GREAT iPad2 GIVEAWAY!!!!

VISIT US AT HFMA’S ANI BOOTH #1914 AND WIN AN iPad2

http://www.hfmaconference.org/

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.



• 
  
  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.



• 
  
  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.



• 
  
  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.

Nearterm recognized by Houston Area Association of Personnel Consultants

Nearterm was again recognized at the Annual Houston Area Association of Personnel Consultants (HAAPC) awards banquet on Wednesday, April 20th for a variety of “wins”. Among them, we were # 1 in the contract/temporary technical professional division. Jim Higgins was recognized for his many contributions as a Lifetime Member.

Congratulations all!

Please come visit us at the HFMA Gulf Coast Chapter Annual Meeting & Conference

Nearterm has always promoted revenue cycle education, both through our practice and also sponsorship. As Silver Sponsors, we are excited about the HFMA Gulf Coast Chapter Annual Conference scheduled for May 26th at the Omni in Houston. The educational content will be great and the networking opportunities make this conference a very enjoyable event. We hope you will stop by our exhibit area and say hello!

What are the “pros & cons” of centralized revenue cycle processing?

Provider organizations that have become multi-facility entities often consider centralizing revenue cycle and/or AR processing. The strategy is usually aimed at lower operating cost, performance improvement and better customer service. Nearterm has a lot of experience assisting clients with centralization (and decentralization) initiatives and so we could write volumes on this topic, but in lieu of that, this BLOG offers a just few “bite sized” observations that you might find interesting.

Homogeneous Volumes:
Banking, financial services, retail industries and others have been very successful with centralized billing, payroll, collection processing. If they can do it, we can do it, right? Not so fast. Every transaction processed through their clearing houses looks the same. A VISA charge transaction is the same in every state and for that matter, all over the world - homogeneous volumes. However, when two or more hospitals having different operating systems, contracts, policies and patient types consolidate, the volumes are different - heterogeneous. There are technical solutions but cost, lead time and maintenance of these conduits can be material in the centralization decision. If the organization does not achieve like volumes in the proposed processing environment, arguably, it has just combined things under the same roof, still functioning as before and with little or no gain of efficiency.

Distributed Impact:
There are two ways to capture the benefits of distributed impact through centralization of hospital revenue cycle processing; management and technology. Consolidation of organization structure usually results in a budget that improves compensation offerings available to build a new management team. This enables you to attract stronger talent and benefit from their expertise across the newly centralized operation. Likewise, surviving technology represents an opportunity.

Business Relationships & Communication:
Relationship challenges are often underestimated. We are referring to the multiple relationship and accountability changes that occur when for example a hospital moves billing and collections to a centralized business office (CBO). Who is responsible for AR performance? If the hospital is allocated CBO expense, does it have control over CBO budget? How are data collection and data entry problems that begin in access handled to the extent that they impact CBO performance? There are many questions to resolve well ahead of the decision to centralize. We recommend report design that clearly delineates accountabilities between entities and detailed policy statements about accountability. Drafting these and using them as compatibility “tests” prior to the decision may reveal crucial development opportunities that if addressed, promote a harmonious and successful transition.

Summary:
Centralization and consolidation of revenue cycle processing can be a very effective way to meet the challenges facing provider organizations in these changing times. Many have done it successfully. We also know that many “centralized” organizations would like to “decentralize” and would say they should never have done it in the first place. Generally, the key is consensus about expectations, timeline and accountability established as part of the decision process, not the implementation process.

The above are intended as broad overview. Nearterm Revenue Strategists are always ready to work with you in considering AR processing venue and any other Revenue Cycle initiatives under consideration.

Too busy to look at patient accounts?

I actually thought I was that busy myself early in my career. After all, there was a hospital budget to prepare, a seemingly unending stream of meetings to attend, performance appraisals to complete, AR reports to produce/review, a conversion right around the corner and a myriad of other priorities. Then one day I was asked, “What is the work product of the revenue cycle organization that you manage?” That’s an easy answer, I thought….it is 3 things-cash, patient satisfaction and cost effectiveness. Then came a lightning bolt that said those 3 things are certainly objectives but they might not be the work product. I asked myself what I could do to ascertain that the revenue cycle team was doing the things every single day that help us achieve those objectives. Conclusion; look at accounts and think of that as a review of our work product. Include that as part of my management practice.

The protocol was more than a look at random accounts. Reports were designed that queued a specific stratification of patient type, payor, balance range, age and alpha split at intervals that would provide me with statistically meaningful samples. I scheduled 3 consecutive hours each week to shut my door and review the designated accounts. The review was a discovery process so I looked at almost everything in each account history. When problems and/or questions came up, I would either call whoever in my organization was responsible, ask them to pull up the account and review it with them or else post a note to the account requiring a response. I was in a leadership position and had a lot of employees in several facilities reporting to me so these calls and notes came as a surprise to many until word was out that I had embraced this practice.

If I had to single out a management practice that effectively helped us improve revenue cycle performance and accountability, review of work product would be it. A number of positive things happened relatively quickly when this protocol was implemented. Here are a few examples;

• We learned that many of the things we thought we were doing were not really being done consistently or in some cases at all. By surfacing these items, we could address them. You can’t fix what you don’t know about.


• 
  
  The entire organization, not just the management team, became engaged in problem solving. When account history patterns surfaced, the people doing the work typically had the right solutions but had not been asked for their ideas before.


• 
  
  It became apparent throughout the revenue cycle organization that account documentation was of critical importance. When I would call an AR technician to ask why no work was documented on an account, the response was often that the work was done just not documented. We had a teaching moment to reiterate “If it is not documented, it was not done”.


• 
  
  Managers who reported to me were out of touch with the work product of their employees. When I personally began to get involved at the detail level, they quickly realized they had better do the same. When I identified a problem by talking with one of their staff, I would then contact the manager to discuss the problem and how we might solve it. It was not long until they too began account reviews similar to the ones I was doing so that they could identify and bring opportunities to me rather than their folks telling me. They were a very good team when we started and were even better as a result of this practice.


• 
  
  I had always talked and written internally about what was important in our organization. However, I don’t think people embraced my guidance about what was important until they saw that I was investing my time focusing on lag times, wait times, quality of calls, frequency of contacts and other things I could see by looking at a patient account. As I shared in a previous BLOG, people decide what is important based on how we spend our time, not what we say or write in memos.


• 
  
  The whole process was not only revealing and educational but it was also fun! I got to know the people doing the work a lot better and enjoyed the collegial approach that grew from the process. I got a lot closer to the people in my shop.

As a revenue cycle strategist, I am critical of senior managers who are not attuned to the details of their operation. Patient account managers have to have a mechanism and the discipline to know what is happening in their offices.

What can revenue cycle professionals learn from military science?

As Revenue Cycle professionals, we are often asked to develop and present a “strategy” but we are rarely asked to address “tactics” per se. As a result, the defining line has blurred between the two. Take a moment to review the following and consider their importance and associated differences;

 

Strategy:

The science or art of military command as applied to the overall planning and conduct of large-scale combat operations.

Tactics:

The technique or science of securing the objectives designated by strategy, especially the art of deploying and directing troops, ships and aircraft in coefficient maneuvers against the enemy.

I submit that making this distinction is critical for healthcare revenue cycle and financial leaders. It is more than just semantics. The following illustrates its impact on how we approach things.

1. 
   
   Hiring:
   When asking job candidates interview questions about how they might handle certain situations or operating conditions, do you get a tactical response or a strategic answer? Perhaps if the candidate focuses mostly on tactics, you would consider them for different roles than if they provide more strategic responses.




2. 
   
   Managing Change:
   Your organization has acquired multiple facilities over the course of recent years and the question of centralized AR processing hits the table. Are you thinking about development of a strategic plan or are you speculating about how billing data will be transferred (and the multitude of other tactical challenges inherent in this initiative)? Unfortunately, businesses often “skip” strategic thinking and planning when addressing key opportunities. This often leads to the conclusion that the original idea was a bad one or that people have underperformed when the reality was simply that an absence of strategy caused a great idea to fail implementation.

So when you are considering a central business office, integration of physician billing, a computer conversion, a denial management plan, or any other initiative, develop and test a strategy before you leap into the tactical component.

We hope this and other practical experiences Nearterm has accrued over the recent 20 years will be of value to you. We have served in both strategic and tactical roles with our clients and we would welcome your call us at 281-646-1330 if you have questions.