Revenue Cycle DRP

REVENUE CYCLE DISASTER RECOVERY PLANNING (DRP) IS CRITICAL

Most hospitals have highly detailed disaster plans that are mostly focused on direct patient care issues and that is absolutely the appropriate focus. However, we as revenue cycle professionals advocate the reminder that cash flow is a critical when disaster strikes. The following wikipedia link articulates DRP issues fairly well - http://en.wikipedia.org/wiki/Disaster_recovery_plan

Here are a few questions to think about as you review your revenue cycle disaster plan:

• What is the increased volume capacity of the hospital and how would sudden increased volume caused by a disaster and perhaps sustained for several weeks impact registration, coding, billing and collections? For example, if you are accustomed to X OP/ED visits and Y census, what happens if volumes increase to hospital capacity? Is it a 25% increase, 40% or more? If your system is down and staff can't get to work, what is the plan?
• How quickly can EHR's, subsidiary AR ledgers, patient account histories and other data be accessed and what would the process be to do it?
• Is there a resource in the revenue cycle operation that is well versed in securing funds from various agencies that are involved in disaster relief?

Generally, 99% of hospital employees live in the immediate area surrounding the facility. They are therefore in the effected area and most are either dealing with personal trauma or in other cases they are patients. But the work of financial and revenue cycle professionals must continue in order to maintain patient services and to support the viability of the hospital. This includes management and technicians as well.

The contemporary and increasing practice of using remote hospital resources for certain functions is an option to consider, not only during disaster conditions but routinely. This option delivers an experienced labor pool and/or leadership team when the need arises.

Nearterm is in the business of providing interim resources to healthcare providers as part of the business model. Nearterm has clients routinely accessing this model as part of their routine non-disaster operation but it is easily applied when providers face disaster management challenges. Resources might include senior financial leaders, department heads, HIM Directors, Patient Financial Service Managers, Coding Managers, Collectors, Billers, call center personnel and more.

We are always interested in sharing solutions developed by hospitals and colleagues. Please feel free to share your experience by responding to this blog. If you would like to hear more about how we can be of assistance or simply get acquainted, let's talk.

Jim Matthews; Nearterm Corporation

(281) 646-1330

jmatthews@nearterm.com

Work claim edits remotely – a great idea for many hospitals.

We all want to handle claims only once. We do all we can to preclude denials. But when you categorize the reasons your scrubber rejects claims, you find that in order to resolve that prioritized list, many disciplines have to get involved e.g. coders, clinicians, charge master, and perhaps the patient. Often more than one of these disciplines is involved so that tracking resolution progress becomes a challenge. That said, most hospitals find that a credentialed coder can quickly resolve a high percentage of edits. Coders are in high demand and short supply so therein lays a challenge in many communities.

One hospital has addressed this challenge by using remote coders to manage claim edits. This is different than the commonly used practice of remote coding because the work volume includes only rejects, not initial charts and the work list is generated out of the billing system. All claims “kicked out” by the billing edit system for a coding-related reason are routed electronically to a remote coder who has access to facility records via VPN. Claims are resolved same day and returned for billing. The hospital has captured the following benefits as a result of this protocol:

• Claims are turned around for billing immediately instead of enduring a routing process in the hospital. The hospital gets paid faster.



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  There is little or no allocation of hospital based coder time to respond to billing requests. Vacancy, vacations, volume swings and other factors driving the availability of hospital based coders to work on claim requests are no longer a problem for billing.



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  It is a cost effective way to access professional coding time. As volumes fluctuate from day to day, utilization of the remote coder time fluctuates proportionately.



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  Remote coders can focus on identification of patterns and recommend solutions easily because they are focused only on claims that have rejected. They might recommend charge master updates, new coding practices, physician education and/or many other ideas.

The process is very easy to implement and there is no start-up cost. If you are already using remote coders to work your edits, please share your experience with us. If you are considering it, please feel free to contact Nearterm and we will be happy to explore the details with you.