Integrating Care Coordination in the Revenue Cycle

TraceCommunication.com

“Integrating Care Coordinationin the Revenue Cycle”

May 6, 2014 | 1pm ET, 10 am PT

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May 6, 2014 | 1pm ET, 10 am PT

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• Housekeeping Items• Introduction of Speakers and Presentation• Q&A Session


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Darlene GondrellaVP of Care Coordination

West Jefferson Medical Center


Today’s Presenter

Darlene Gondrella, RN, BSN, CCMVice President, Care Coordination



Today’s Agenda

Engaging care coordination in the revenue cycle

Integrating clinical & revenue cycle teams

Bridging communication gaps

Reducing admissions


Care Coordination Strategies for Improved Performance

Care Coordination at WJMCIntegration with the Revenue Cycle

Processes to Improve Rev Cycle Performance

Darlene Gondrella



427-bed, not-for-profit community hospital in Marrero,

LA, close to New Orleans

Medical staff of more than 400 and employee/volunteer base of

1900

National awards for clinical excellence across many of our

subspecialties


Care Coordination at WJMC

• Case managers• Social workers• Discharge planners• Discharge expeditor

Inpatient

• Case managersOutpatient


Care Coordination in the Revenue Cycle

Chief Administrative Officer• Patient Access• Case Management (Inpatient and Outpatient)• Patient Business Services• Health Information Management• Physician Clinics• Hospitalists• Cardiac/Neuro/Oncology /Palliative Care Service Lines• Marketing• Retail


Integration with Care Coordination

Bridging communication gaps

Decrease unnecessary denials

Reduce readmissions to prevent reduction in pay penalties


Revenue Cycle Team

• Patient Access Services• Case Management• Patient Business Services• Health Information Management• Service Line Development

Meets monthly with CAO


Revenue Cycle Team

Coding

Denials

Trends

RAC audits

Training needs

New CMS rules and regs


Bridging Communication Gaps

Monthly meetings

Education, Education, Education

Access to transparent,

timely patient information

and data


Education

Physician office lunch & learn sessions

Monthly hospitalist meetings

Articles in physician newsletters re: upcoming regs/changes that affect the Medical Staff

Interdisciplinary team meetings for new service line development


CM in Relation to the Revenue Cycle


CM Challenges

•Number of days approved, level of care•Lack of clinical

Medical Necessity Denials

•Inaccurate or incomplete documentation•Missing information

Documentation Failures

•Rework, inefficiency•Payment delays, underpayment

Time Constraints

•Duplication•Manual, paper-based process

Medicaid Notification

•Time intensive•Back and forth

Discharge Planning


Technology Implementation

Real-time recording of all conversations

Ability to send transcripts of recordings to insurance companies

Reduced denials, less time spent preparing

appeals

Complete record of information coming in

and going out

Improved workflow and time savings

Savings in paper record storage

Capture and save information in a single

click

Less time spent printing, scanning and

filing

Reduced medical necessity denials


Patient View


Coordinate daily CM activities


CM in Relation to the Revenue Cycle


Pre-Admission

Patient class for ED Admissions


Admission

Document clinical reviews for urgent/emergent

admissionsRecord admission

notification


Concurrent

Record concurrent review calls with payers


Discharge

Blast fax discharge placement


Post-Discharge

Insurance logs/denial letters

Patient Follow-up


Denial Appeals Follow-up

More efficient use of time • Proof of authorization• Proof of notification• Proof of clinical info sent

Proof of authorization lead to decreased denials


Initial Outcomes

Avoided initial denials from payers by showing documented proof of calls

Improved turnaround time on claims payments by 30 – 60 days

Increased percentage of medical necessity denials overturned from 56 percent to nearly 83 percent

Reduced number of medical necessity denials

Allowed case manager previously handling appeals to take on full case load


Patient Follow-up

Outpatient Care Coordination•Phone calls post discharge – recorded•Early identification of symptoms – early intervention•Review calls for quality•Teachback•Customer service•Complaints

•OP can resend information that was previously sent to HH agency with click of a button



Reduce Readmissions

CTC Clinic•Free service – appt in 24-48hrs.•Assists PCP when they do their follow up visit in 3-5 days

Dispo codes for planned readmits – CM

working with HIM to ensure correct coding

Dispo codes for AMA




Conclusion


Questions?

Please submit questions using the Q&A section in the participant panel.


Thank you!

Blair WrightThe White Stone Group, [email protected]

Darlene GondrellaWest Jefferson Medical Center

[email protected]

Healthcare

Integrating Care Coordination in the Revenue Cycle