Palm Beach County Medical Society & Keiser University

LUNCH & LEARN

MANAGERS/ADMINISTRATORS MEETING

Wednesday, September 9th, 2015

:

“Revenue Cycle Management”

SPEAKER

Juan H. Kouri, MHSADirector Business DevelopmentProMD Practice Management

In times of declining/decreased revenue, Practice Managers must evaluate their current operations to assure they are using a “best practice” approach in the following key areas of their operations:

Financial

Practice Management System/EMR

Billing & Collections – performance benchmarks

Cash controls ◦ System generated receipts ◦ Patient payments posted by Front Desk & reconciled at

end of day (system to match actual cash collected)◦ Daily practice reconciliation (“Daily Closing” should

include total revenue collected & deposited to bank)

Monthly practice performance report generated to track/trend performance

Patient Registration Form should include financial liability verbiage allowing practice to charge back patient for any collection fee associated with non-payment

Financial record keeping using accounting-type software (e.g. QuickBooks) to track revenue & expenses

Reconciliation of practice management system VS QuickBooks

Workflow that ensures all patients are verified to confirm coverage, identify patient’s financial responsibility, and collect at time of visit

Employees aware of contractual amounts in order to collect co-insurance & deductibles at time of service

Fee schedules (insurance plans, Medicare, Medicaid, etc.) entered in order for system to identify underpayments.

EMR capability (interface with PM)

Ability to generate system encounters

Track “open” encounters via system report to assure all charges are posted

EMR system should be certified in order to qualify for stimulus monies.

The financial viability of a medical practice depends on the performance outcomes of its physician billing process. Establishing industry recognized benchmarks* for key performance measures can assist in determining whether your revenue cycle and account receivables are performing at optimal levels.

* Benchmarks were established using Medical Group Management Association (MGMA) industry standards in conjunction with ProMD proprietary statistical data

1. Proper Financial Responsibility documents2. Correct and accurate patient Appointment Scheduling & Registration3. Copies of Insurance card and ID card

4. Determination and collection of patient responsibility (co-pays, deductibles and co-insurance)

5. Check-in and Check-pout process

1. Charge Posting (Modifiers) 2. Claim Submission 3. Payment Posting 4. Insurance Collections 5. Guarantor Collections

No. 11 on that MGMA report: collecting from self-pay patients or those with high-deductible health plans

Typically, front-desk personnel are interested in checking the patient in and confirming and updating insurance coverage information. Requesting payment from patients who may have medical issues and want to visit with the doctor isn't easy

MGMA Perspective (Cont’d.)

Understanding the different types of insurance coverage and plans patients may have. ◦ Is the patient a self-pay patient? ◦ Do we only have to worry about collecting a copayment? ◦ Does the patient have a high-deductible that hasn't been

met yet this year? ◦ Will the patient have a coinsurance obligation that won't be

known until he or she is seen by the doctor?

Each of these categories may trigger a different approach to collecting on day of service. The collection process should be outlined for front-desk staff in a practice's policies and procedures manual.

CPT CodesCPT Codes AetnaAetna BCBS BCBS UHCUHC

5745257452 364364 424424 $ 365 $ 365

5943059430 252252 253253 $ 250 $ 250

9921299212 7171 9090 $ 80 $ 80

A/R◦ % > 120 days = 18% or less◦ % < 61 days = 75% or greater

Days in A/R◦ 60 days or less

The Net (or Gross) Collection Rate lets you know how much money you collected of the money you could have collected◦ the collection rate should be greater than 90% after 6

months and greater than 95% after 9 months

Manage your office like a business using proven business strategies that increase productivity and efficiency

Track & trend financial performance in order to identify any fluctuations that might have a negative effect in office revenue

Pre-verify all patients prior to visit

Have full knowledge of your reimbursement rates in order to collect patient’s financial responsibility

Whether billing is outsourced or done in-house, monitor outcomes while comparing to industry benchmarks

Perform due-diligence when selecting PM/EMR system & apply for incentive monies