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  • The Right Questions to Diagnose Physician Practice Financial Pains
    practices Historically billing has always been a back office function Physicians and other practice administrators don t have insight into any errors that the coding staff is making and they re not always alerted to cash flow problems Improving revenue cycle processes might require evaluating your payment and denials processes on your own or working with a revenue cycle management services vendor to do so Either way you choose an analysis of your revenue cycle processes can encourage timely payer and patient payments and result in improved billing and payment experiences for your patients Leighton Noel is revenue cycle management specialist Greenway Health Birmingham Ala Publication Date Tuesday April 14 2015 BACK TO PAGINATION Insights from Forum Sponsor Greenway Health Physician practices should seek operational answers to their revenue challenges If you could treat your practice s shrinking profitability the same way as you treat your patients ailments how would you improve its financial health At first glance you may attribute the symptoms to repercussions of the Affordable Care Act and other increasing regulations or the overall decline in reimbursements from payers But by assuming your financial issues are out of your control you could be ignoring a significant underlying issue The true answer to the cause of your financial pains might be your revenue cycle processes However you may just not be asking the right questions to uncover those faulty processes Do You Know What Your Payers Are Paying For example I once talked to an orthopedic group that was being underpaid for a common injection they billed for quite often which resulted in a loss of hundreds of thousands of dollars each year all because of a processing error To bill accurately and collect what they re owed practices must frequently research changing payer rules update fee schedules and ensure payers are paying the correct amounts Are You Collecting from Your Patients As unpredictable as insurance payers may be patient payments can be a much more unreliable source of revenue With the rise of high deductible health plans patients will more often be responsible for payments but physician practices that are used to traditional billing don t always successfully collect what they re owed And once patients leave the office they re much less likely to pay which isn t all that surprising considering only 32 percent of patients who owe money receive a collection letter When Is the Last Time You Tackled Your Claims Denial Backlog Some practices have a backlog of denials that has been sitting out there for 90 plus days And it s likely they ll never get to them Almost 20 percent of claims are denied annually and 65 percent of those denials are never worked These questions can reveal a problem common in physician practices Historically billing has always been a back office function Physicians and other practice administrators don t have insight into any errors that the coding staff is making and they re not always alerted to cash flow problems Improving revenue cycle processes might require evaluating your payment and denials processes on your own or working with a revenue cycle management services vendor to do so Either way you choose an analysis of your revenue cycle processes can encourage timely payer and patient payments and result in improved billing and payment experiences for your patients Leighton Noel is revenue cycle management specialist Greenway Health Birmingham Ala Publication Date Tuesday April 14 2015 Comments Please login to add your comments Add Comment Text Only 2000 character limit Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to

    Original URL path: http://www.hfma.org/Content.aspx?id=29597 (2016-02-10)
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  • Paying Patient COBRA Payments May Reduce Bad Debt
    or comments about this article in the comment section below or via the Revenue Cycle Forum LinkedIn discussion board What is your organization s policy on paying patients COBRA payments What other ways is your organization partnering with patients to find financial assistance opportunities BACK TO PAGINATION Working with patients to identify and secure sources of insurance such as COBRA can help hospitals reduce bad debt and better comply with coming healthcare legislation Hospitals looking for creative options to assist patients during job transitions may want to consider paying healthcare insurance continuation premiums Under COBRA Consolidated Omnibus Budget Reconciliation Act of 1985 workers can continue their employer provided health insurance assuming they were enrolled for 18 to 36 months as long as they pay the premiums They must enroll in the program within 60 days of layoff termination or another qualifying event The U S Department of Labor s Frequently Asked Questions COBRA Continuation Health Coverage includes additional information on eligibility and qualifying events When a financial counselor is discussing payment options with a patient the counselor may uncover the fact that the patient was recently unemployed says Christine Fontaine CHFP CPAM vice president revenue cycle solutions OptumInsight This could launch a screening process in which the counselor determines if the patient is eligible for COBRA has no other existing insurance and is able to make the premium payments COBRA premiums are very expensive and some patients may not be able to afford to make them Depending on the results of the screening and the reasons for the patient s hospital visit it may make sense for the hospital to pay the patient s COBRA premium for a month or two This strategy could be appropriate if the patient s treatment involves high cost drugs such as chemotherapy drugs or infused antibiotics Lengthy inpatient stays may also warrant this approach Hospitals need to weigh the cost of the treatment with the cost of paying the COBRA premium says Kristen Shoup MBA RHIA manager revenue cycle Wooster Community Hospital Wooster Ohio A patient admission is going to have a much heftier price tag than a COBRA payment or two This is a sample article from HFMA s Revenue Cycle Forum a job specific networking community Learn more about the Forums The Potential Benefits There are several benefits to paying a patient s COBRA premiums First it ensures the patient has adequate insurance coverage for the services the hospital provides says HFMA s Suzanne Lestina FHFMA CPC director revenue cycle MAP It also serves as a community service because patients receive complete coverage for all their health care such as services provided by physicians or rehabilitation facilities in addition to the hospital Paying a COBRA premium can also enhance patient satisfaction and build loyalty It can solve the patient s short term insurance needs while supporting continuity of coverage for patients which is helpful should they find new employment and want to go on a new employer s health plan Enrolling in COBRA can be confusing and intimidating and some patients avoid it until there is an emergency says Shoup Hospitals that agree to not only pay the premium for a short term but help the patient understand and navigate the enrollment process can engender patient goodwill while receiving reimbursement for services Streamlining the COBRA process for patients can also possibly encourage them to make future payments on their own A Formal Policy Before committing to paying patients COBRA premiums hospitals should develop a formal policy that addresses the topic Policies should be vetted by your legal department says Fontaine Although paying COBRA payments is legal and acceptable organizations should define the process and make sure they follow the policy they have in place Access related tool Sample Policy for Paying Patients COBRA Premiums Keep in mind that paying a patient s COBRA premium is a temporary solution because the coverage will only last as long as the premiums are paid If a patient re enters the hospital six months after the initial visit and has not maintained the premium payments there could be a lapse in coverage says Shoup Plus when the 18 to 36 month timeframe elapses the patient may be without insurance if he or she has not found employment To address coverage issues over the long term it may be beneficial for the hospital to seek additional options for the patient such as state and federal insurance programs including Medicaid ACA Requirements Identifying potential sources of insurance such as COBRA is more than just a good idea it is becoming necessary in the new healthcare environment The Affordable Care Act requires hospitals to get involved in researching insurance options says Lestina For example the legislation requires hospitals to fully explore all possible third party reimbursement vehicles and document this effort before starting the collections process Determining whether patients are eligible to extend their healthcare coverage under COBRA is one option It can help ensure that patients receive necessary care and that the hospital limits bad debt from unreimbursed care Kathleen B Vega is a freelance healthcare writer and editor who contributes regularly to HFMA Forums Kathleen kbvega com Interviewed for this article Christine Fontaine CHFP CPAM is vice president revenue cycle solutions OptumInsight Baltimore and a member of HFMA s Maryland Chapter cfontaine caremedic com Kristen Shoup MBA RHIA is manager revenue cycle for Wooster Community Hospital Wooster Ohio and a member of HFMA s Northeast Ohio Chapter kshoup wchosp org Suzanne Lestina FHFMA CPC is director Revenue Cycle MAP HFMA slestina HFMA org Discussion Starters Forum members Please add your questions or comments about this article in the comment section below or via the Revenue Cycle Forum LinkedIn discussion board What is your organization s policy on paying patients COBRA payments What other ways is your organization partnering with patients to find financial assistance opportunities Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from

    Original URL path: http://www.hfma.org/Content.aspx?id=15591 (2016-02-10)
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  • ICD-10 Transition: How to Protect Your Practice from Revenue Loss
    of clients nationwide they won t just spot denial trends within your practice but also denial trends across the country This allows them to pinpoint and fix the issue often before it impacts your practice The most effective billing organizations also have unique knowledge about billing for specific specialties and geographic locations which means they know all the coding nuances and billing rules including those related to ICD 10 for the payers you bill most often With the right revenue cycle management partner your practice can survive and even thrive during the ICD 10 transition Leighton Noel is revenue cycle management specialist Greenway Health Birmingham Ala Publication Date Thursday July 09 2015 BACK TO PAGINATION Insights from Forum Sponsor Greenway Health If physician practices take the right steps to prepare for the ICD 10 conversion they can survive and even thrive after the transition The Oct 1 2015 transition to ICD 10 will affect physician practice revenue however whether that impact is positive or negative depends on you Inadequate training can lead to coding errors and reimbursement delays increased workloads may require additional staff and failure to test with payers can cause a lag in payments But with proper preparation you can minimize ICD 10 s threat to your revenue and profitability Prepare your Finances When it comes to practice finances it s best to prepare for the worst Make sure your practice has a healthy cash flow now so that even if you do experience a drop in revenue you ll survive the hit Start by examining your financial workflow to identify and incorporate best practices for collecting payments and determine which claims you can still collect and which should be written off This will paint a clear picture of the current state of your finances which can help you figure out how much you ll need on hand in October To start generating that additional cash flow you might consider using a revenue cycle management service to help your practice rework claims and file secondary claims both of which can boost your income By increasing your revenue now you will be in a better spot if it dips immediately after the ICD 10 deadline Monitor Denial Trends As you work to improve your cash flow you certainly don t want to make or repeat costly mistakes For example if your practice keeps receiving a denial on a certain claim code you want to be able to identify and fix it as soon as possible to prevent small losses from turning into significant drops in reimbursement And you don t have to do this alone Revenue cycle management services can monitor denial trends and pass that knowledge back to your practice so you can proactively prevent denials Your revenue cycle management team can not only explain denial trends they can also suggest methods for improving your revenue collection For example front desk staff should always check patients insurance eligibility before appointments and copayments should be collected at the time of service This will be crucial once the ICD 10 transition hits so that your practice can quickly realize if you are making mistakes when filing claims and figure out how to fix them Partner with a Full Service Billing Company One of the benefits of working with a full service billing company or revenue cycle management service is the ability to capitalize on economies of scale Because these organizations process a large quantity of claims for hundreds or thousands of clients nationwide they won t just spot denial trends within your practice but also denial trends across the country This allows them to pinpoint and fix the issue often before it impacts your practice The most effective billing organizations also have unique knowledge about billing for specific specialties and geographic locations which means they know all the coding nuances and billing rules including those related to ICD 10 for the payers you bill most often With the right revenue cycle management partner your practice can survive and even thrive during the ICD 10 transition Leighton Noel is revenue cycle management specialist Greenway Health Birmingham Ala Publication Date Thursday July 09 2015 Comments Please login to add your comments Add Comment Text Only 2000 character limit Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping

    Original URL path: http://www.hfma.org/Content.aspx?id=32125 (2016-02-10)
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  • Reducing Denials for Commonly Ordered Lab Tests
    lesion requires biopsy need MRI to evaluate level of treatment Emphasize diagnosis A physician provider should document a diagnostic need and not merely list the patient s symptoms on an outpatient order For example physicians should say Dyspnea pedal edema hx of MI need to differentiate cardiac from respiratory origin of symptoms Establish reasonableness Documentation must describe why the test or exam is reasonable for diagnosis or treatment For example writing the phrase ordered in accordance with accepted standards of medical practice to establish diagnosis is a fairly straightforward statement that will establish reasonableness Case Study Increasing Payments for the BNP Lab Test Let s use an example to illustrate One common laboratory test that typically is not paid is the B type natriuretic peptide or brain natriuretic peptide BNP Physicians use the test to determine whether a patient who is short of breath has congestive heart failure CHF or to determine the severity of their CHF However CMS has determined that in most situations the BNP test is not cost effective and is clinically unwarranted in almost all cases This puts a hospital a physician or a physician group at risk for targeting by commercial and federal payers for overpayments and denials By following these steps the revenue cycle team can determine those cases that warrant BNP testing and educate physicians ED practitioners and clinical documentation specialists on how to communicate the necessity of the test through documentation These steps can be followed for analysis of other lab tests as well Determine cost and compare to other hospitals in your region Ask your laboratory director how much it costs your hospital to perform one BNP assay Next review payment fee schedules for laboratory tests for your particular region Your regional Medicare Administrative Contractor MAC should be able to direct you to the fee schedule appropriate to your hospital Isolate and compare your hospital s specific BNP payment number Analyze payment trends Next run a report identifying every BNP performed on an outpatient in your facility during the previous quarter Identify how many of these charges were paid how many were rejected and how many are pending Note the physician associated with each of these BNP orders and the diagnosis code assigned to each account Include inpatient BNPs Inpatient BNPs are also increasingly being targeted by commercial payers and or various auditors Because BNPs performed on inpatients are paid as part of a DRG for Medicare beneficiaries they will not be specifically denied and CMS BNPs should be managed from a resource utilization and cost saving perspective Therefore run a separate report for the same time period as the outpatient BNPs identifying every BNP performed on an inpatient Just as you did with the outpatient accounts identify the ordering physician and the diagnosis code billed on each inpatient account You should now have a complete listing of all BNPs ordered during the previous three months the practitioner who ordered the assay and the discharge diagnosis code listed on the bill Identify discharge diagnosis codes Access your MAC website and view the BNP local coverage determination LCD for your region or national coverage determination NCD The list will provide diagnosis codes that support payment for a BNP assay The LCD will also state the documentation requirements that must accompany the supporting diagnosis code CMS is non negotiable in requiring that all components of the LCD be met to properly bill for an assay Identify all accounts on your compiled list that have corresponding discharge diagnosis codes listed in the LCD NCD All other accounts those whose discharge diagnosis codes are not on the LCD do not meet criteria for billing Do not be alarmed if a very high percentage of your accounts are not supported by discharge codes Review documentation Accounts with assigned discharge codes that are on the LCD list may or may not meet the remaining criteria Perform a chart review to identify documentation explicitly stating the patient is exhibiting symptoms of dyspnea or acute respiratory distress and whether or not a medical history of congestive heart failure or obstructive pulmonary disease is present There must be some indication that the BNP is required to distinguish the cause of the dyspnea Again do not be alarmed if a significant portion of your accounts with an appropriate discharge diagnosis code does not have accompanying documentation required by the LCD Involving the Team After you have evaluated your hospital s status follow the established reporting ladder used to introduce new processes Use the following script as a basis for your conversations with your physician advisor compliance officer professional staff educator or physician staff services leader Describe the problem Ordering and billing of BNP has received increased national attention by multiple federal integrity programs and specialty groups We had X BNPs ordered in the last quarter Describe the professional responsibility One component is not present to meet billing requirements all documentation components must be met Describe your hospital s requirement We need to bring our practitioners into compliance with existing regulations in order to appropriately bill for BNPs and avoid denials repayments and auditor scrutiny Describe your desired action plan I would like or I would like our chief medical officer to notify each practitioner about BNP ordering requirements and then monitor compliance and follow up as the physician advisor or educator or staff services recommends Communicating with Physicians In consultation with your physician advisor consider generating a letter to be sent to each practitioner outlining the problem and the required compliance actions A second letter with case specifics can be sent when future reports indicate insufficient documentation practice patterns Related tool Physician Notification Letter for Denied Tests Be prepared for inevitable physician challenges Explain that the directives are imposed on all practitioners in your region and in the best interest of your patients your hospital is required to abide by these regulations With your hospital specific financial reports practice pattern facts and coverage determinations in hand discussions will be more productive than you may have experienced in the past Preventing Denials Filing appeals for denial of payment for BNP assays and other frequently ordered yet infrequently reimbursed labs will not be cost effective Prevention is the best cure when it comes to avoiding denials Marian Ses Howe RNC is risk manager Summit Healthcare Regional Medical Center Show Low Ariz Discussion Starters What do you think Please share your thoughts in the comments section below What tests are commonly denied for your hospital and what steps are you taking to resolve the problem How are you communicating with physicians about proper documentation to avoid denials Publication Date Friday September 12 2014 BACK TO PAGINATION Revenue cycle leaders are more likely to convince physicians to change their documentation habits by analyzing how the coding and documentation are affecting payments for commonly ordered lab tests Hospitals and health systems may not receive payment for commonly ordered laboratory tests For those tests that are paid many come under audit scrutiny and eventual recoupment of payment results To minimize that risk revenue cycle leaders should determine what types of tests are being denied review reasons for denials and communicate with hospital leaders and physicians on how to prevent such denials This is a sample article from HFMA s Revenue Cycle Forum Learn more about HFMA Forums and subscribe Understanding the Approach In general revenue cycle staff coders and physicians should follow these tips to increase payment of outpatient tests Use Local Coverage Determinations LCDs The Medicare Coverage Database offers LCD information that is required in a medical record for clean billing Assign ICD 9 codes that support medical necessity Because there is no single definition for medical necessity documentation must describe why the exam or test is necessary for this particular patient in this particular situation For example physicians should say Unable to determine from CXR if lesion requires biopsy need MRI to evaluate level of treatment Emphasize diagnosis A physician provider should document a diagnostic need and not merely list the patient s symptoms on an outpatient order For example physicians should say Dyspnea pedal edema hx of MI need to differentiate cardiac from respiratory origin of symptoms Establish reasonableness Documentation must describe why the test or exam is reasonable for diagnosis or treatment For example writing the phrase ordered in accordance with accepted standards of medical practice to establish diagnosis is a fairly straightforward statement that will establish reasonableness Case Study Increasing Payments for the BNP Lab Test Let s use an example to illustrate One common laboratory test that typically is not paid is the B type natriuretic peptide or brain natriuretic peptide BNP Physicians use the test to determine whether a patient who is short of breath has congestive heart failure CHF or to determine the severity of their CHF However CMS has determined that in most situations the BNP test is not cost effective and is clinically unwarranted in almost all cases This puts a hospital a physician or a physician group at risk for targeting by commercial and federal payers for overpayments and denials By following these steps the revenue cycle team can determine those cases that warrant BNP testing and educate physicians ED practitioners and clinical documentation specialists on how to communicate the necessity of the test through documentation These steps can be followed for analysis of other lab tests as well Determine cost and compare to other hospitals in your region Ask your laboratory director how much it costs your hospital to perform one BNP assay Next review payment fee schedules for laboratory tests for your particular region Your regional Medicare Administrative Contractor MAC should be able to direct you to the fee schedule appropriate to your hospital Isolate and compare your hospital s specific BNP payment number Analyze payment trends Next run a report identifying every BNP performed on an outpatient in your facility during the previous quarter Identify how many of these charges were paid how many were rejected and how many are pending Note the physician associated with each of these BNP orders and the diagnosis code assigned to each account Include inpatient BNPs Inpatient BNPs are also increasingly being targeted by commercial payers and or various auditors Because BNPs performed on inpatients are paid as part of a DRG for Medicare beneficiaries they will not be specifically denied and CMS BNPs should be managed from a resource utilization and cost saving perspective Therefore run a separate report for the same time period as the outpatient BNPs identifying every BNP performed on an inpatient Just as you did with the outpatient accounts identify the ordering physician and the diagnosis code billed on each inpatient account You should now have a complete listing of all BNPs ordered during the previous three months the practitioner who ordered the assay and the discharge diagnosis code listed on the bill Identify discharge diagnosis codes Access your MAC website and view the BNP local coverage determination LCD for your region or national coverage determination NCD The list will provide diagnosis codes that support payment for a BNP assay The LCD will also state the documentation requirements that must accompany the supporting diagnosis code CMS is non negotiable in requiring that all components of the LCD be met to properly bill for an assay Identify all accounts on your compiled list that have corresponding discharge diagnosis codes listed in the LCD NCD All other accounts those whose discharge diagnosis codes are not on the LCD do not meet criteria for billing Do not be alarmed if a very high percentage of your accounts are not supported by discharge codes Review documentation Accounts with assigned discharge codes that are on the LCD list may or may not meet the remaining criteria Perform a chart review to identify documentation explicitly stating the patient is exhibiting symptoms of dyspnea or acute respiratory distress and whether or not a medical history of congestive heart failure or obstructive pulmonary disease is present There must be some indication that the BNP is required to distinguish the cause of the dyspnea Again do not be alarmed if a significant portion of your accounts with an appropriate discharge diagnosis code does not have accompanying documentation required by the LCD Involving the Team After you have evaluated your hospital s status follow the established reporting ladder used to introduce new processes Use the following script as a basis for your conversations with your physician advisor compliance officer professional staff educator or physician staff services leader Describe the problem Ordering and billing of BNP has received increased national attention by multiple federal integrity programs and specialty groups We had X BNPs ordered in the last quarter Describe the professional responsibility One component is not present to meet billing requirements all documentation components must be met Describe your hospital s requirement We need to bring our practitioners into compliance with existing regulations in order to appropriately bill for BNPs and avoid denials repayments and auditor scrutiny Describe your desired action plan I would like or I would like our chief medical officer to notify each practitioner about BNP ordering requirements and then monitor compliance and follow up as the physician advisor or educator or staff services recommends Communicating with Physicians In consultation with your physician advisor consider generating a letter to be sent to each practitioner outlining the problem and the required compliance actions A second letter with case specifics can be sent when future reports indicate insufficient documentation practice patterns Related tool Physician Notification Letter for Denied Tests Be prepared for inevitable physician challenges Explain that the directives are imposed on all practitioners in your region and in the best interest of your patients your hospital is required to abide by these regulations With your hospital specific financial reports practice pattern facts and coverage determinations in hand discussions will be more productive than you may have experienced in the past Preventing Denials Filing appeals for denial of payment for BNP assays and other frequently ordered yet infrequently reimbursed labs will not be cost effective Prevention is the best cure when it comes to avoiding denials Marian Ses Howe RNC is risk manager Summit Healthcare Regional Medical Center Show Low Ariz Discussion Starters What do you think Please share your thoughts in the comments section below What tests are commonly denied for your hospital and what steps are you taking to resolve the problem How are you communicating with physicians about proper documentation to avoid denials Publication Date Friday September 12 2014 Comments Please login to add your comments Add Comment Text Only 2000 character limit Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY The Future of Online Patient Billing Portals This white paper written by Apex President Patrick Maurer discusses methods to increase patient adoption of online payments Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections This white paper shows why patient centric approaches to online payment portals are important complements to traditional provider centric approaches HFMA Business Profiles Optum Enabling Transformative Change Elena White vice president of risk quality and network solutions for Optum discusses how healthcare providers

    Original URL path: http://www.hfma.org/Content.aspx?id=24953 (2016-02-10)
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  • Insights into Medicare Part A and Part B Rebilling
    hospital appeals the denial up to 180 days after they receive notice that their appeal is final The new policy which is effective for claims with dates of admission after Oct 1 2013 requires that revenue cycle departments rebill Part A denied claims under Part B within one year of the date of service In many cases hospitals won t receive notice of the denial until well after a year has passed from the date of service which means revenue cycle departments won t be able to take advantage of rebilling Furthermore there is no option to appeal the Part A denial and then pursue Part B payment in the event you lose the appeal CMS is aware of the impact of its policy and many people opposed the policy during rulemaking but the agency adopted it anyway How can hospitals avoid missing rebilling opportunities because of the limited timeframe Polston Hospitals can avoid this conundrum at least in some cases by conducting self audits which under the new rule allow hospitals the opportunity to change their minds after the beneficiary has been discharged and determine their services should be billed on an outpatient basis under Part B rather than Part A If this is done within one year of the date of service then Part B claims can be submitted There are many requirements to rebilling pursuant to a self audit including the beneficiary notice but I have seen some hospitals beginning to turn to this procedure Are there any other recent CMS rules that affect rebilling Polston At the same time it finalized the A to B rebilling policy CMS also finalized the new inpatient coverage standard the two midnight rule and imposed new physician certification and inpatient order requirements as a condition of Medicare payment These rules are very controversial and they raise many operational questions For example if a hospital becomes aware that a physician order or certification is technically defective and cannot be fixed because the patient has been discharged what rules apply as to whether the hospital can rebill for those services under Part B Does it require all of the cumbersome self audit procedures Now that some hospitals have been rebilling Part A claims as Part B claims for approximately six months what challenges are their revenue cycle leaders encountering as they work through the process Polston Some hospitals are finding that MACs Medicare administrative contractors aren t giving revenue cycle staff adequate remittance advice when a rebilled claim is accepted Payments are being received without adequate information to link the MAC payment to the beneficiary at the patient account level Without adequate remittance advice it is difficult for revenue cycle staff to reconcile these claims and patient accounts based on the new Part B criteria For example when a claim switches from Part A to Part B revenue cycle staff use remittance advice to determine whether the hospital owes Medicare patients deductible or copayment refunds or whether patients owe the hospital money based on the new Part B claim To resolve this problem revenue cycle leaders should first contact the MAC to obtain the additional remittance advice Some of my clients have not been successful and have had to go to the next step which is to contact CMS The agency should open a line of communication between revenue cycle leaders and MACs to resolve this problem Another challenge encountered by some revenue cycle leaders is that CMS s new Part B billing policy actually requires providers to submit two Part B bills an outpatient Part B bill for services that are provided in the three day payment window before the patient is formally admitted and an inpatient Part B claim for services provided after the point of admission It sounds easy in principle but it can be difficult in practice For example some revenue cycle operations find it difficult to determine exactly what procedures or services should be billed on which claims This requirement seems like an unnecessary splitting of the Part B claim and the better approach would be to allow submission on one bill type Can revenue cycle staff offset patient payments made toward the Part A claim against any patient financial responsibility owed on the Part B claim Polston CMS states that if a beneficiary is charged a deductible for a Part A hospital stay and that stay has been denied the hospital must refund the deductible to the beneficiary However CMS has not provided express guidance on whether providers could use Part A deductibles already paid by patients to cover new patient financial responsibilities for the rebilled Part B claim The ability to offset patient responsibility due on a Part B claim with payments already made on the denied Part A claim would offer greater efficiency to revenue cycle departments as well as Medigap insurers but CMS has dragged its feet in expressly stating that this is acceptable As long as there is no confusion to the beneficiary it seems irrational not to allow it What is your advice to revenue cycle leaders who are facing the challenge of applying these new rebilling rules Polston Spend the time to familiarize yourself and your staff with the new CMS guidance on Medicare rebilling It requires a time investment but understanding how these rules work will pay off in the long run At the end of the day you will be left with unanswered questions so apply the guidance in as reasonable as a fashion as possible However continue to press and demand answers from CMS through all channels of communications such as emails to the agency personnel who are implementing the A to B rebilling policy Mark Polston is the former chief litigation counsel for CMS and a partner in the healthcare practice of King Spalding Washington D C Discussion Starters Forum members Please share your insights questions and comments about the content in this article You can use the inshare button at the top of this web page or visit the Revenue Cycle Forum LinkedIn discussion board What challenges have you experienced with rebilling Medicare Part A claims under Part B What solutions helped you overcome those challenges What tools or resources are you using to keep up with CMS guidance on Medicare rebilling rules Publication Date Thursday November 14 2013 BACK TO PAGINATION Some hospitals are using self audits to avoid the stricter rebilling timeframe required in CMS s recent rule changes The Centers for Medicare and Medicaid Services CMS Part A to Part B rebilling rules allow hospital revenue cycle departments to recover payment for certain denied claims However the ability to rebill is presenting new challenges including a tighter deadline to rebill claims and some revenue cycle departments experiencing limited advice on reconciling patient accounts after a rebilled claim is accepted explains Mark Polston a partner in the healthcare practice of King Spaulding in Washington D C and former chief litigation counsel at CMS This is a sample article from HFMA s Revenue Cycle Forum a discussion and networking community for revenue cycle leaders LEARN MORE AND SUBSCRIBE What recent changes have been made to the CMS rules on rebilling Medicare Part A inpatient claims as Medicare Part B outpatient claims Polston Often when a Part A claim is denied for lack of medical necessity the denial is based on the notion that the care was provided in the incorrect setting inpatient versus outpatient rather than on the basis that the services themselves were not medically necessary In such cases revenue cycle leaders could rebill for those medically necessary services under Part B except in limited circumstances such as ancillary items like supplies Procedures such as surgeries could not be billed for In March 2013 the agency adopted an interim rebilling policy change for Part A claims denied for lack of medical necessity Hospitals could rebill Part B for services that were provided after the point of formal admission as long as those services would be medically necessary if provided on an outpatient basis For example if a patient was admitted and subsequently a procedure such as cardiac catheter or a surgery were performed revenue cycle leaders could bill for those procedures on an inpatient Part B claim if the Part A claim was denied on the basis that the inpatient stay was not medically necessary As of Oct 1 CMS adopted the rebilling policy permanently However the final rule gives revenue cycle leaders much less time to rebill Part A claims Under the March interim policy which applies to Part A claims with dates of admission before Oct 1 2013 that are denied for lack of medical necessity revenue cycle leaders can submit rebilled Part B claims up to 180 days after the Part A denial or if the hospital appeals the denial up to 180 days after they receive notice that their appeal is final The new policy which is effective for claims with dates of admission after Oct 1 2013 requires that revenue cycle departments rebill Part A denied claims under Part B within one year of the date of service In many cases hospitals won t receive notice of the denial until well after a year has passed from the date of service which means revenue cycle departments won t be able to take advantage of rebilling Furthermore there is no option to appeal the Part A denial and then pursue Part B payment in the event you lose the appeal CMS is aware of the impact of its policy and many people opposed the policy during rulemaking but the agency adopted it anyway How can hospitals avoid missing rebilling opportunities because of the limited timeframe Polston Hospitals can avoid this conundrum at least in some cases by conducting self audits which under the new rule allow hospitals the opportunity to change their minds after the beneficiary has been discharged and determine their services should be billed on an outpatient basis under Part B rather than Part A If this is done within one year of the date of service then Part B claims can be submitted There are many requirements to rebilling pursuant to a self audit including the beneficiary notice but I have seen some hospitals beginning to turn to this procedure Are there any other recent CMS rules that affect rebilling Polston At the same time it finalized the A to B rebilling policy CMS also finalized the new inpatient coverage standard the two midnight rule and imposed new physician certification and inpatient order requirements as a condition of Medicare payment These rules are very controversial and they raise many operational questions For example if a hospital becomes aware that a physician order or certification is technically defective and cannot be fixed because the patient has been discharged what rules apply as to whether the hospital can rebill for those services under Part B Does it require all of the cumbersome self audit procedures Now that some hospitals have been rebilling Part A claims as Part B claims for approximately six months what challenges are their revenue cycle leaders encountering as they work through the process Polston Some hospitals are finding that MACs Medicare administrative contractors aren t giving revenue cycle staff adequate remittance advice when a rebilled claim is accepted Payments are being received without adequate information to link the MAC payment to the beneficiary at the patient account level Without adequate remittance advice it is difficult for revenue cycle staff to reconcile these claims and patient accounts based on the new Part B criteria For example when a claim switches from Part A to Part B revenue cycle staff use remittance advice to determine whether the hospital owes Medicare patients deductible or copayment refunds or whether patients owe the hospital money based on the new Part B claim To resolve this problem revenue cycle leaders should first contact the MAC to obtain the additional remittance advice Some of my clients have not been successful and have had to go to the next step which is to contact CMS The agency should open a line of communication between revenue cycle leaders and MACs to resolve this problem Another challenge encountered by some revenue cycle leaders is that CMS s new Part B billing policy actually requires providers to submit two Part B bills an outpatient Part B bill for services that are provided in the three day payment window before the patient is formally admitted and an inpatient Part B claim for services provided after the point of admission It sounds easy in principle but it can be difficult in practice For example some revenue cycle operations find it difficult to determine exactly what procedures or services should be billed on which claims This requirement seems like an unnecessary splitting of the Part B claim and the better approach would be to allow submission on one bill type Can revenue cycle staff offset patient payments made toward the Part A claim against any patient financial responsibility owed on the Part B claim Polston CMS states that if a beneficiary is charged a deductible for a Part A hospital stay and that stay has been denied the hospital must refund the deductible to the beneficiary However CMS has not provided express guidance on whether providers could use Part A deductibles already paid by patients to cover new patient financial responsibilities for the rebilled Part B claim The ability to offset patient responsibility due on a Part B claim with payments already made on the denied Part A claim would offer greater efficiency to revenue cycle departments as well as Medigap insurers but CMS has dragged its feet in expressly stating that this is acceptable As long as there is no confusion to the beneficiary it seems irrational not to allow it What is your advice to revenue cycle leaders who are facing the challenge of applying these new rebilling rules Polston Spend the time to familiarize yourself and your staff with the new CMS guidance on Medicare rebilling It requires a time investment but understanding how these rules work will pay off in the long run At the end of the day you will be left with unanswered questions so apply the guidance in as reasonable as a fashion as possible However continue to press and demand answers from CMS through all channels of communications such as emails to the agency personnel who are implementing the A to B rebilling policy Mark Polston is the former chief litigation counsel for CMS and a partner in the healthcare practice of King Spalding Washington D C Discussion Starters Forum members Please share your insights questions and comments about the content in this article You can use the inshare button at the top of this web page or visit the Revenue Cycle Forum LinkedIn discussion board What challenges have you experienced with rebilling Medicare Part A claims under Part B What solutions helped you overcome those challenges What tools or resources are you using to keep up with CMS guidance on Medicare rebilling rules Publication Date Thursday November 14 2013 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA

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  • Zeroing in on Cardiac Care Claims
    You can use the inshare button at the top of this web page or visit the Revenue Cycle Forum LinkedIn discussion board What challenges have you encountered with reimbursement for cardiac claims What solutions were helpful in overcoming challenges with cardiac care claims BACK TO PAGINATION Correctly identifying cardiac care claims as inpatient or outpatient helps ensure the maximum payer reimbursement Claims for cardiac procedures are under increasing scrutiny from payers because the high cost of cardiac care presents an opportunity for payers to trim costs on reimbursements At this time Medicare fee for service FFS is applying the most pressure but all payers are watching closely due to the large expenditures says Ralph Wuebker MD chief medical officer Executive Health Resources Inc Newtown Square Pa By tracking cardiac claims data and payer requirements hospitals can ensure appropriate reimbursement and avoid claim denials However many hospitals and health systems are not taking advantage of the benefits of analyzing their cardiac claims As much as 50 percent of the providers may not be using revenue cycle metrics or developing utilization dashboards to track performance estimates Wuebker Many hospitals cite a lack of time and resources to collect and analyze claims and payer data However when it comes to cardiac claims Wuebker says this investment is usually money well spent Inpatient Versus Outpatient Codes For example a 1 000 bed hospital was losing as much as 10 to 20 million per year because 99 percent of its cardiac procedures were incorrectly categorized as outpatient which pays a lower reimbursement rate than inpatient claims under Medicare FFS This hospital didn t have the staff to track whether the cardiac claims were coded correctly When significant reimbursement is in jeopardy because a hospital is not tracking payer and denial data for cardiac cases then it warrants freeing up one case manager to review cardiac procedures Wuebker says To start look at your current outcomes if you are out of the norms consider a chart review to isolate the problem areas The key is to correctly categorize the patient at the time of immediately following the procedure with documentation supporting the admission decision included in the patient chart says Wuebker Cardiac Claims Comparisons Tracking inpatient versus outpatient metrics can shed light on missed reimbursement opportunities but it is only the first level in data gathering Wuebker recommends comparing the following factors for both inpatient and outpatient cases Payers Determine the source of reimbursement for cardiac cases and compare reimbursement rates and denials to determine payers reimbursement patterns between outpatient and inpatient claims For example many commercial payers mandate a particular status for certain types of procedures If there is a large difference in inpatient versus outpatient payment those payers will likely be watching the claims very closely Emergency department ED admissions The majority of cardiac procedures admitted through the ED are likely to meet inpatient criteria says Wuebker He estimates that if your inpatient rate for ED admit cases is lower than 80 percent then you may be losing reimbursement by incorrectly coding those cases as outpatient It is very unusual for a hospital s inpatient rate to be lower than 80 percent for ED admit cases due to the high acuity of a patient getting an urgent procedure says Wuebker Elective procedures Zero and one day stay scheduled procedures billed as inpatient are the most likely to be questioned by payers says Wuebker It is necessary to ensure that a compliant process is in place for properly admitting the patient and that strong documentation is in the patient record to support that decision In addition cases that have been referred by a physician and include an overnight stay are most likely to be questioned by payers If there is concern about vulnerability start with a data analysis and then conduct an audit if necessary Same day discharge Most cardiac procedure patients who go home the same day as the procedure should be outpatient A comparison of admit dates and discharge dates will illustrate whether a provider s overnight stay rate should be examined further If 10 to 20 percent of these cases are inpatient without an overnight stay you have a huge vulnerability if subjected to an audit says Wuebker Device versus catheter procedure Device based procedures defibrillators and pacemakers are a primary target area of the Office of Inspector General and the Department of Justice These agencies are specifically looking for compliance with National Coverage Determinations NCDs It is critical to ensure the practice and documentation satisfies the particular NCD for each procedure Physicians Tracking inpatient versus outpatient statistics by physician reveals which ones may require some additional guidance on determining patient status The Benefits of Metrics Metrics that populate performance dashboards and scorecards serve two major functions They help hospital staffs prioritize the time they spend on claims and denials and they introduce opportunities to improve the utilization process HFMA s MAP Keys are examples of key performance indicators Developed by industry leaders led by HFMA these industry standard metrics define revenue cycle performance and allow providers to track revenue cycle performance against their goals and compare performance to peer groups and to the industry as a whole Metrics and dashboards help providers see when they are in danger of crossing a critical line and they offer advance notice so problems can be fixed before they escalate Wuebker says Betty Hintch is editor newsletters and forums at HFMA Interviewed for this article Ralph Wuebker chief medical officer Executive Health Resources Inc Newtown Square Pa Discussion Starters Forum members Please share your insights questions and comments about the content in this article You can use the inshare button at the top of this web page or visit the Revenue Cycle Forum LinkedIn discussion board What challenges have you encountered with reimbursement for cardiac claims What solutions were helpful in overcoming challenges with cardiac care claims Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating

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  • Improving Registration: Ideas from HFMA Members on Making a Positive First Impression
    their signatures The staff should also remember that many patients and visitors may be hearing impaired so they should speak clearly enunciate well and look directly at the person when speaking Sometimes patients or family members have concerns that need to be brought to another level One way to address these instances is to establish a dedicated phone line to handle patient complaints or concerns that routes directly to key executives For more information on joining HFMA s Forums and gaining access to the listserv visit hfma org forums Ed Avis is a freelance writer based in Oak Park Ill who contributes regularly to HFMA publications Publication Date Wednesday October 07 2015 BACK TO PAGINATION Patient registration can be improved with practical ideas like providing useful information and directions to unique amenities such as valet parking and pager systems in waiting rooms A hospital registration area is like the foyer to a home The experience visitors receive there may significantly impact their overall impression of the hospital How can a hospital improve the registration experience HFMA members answered that question which was posted recently on the HFMA Forum listserv Here are the best ideas from that exchange The First Encounter Preregistration Two respondents suggested that preregistration is an important step in creating a pleasant registration experience The preregistration should include useful information that will improve the patient experience and assist patients with their financial responsibilities such as providing instructions for arrival and providing patients with information about their copayments and deductibles Parking Lot Connection Several ideas from the listserv responses concern patient arrival For example valet parking is a good way to create a good first impression Other ideas include having volunteers in golf carts drive patients from their cars to the front door of the hospital and having someone with a tablet computer meet patients in the parking lot and launch the registration process right there Pleasant Greetings Greeting the patients warmly with smiles and eye contact is also important One respondent said that in her hospital if patients or visitors need directions a staffer walks those individuals to their destination rather than just explaining how to get there or pointing them in the right direction Also patients should be moved quickly to a registrar so that they perceive that their waiting time is short One respondent mentioned that her hospital uses a pager system to alert patients when it is time for them to be served The pager makes it unnecessary for staff to call out names protecting patient privacy Comfortable Spaces Naturally having a pleasant atmosphere in the registration area is important Among the ideas raised to create a pleasant space is playing soft music displaying fresh flowers and live plants and offering coffee water and snacks One respondent noted that she is familiar with a hospital that has an actual shopping mall with stores and a restaurant right off the lobby Available Information Patients and family members in the registration area are often scared and confused so in some cases the best way to create a good impression is to provide information Two listserv respondents mentioned that they provide welcome packets including a letter from the CEO to incoming patients The packet can also include a physician directory a copy of patients rights and responsibilities contact numbers and e mail addresses for managers in each department and other phone numbers to call if there are concerns or problems Understanding Staff Interactions between staff and patients and family members play a key role in establishing comfort levels Staff should be well educated on hospital matters and they should carefully explain the paperwork being presented rather than rushing patients to provide their signatures The staff should also remember that many patients and visitors may be hearing impaired so they should speak clearly enunciate well and look directly at the person when speaking Sometimes patients or family members have concerns that need to be brought to another level One way to address these instances is to establish a dedicated phone line to handle patient complaints or concerns that routes directly to key executives For more information on joining HFMA s Forums and gaining access to the listserv visit hfma org forums Ed Avis is a freelance writer based in Oak Park Ill who contributes regularly to HFMA publications Publication Date Wednesday October 07 2015 Comments Please login to add your comments Add Comment Text Only 2000 character limit Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical

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  • Reengineering the Revenue Cycle to Improve the Patient Experience
    additional expertise Armstrong acknowledges the challenge but says improving patient experience can lead to quicker payment from patients Armstrong also suggests that organizations consider changing the name of the revenue cycle department to something that patients can more easily understand such as patient business services With everything that s happening in health care today it s time to really look at your overall organization Armstrong says I m more convinced than ever that hospitals have to organize as more of a service organization says Armstrong Creating a better experience in the revenue cycle requires adapting or creating a new patient financial services role to respond to the rise in healthcare consumerism As more and more patients become responsible for managing their healthcare services they will have more questions Armstrong says And hospitals should have the answers Access the Related Tool Patient Business Services Organization Chart Early Adopters Armstrong says some hospitals have begun to adapt their patient financial services to reflect a higher level of service For example in a few revenue cycle departments the work is divided An assigned PFS counselor addresses patient questions from registration to discharge and another PFS counselor is assigned to handle patient accounts after discharge Other revenue cycle departments are assigning patients to specific PFS counselors who then follow the patient from the front end to the back end of the revenue cycle Some hospitals have expanded their patient counselor roles to include the duties of a navigator to assist with state exchanges and some have even outsourced these navigator PFS duties to an outside vendor Addressing Patient Frustrations For many revenue cycle departments the fundamental problem with customer service is that staff especially those on the front end lack the clinical and business knowledge required to handle complex patient questions says Armstrong The result is that patients calling with an eligibility question for example are too often transferred from one staff member to another to get an answer I think the frustrating point for patients today is that you re always talking to somebody different he says Not getting patient questions answered correctly or in a timely manner can have serious business implications if consumers choose to seek care from other providers Armstrong says Acquiring Expertise For organizations to provide higher levels of customer service the frontline role must be given more prominence in the revenue cycle department structure says Armstrong You don t have to change your organization significantly but you do have to create the position Armstrong says Although many organizations have implemented a navigator role Armstrong says these positions mainly address helping patients find coverage through the state and federal health insurance marketplaces The new patient business service executive role would extend beyond the role of a navigator and report to the director of customer service A few hospitals are already drawing clear reporting lines from patient financial services to a customer service director and I predict others will follow suit says Armstrong Staff in this role should have a wide range of knowledge in the following areas Revenue cycle operations The patient business service executive should be familiar with processes at the front and back end of the revenue cycle As a result this staff member is equipped to address most patient questions in one phone call or during one in person visit Armstrong says Clinical terminology The patient business service executive should be familiar with general clinical terms and care treatment External issues The patient business service executive should be familiar with industry trends For example this staff member would have a general knowledge of health reform and its resulting impacts Revenue cycle leaders would have to develop a comprehensive curriculum in clinical terminology and coding customer service public relations and managed care reimbursement To quickly address patient issues the patient business service executive whether internal or outsourced would have the authority to obtain assistance from other areas of the revenue cycle i e patient access utilization review health information management and billing and within the hospital or healthcare system e g managed care clinical operations etc Overall the patient business service executive would have to be able to walk the patient through the revenue cycle process and foster a belief that if you have to go in for a procedure or other healthcare service this provider is the greatest place to go to Armstrong says For example one hospital reinforces patient trust by assigning patients to specific PFS counselors who then follow the patient from the front end to the back end of the revenue cycle The advantage to this approach is that a counselor who is familiar to the patient can address thorny payment related questions at any stage in the payment process Armstrong says Exploring Options If instituting one comprehensive role that addresses patient questions from the front end to the back end of the revenue cycle is not feasible Armstrong says organizations can consider the following options Assigning patients to specific PFS staff One staff member may manage patients with last names beginning with A through L while another would cover patients with names beginning with M through Z etc Triaging patient questions Less complex questions can be handled by frontline staff and more complicated questions can be sent directly to staff with specific expertise Training back end staff Provide more comprehensive training to staff on the back end of the revenue cycle so these staff members can fill in when front end operations needs assistance Assessing Cost to Value A rise in the number of newly insured patients as a result of health insurance exchange plans and Medicaid expansion greater out of pocket patient costs and increasing calls for price transparency require a fundamental shift in how revenue cycle staff view their roles It may be too early to tell but as Medicare and other payers reimburse partially on patients satisfaction customer service and handling the patient right the first time will be critical Also I think more patients are willing to pay a bill if they ve had a good experience and if they understand the bill Armstrong says Karen Wagner is a freelance healthcare writer and editor who contributes regularly to HFMA publications Interviewed for this article Terry Armstrong president State Collection Service Inc Madison Wis and a member of HFMA s Tennessee Chapter Discussion Starters Forum members Please comment below scroll down past the advertisements to the comment section What are the challenges to providing better customer service in your revenue cycle department Do you think an upgrade patient financial services role would help your revenue cycle department deliver better customer service and improve performance Publication Date Thursday April 17 2014 BACK TO PAGINATION Most patients don t differentiate between the front end and the back end of the revenue cycle One solution might be to train staff to handle both responsibilities Revenue cycle departments can be more responsive to patients if they upgrade the role of the patient financial services PFS counselor to a patient business service executive says Terry Armstrong president of State Collection Service Inc Madison Wis a revenue cycle service company This professional would have wide latitude to assist patients with both front end and back end revenue cycle processes This is a sample article from HFMA s Revenue Cycle Forum Learn more about HFMA s Revenue Cycle Forum and subscribe The patient financial service executive would be the primary patient contact supported by other staff including registrars billers coders and call center staff Complex patient accounts would be handled exclusively by the patient financial service executive Revenue cycle leaders who upgrade the PFS role need to consider the cost of training and higher compensation for staff with additional expertise Armstrong acknowledges the challenge but says improving patient experience can lead to quicker payment from patients Armstrong also suggests that organizations consider changing the name of the revenue cycle department to something that patients can more easily understand such as patient business services With everything that s happening in health care today it s time to really look at your overall organization Armstrong says I m more convinced than ever that hospitals have to organize as more of a service organization says Armstrong Creating a better experience in the revenue cycle requires adapting or creating a new patient financial services role to respond to the rise in healthcare consumerism As more and more patients become responsible for managing their healthcare services they will have more questions Armstrong says And hospitals should have the answers Access the Related Tool Patient Business Services Organization Chart Early Adopters Armstrong says some hospitals have begun to adapt their patient financial services to reflect a higher level of service For example in a few revenue cycle departments the work is divided An assigned PFS counselor addresses patient questions from registration to discharge and another PFS counselor is assigned to handle patient accounts after discharge Other revenue cycle departments are assigning patients to specific PFS counselors who then follow the patient from the front end to the back end of the revenue cycle Some hospitals have expanded their patient counselor roles to include the duties of a navigator to assist with state exchanges and some have even outsourced these navigator PFS duties to an outside vendor Addressing Patient Frustrations For many revenue cycle departments the fundamental problem with customer service is that staff especially those on the front end lack the clinical and business knowledge required to handle complex patient questions says Armstrong The result is that patients calling with an eligibility question for example are too often transferred from one staff member to another to get an answer I think the frustrating point for patients today is that you re always talking to somebody different he says Not getting patient questions answered correctly or in a timely manner can have serious business implications if consumers choose to seek care from other providers Armstrong says Acquiring Expertise For organizations to provide higher levels of customer service the frontline role must be given more prominence in the revenue cycle department structure says Armstrong You don t have to change your organization significantly but you do have to create the position Armstrong says Although many organizations have implemented a navigator role Armstrong says these positions mainly address helping patients find coverage through the state and federal health insurance marketplaces The new patient business service executive role would extend beyond the role of a navigator and report to the director of customer service A few hospitals are already drawing clear reporting lines from patient financial services to a customer service director and I predict others will follow suit says Armstrong Staff in this role should have a wide range of knowledge in the following areas Revenue cycle operations The patient business service executive should be familiar with processes at the front and back end of the revenue cycle As a result this staff member is equipped to address most patient questions in one phone call or during one in person visit Armstrong says Clinical terminology The patient business service executive should be familiar with general clinical terms and care treatment External issues The patient business service executive should be familiar with industry trends For example this staff member would have a general knowledge of health reform and its resulting impacts Revenue cycle leaders would have to develop a comprehensive curriculum in clinical terminology and coding customer service public relations and managed care reimbursement To quickly address patient issues the patient business service executive whether internal or outsourced would have the authority to obtain assistance from other areas of the revenue cycle i e patient access utilization review health information management and billing and within the hospital or healthcare system e g managed care clinical operations etc Overall the patient business service executive would have to be able to walk the patient through the revenue cycle process and foster a belief that if you have to go in for a procedure or other healthcare service this provider is the greatest place to go to Armstrong says For example one hospital reinforces patient trust by assigning patients to specific PFS counselors who then follow the patient from the front end to the back end of the revenue cycle The advantage to this approach is that a counselor who is familiar to the patient can address thorny payment related questions at any stage in the payment process Armstrong says Exploring Options If instituting one comprehensive role that addresses patient questions from the front end to the back end of the revenue cycle is not feasible Armstrong says organizations can consider the following options Assigning patients to specific PFS staff One staff member may manage patients with last names beginning with A through L while another would cover patients with names beginning with M through Z etc Triaging patient questions Less complex questions can be handled by frontline staff and more complicated questions can be sent directly to staff with specific expertise Training back end staff Provide more comprehensive training to staff on the back end of the revenue cycle so these staff members can fill in when front end operations needs assistance Assessing Cost to Value A rise in the number of newly insured patients as a result of health insurance exchange plans and Medicaid expansion greater out of pocket patient costs and increasing calls for price transparency require a fundamental shift in how revenue cycle staff view their roles It may be too early to tell but as Medicare and other payers reimburse partially on patients satisfaction customer service and handling the patient right the first time will be critical Also I think more patients are willing to pay a bill if they ve had a good experience and if they understand the bill Armstrong says Karen Wagner is a freelance healthcare writer and editor who contributes regularly to HFMA publications Interviewed for this article Terry Armstrong president State Collection Service Inc Madison Wis and a member of HFMA s Tennessee Chapter Discussion Starters Forum members Please comment below scroll down past the advertisements to the comment section What are the challenges to providing better customer service in your revenue cycle department Do you think an upgrade patient financial services role would help your revenue cycle department deliver better customer service and improve performance Publication Date Thursday April 17 2014 Comments Please login to add your comments Add Comment Text Only 2000 character limit Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY The Future of Online Patient Billing Portals This white paper written by Apex President Patrick Maurer discusses methods to increase patient adoption of online payments Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections This white paper shows why patient centric approaches to online payment portals are important complements to traditional provider centric approaches HFMA Business Profiles Optum Enabling Transformative Change Elena White vice president of risk quality and network solutions for Optum discusses how healthcare providers can leverage data and technology as they enable risk in their organization HFMA RESOURCE LIBRARY Payment Portals Can Improve Self Pay Collections and Support Meaningful Use Increased

    Original URL path: http://www.hfma.org/Content.aspx?id=22368 (2016-02-10)
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