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Team Approach!
A Plan to Anticipate and Respond to Changes in the Industry
A Culture for Learning & Motivation
Written Standardized Processes
Knowledge of Workflow, Job Responsibilities, & Goals for all areas
Training processes (initial and ongoing)
Monitoring & Accountability
Acknowledgement & Celebration of Success
Results! Improved Patient Care, Increased Income for the Practice & Satisfaction for all
members of the Staff and Physician Leaders!
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Patient Responsibility as a Percent of
Total Revenues
Source: 2007 & 2013: “The ‘Retailish’ Future of Patient Collections”, Celent, February 2009,http://reports.celent.com/2013: MGMA Practice Perspectives on Payment – 2009,http://www.mgma.com/patientpayments/, Median data reported.
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Patients Late - 15.4% No ID - 8.2% No source of payment - 23.7%
Language issue – 6.6%Illiterate – 2.5%Duplicate work – 100%
No insurance card – 16.4%Wrong demographics – 13.8%
Clinician busy – 6.4%Equipment issues – 2.2%
Language issue – 6.6%Duplicate clinician work – 11.2
No Documentation – 26.4%Hand-off issues – 9.7%
Patient Sneaks Out - 1.1%Not able to pay – 26.8
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/ERA
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Are your Referrals Declining? If so, why?
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Revenue Cycle Step Access to Patients and Information Performance Target
Initial patient phone call Receptionist 98% with complete information
Patient data gathering Receptionist 98% clean claims (first run)
Insurance Card Receptionist 100% of cards copied or verified
ID copying/Scanned Receptionist 100% patients
Insurance verification / pre-authorization /referrals
100% of all insured patients/pre-auth # acquired & documented
Forms completion Receptionist 100% of forms complete & signed by patient and staff
Patient notice of co-payments Receptionist 100% patients informed at Time-of-Service
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Revenue Cycle Step Access to Patients and Information Performance Target
Point-of-service collections co-payments
ReceptionistCollect 100% of possible patient deductibles/co-insurance & self pay
Point-of-service collections --balance due
Receptionist Collect 100% of patient responsibility at time of service
Credit extension/payment plans Collect 50% of patient responsibility then set up payment plan for automatic withdrawal no more than 4 months
Verify Credit transaction/payment plans
Verify all payment plan debts transactions weekly. If NSF is received contact patient, either set up new debt instrument or demand payment in full.
Referring Physician Order scanned to patient file
Receptionist/MA 100%
Patient/demographic data entry Receptionist Same day 100% complete information 98% accuracy
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Revenue Cycle Step Access to Patients and Information Performance Target
Documentation of services Physician 100% same day **Complete after each encounter
Coding for services Physician/Certified Coder 98% within 24 hours after operative report or chart
Verification of all Charting & Codingentered daily
Physician 24 hours charge/Billing
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Revenue Cycle Step Access to Patients and Information Performance Target
Missing encounter report Billing Department Report ran Weekly
Charge entry/claims processing Billing 24 hours or less, 100% of charge tickets, 98% cleans claims (first run)
Charge entry verification Billing 99% accurate entry of charge
Claims audit Billing/Coder 100% of charges pass system rules engine
Explanation-of-benefits Billing 95% of payments posted within 24 hours of receipt
Outstanding claims research Billing 100% of claims worked every 15 days
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Revenue Cycle Step Access to Patients and Information Performance Target
Rejected claims research Billing Claims worked within 24 hours of receipt
Claims denial tracking Billing2% or less of total claims denied/Monthly report submitted to Management
Appropriate payer payment review BillingMonthly reporting and follow-up within 10 business days
Review all Patients Credit Balances BillingMonthly prior to stmt distribution review all accounts with Credit Balance. Issue check where applicable.
Apply Interest to Patient Accounts BillingMonthly prior to stmt distribution apply interest to accounts based on Clinic's Policy.
Patient statement Billing100% of patients w/balance receive stmt accordingly: 1st 0 day, 2nd 28 days, 3rd 28 days collection letter, 4th 28 days demand letter
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Revenue Cycle Step Access to Patients and Information Performance Target
Pre-collections notice processing Billing100% of patients w/outstanding balances 35-40 days old receive contact regarding their past due account. (2 phone calls 5 business days to connect)
Pre-collections follow up Billing100% of patients contacted w/outstanding balances 40-90 days or older receive contact regarding account. (2 phone calls 5 business days to connect)
Pre-collections telephone contact Billing
100% of patients w/outstanding balances 100 days or older MUST be contacted by office prior to submission to collection agency (2 phone calls 5 business days to connect)
Collections pending list generation Billing Submit report to practice monthly
Service termination no-show Physician Patients are terminated after no-show _____# times
Collections process Outside vendorMonthly submission of 98% of qualifying patients. Physician reviews.
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Revenue Cycle Step Access to Patients and Information Performance Target
End of Day Close Receptionist/Billing/Management100% of money balanced to logs and system by end of day
Weekly deposit report Receptionist/Billing/Management Submitted to Management
Deposit (system to bank) Reconciliation
ManagementReconciliation and follow-up within 2 business days of receipt (weekly reconciliation reduces month end closes)
Month End Close & Report Billing/ManagementSubmitted to Management by the 7th of the following month
Year End Close & Report Billing/ManagementSubmitted to Management by the 7th of the following month
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