REVENUE CYCLE LEARNING PLAN: Bringing it full circle Zoe Wolf Director of Revenue Cycle Sixteenth...

2014 WPHCA FALL LEARNING SESSION

REVENUE CYCLE LEARNING PLAN: Bringing it full circle

Zoe WolfDirector of Revenue CycleSixteenth Street Community Health CentersMilwaukee, WI

CONFLICT OF INTEREST AND COMMERCIAL INTEREST

None

REVENUE CYCLE LEARNING SERIES

Sponsored by WPHCA

Facilitated by WPHCA STAR Program Manager Provided opportunity for organization leaders

to gain an understanding of all aspects of the revenue cycle

Used outcomes of SVA Consulting STAR Deep Dive as initial discussion points

PURPOSE OF REVENUE CYCLE LEARNING SESSIONS

To provide leadership who are not involved in revenue cycle operations with knowledge of the revenue cycle and revenue cycle processes using operational modules

REVENUE LEARNING CYCLE PARTICIPANTS

EXECUTIVE TEAM (E-TEAM)

CEOExecutive Vice PresidentCFO, Vice President of FinanceVice President of Communications & Public RelationsVice President of Human ResourcesVice President of Information Systems

SENIOR MANAGEMENT TEAM (SMT)

Directors and Managers reporting to E-TEAM membersBehavioral Health CommunicationEnvironmental Health Programs Funds DevelopmentGrants Development Health Education & Community ProgramsInformation Systems Medical ServicesNursing Quality ImprovementRevenue Cycle

THOSE INVOLVED WITH REVENUE CYCLE ON A DAILY BASIS

CFO, VP of FinanceDirector of Revenue CycleManagers and Leads of:

Billing Cash PostingCoding CollectionsFinancial CounselingRegistration

START: Scheduling

and pre-registration

Registration, check-in, eligibility

Financial counseling

Patient care: ordering,

charge capture or creation,

coding

Charge review and scrubbing

Claim submission and

payment posting

Insurance follow up and

denial management

Self-pay follow up, payment

plans and collections

Customer Service

Contract Management

REVENUE CYCLE – PRESENTATION MODULES

Kay Brewer, WHPCA

PRESENTATION FORMAT

One or two modules presented per session Each module is presented by billing office staff subject

matter experts Each presentation allows for open discussion Q & A at the end of each session

Appointment Scheduled

Scheduler/Front office- Answer phone- Schedules

appointments- Cancels

appointments- Reschedules

appointments- Blocks schedule- Appointment

reminder calls

Pre-registration (if applicable)

Registrar/Front Office- Collect

demographics and insurance information

- Mails or calls patient to complete paperwork

Registration

Registrar/Front Office- Verify

Demographics- Enter and/or

verify insurance information (phone or web)

- If in advance:- Arrange for

interpretation or special needs

- Schedule other appointments (ex. Financial Counseling)

Check-in

Front Office- Collect

paperwork and copay

- Check that insurance is verified

- Indicate patient arrival

- Reschedule late patients and follow up with no-shows

Typical Front End Process

Depending on staffing, multiple steps could be

combined across one role.

Insurance

Eligibility

Registrar/Front Office- Log into

insurance site and enter patient information

- OR call insurance company

- Update in EHR

SAMPLE PRESENTATION FORMAT

Kay Brewer, WHPCA

SAMPLE POST-SESSION INFORMATION

Kay Brewer, WHPCA

HOW DID WE USE THE INFORMATION?

Cast votes to prioritize opportunity identified in learning sessions

Determined top four priorities based upon votes Assigned work teams with both E-Team and SMT

members on each team Each work team develops a project plan

• Implementation needs identified• Timeline identified

OUTCOME OF PROJECT PLANS

To be determined