Upload
janel-simon
View
212
Download
0
Embed Size (px)
Citation preview
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