue Cycle
5
BarriersComponents of the Revenue Cycle
BarriersThe Revenue Cycle Assessment Tool
BarriersThe Revenue Cycle Assessment Tool
Revenue Cycle
Assessment
Staffing &
Functions
BarriersReflection
&Planning
BarriersThe Revenue Cycle Assessment
Section 1. Policies and Procedures
Section 2. IT Systems
Section 3. Front End Billing Processes
Section 4. Clinical Billing Processes
Section 5. Coding and Documentation
BarriersThe Revenue Cycle AssessmentSection 6. Claims Submission
Section 7. Remittance Reconciliation
Section 8. Accounts Receivable Management
Section 9. Analysis
Section 10. Third-Party Payer Contracts
Section 11. Provider Credentialing
Appointment scheduling
Pre-registration & authorization
Reminder calls
Registration/check-in
Eligibility verification
Handling of cash
Reconciliation Process
Section 3. Front End Billing Process
Barriers
• HIPPA Privacy Protections• HIPPA Security Protections• KPIs• Reports
Section 9. Analysis
BarriersFeedback
Current Practice Recommendations
Fee Schedules
Fees are set to Medicaid reimbursement rates and rather than the cost of services.
Revise fee schedule to reflect the cost of the services being provided.
Last cost analysis was completed in 2010. Conduct a cost analysis.
Cash
There are no formal, documented processes for the handling of cash received from clients.
Develop & document procedures for the handling of cash.Train staff on new procedures.
BarriersThe Revenue Cycle Assessment Tool
Rhonda Staley, MPHTitle X Sterilization Manager and Revenue Cycle EvaluatorSouth Carolina Dept. of Health & Environmental Control
Questions
Confidential & Covered: Revenue Loss Logic &
Tool
Funding for this project was provided by the Office of Population Affairs (Grant Number 1 FPRPA006059-01-00). The views expressed by this project do not necessarily reflect the official policies of the Department of Health & Human Services; nor does mention of trade names, commercial practices, organizations imply official endorsement by the U.S. Government.
Revenue Logic
• Logic to analyze revenue data to determine unrealized revenue due to an inability to submit claims because of a client request confidentiality.
• Identify visits by patients confidential billing
• Access to relevant claims information for those visits
• Organizations adapted screening processes and retrained staff to implement
Revenue Loss Tool
C&C SAMPLE REPORT11/1/2015 - 11/30/2015
$
29
6
5
Total Revenue
Total number of visits made by clients who have insurance and request not to use it due to need for confidential billing services GO TO TAB #2
Total number of visits made by clients who have insurance but request not to use it
REPORT NAME:REPORT PERIOD:
Total number of visits made by clients
CLAIM
ID
SERV
ICE MONTH
TYPE
OF I
NSURA
NCE
OTHER
INSU
RANCE
TYPE
ALL C
HARGES
(DOLL
ARS)
SLID
ING FE
E SCALE
?
SLID
ING FE
E
PLAN
Amount
Paid
(Doll
ars)
LOST
RE
VENUE (
DOLLARS
)
CPT/H
CPCS
Code (
1)
CPT/H
CPCS
Charg
e (1)
ICD-10
DIAGNOSIS C
ODE (1)
ICD 10 D
IAGNOSIS (1
):
DESCRIP
TION
PATIE
NT
AGEPA
TIENT
SEX
Revenue Loss: Illustration
Peggy, a 19 year-old female, visits her family planning provider. Peggy lives with her parents and is covered by their insurance.Peggy does not want them to know that she was in the clinic today.
Peggy wants to initiate contraceptives today but is not sure which method she wants. The clinician counsels her for 13 minutes on her options for contraceptive methods. Peggy decides to initiate oral contraceptives today and leaves the clinic with a 3 month supply of combined oral contraceptives.
The clinician collects a specimen for a CT/GC screening and sends it to an outside lab.
The entire visit was 18 minutes.
Revenue Loss Tool
Revenue Loss Tool
Evelyn KieltykaSr. Vice President of Program Services
Rhonda WoodmanMedical Billing Manager
Questions
National MeetingMarch 5-8, 2017