PBCMS Presentation-JK- 09.09.2015
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Transcript of PBCMS Presentation-JK- 09.09.2015
Palm Beach County Medical Society & Keiser University
LUNCH & LEARN
MANAGERS/ADMINISTRATORS MEETING
Wednesday, September 9th, 2015
:
“Revenue Cycle Management”
SPEAKER
Juan H. Kouri, MHSADirector Business DevelopmentProMD Practice Management
In times of declining/decreased revenue, Practice Managers must evaluate their current operations to assure they are using a “best practice” approach in the following key areas of their operations:
Financial
Practice Management System/EMR
Billing & Collections – performance benchmarks
Cash controls ◦ System generated receipts ◦ Patient payments posted by Front Desk & reconciled at
end of day (system to match actual cash collected)◦ Daily practice reconciliation (“Daily Closing” should
include total revenue collected & deposited to bank)
Monthly practice performance report generated to track/trend performance
Patient Registration Form should include financial liability verbiage allowing practice to charge back patient for any collection fee associated with non-payment
Financial record keeping using accounting-type software (e.g. QuickBooks) to track revenue & expenses
Reconciliation of practice management system VS QuickBooks
Workflow that ensures all patients are verified to confirm coverage, identify patient’s financial responsibility, and collect at time of visit
Employees aware of contractual amounts in order to collect co-insurance & deductibles at time of service
Fee schedules (insurance plans, Medicare, Medicaid, etc.) entered in order for system to identify underpayments.
EMR capability (interface with PM)
Ability to generate system encounters
Track “open” encounters via system report to assure all charges are posted
EMR system should be certified in order to qualify for stimulus monies.
The financial viability of a medical practice depends on the performance outcomes of its physician billing process. Establishing industry recognized benchmarks* for key performance measures can assist in determining whether your revenue cycle and account receivables are performing at optimal levels.
* Benchmarks were established using Medical Group Management Association (MGMA) industry standards in conjunction with ProMD proprietary statistical data
1. Proper Financial Responsibility documents2. Correct and accurate patient Appointment Scheduling & Registration3. Copies of Insurance card and ID card
4. Determination and collection of patient responsibility (co-pays, deductibles and co-insurance)
5. Check-in and Check-pout process
1. Charge Posting (Modifiers) 2. Claim Submission 3. Payment Posting 4. Insurance Collections 5. Guarantor Collections
No. 11 on that MGMA report: collecting from self-pay patients or those with high-deductible health plans
Typically, front-desk personnel are interested in checking the patient in and confirming and updating insurance coverage information. Requesting payment from patients who may have medical issues and want to visit with the doctor isn't easy
MGMA Perspective (Cont’d.)
Understanding the different types of insurance coverage and plans patients may have. ◦ Is the patient a self-pay patient? ◦ Do we only have to worry about collecting a copayment? ◦ Does the patient have a high-deductible that hasn't been
met yet this year? ◦ Will the patient have a coinsurance obligation that won't be
known until he or she is seen by the doctor?
Each of these categories may trigger a different approach to collecting on day of service. The collection process should be outlined for front-desk staff in a practice's policies and procedures manual.
CPT CodesCPT Codes AetnaAetna BCBS BCBS UHCUHC
5745257452 364364 424424 $ 365 $ 365
5943059430 252252 253253 $ 250 $ 250
9921299212 7171 9090 $ 80 $ 80
A/R◦ % > 120 days = 18% or less◦ % < 61 days = 75% or greater
Days in A/R◦ 60 days or less
The Net (or Gross) Collection Rate lets you know how much money you collected of the money you could have collected◦ the collection rate should be greater than 90% after 6
months and greater than 95% after 9 months
Manage your office like a business using proven business strategies that increase productivity and efficiency
Track & trend financial performance in order to identify any fluctuations that might have a negative effect in office revenue
Pre-verify all patients prior to visit
Have full knowledge of your reimbursement rates in order to collect patient’s financial responsibility
Whether billing is outsourced or done in-house, monitor outcomes while comparing to industry benchmarks
Perform due-diligence when selecting PM/EMR system & apply for incentive monies