Revenue Cycle Optimization Status Report - Cookcountyhealth
Revenue Cycle Optimization Status ReportEkerete AkpanChief Financial OfficerRob Sumter, PhDChief Information Officer02/21/20201
Agenda Overview of The Revenue Cycle CCH Revenue Cycle Journey, Successes & Challenges Cerner Patient Accounting Project Status Project Governance & Structure Project Critical Path Metrics ReviewPatient Access Status - People, Process, TechnologyTime of Service Status - People, Process, TechnologyPost-Service Status - People, Process, TechnologyNext Steps & Discussion2
Overview of The Revenue Cycle3
Overview of the Revenue Cycle The Healthcare Financial Management Association (HFMA) defines a revenue cycle as “Alladministrative and clinical functions that contribute to the capture, management, andcollection of patient service revenue.” 1 The Revenue Cycle begins with Medical Record / Encounter creation, and ends withCollection / Write-off. 3 Critical Divisions of the Revenue Cycle: Pre-service - patient is scheduled and pre-registered for service. The encounter record is generated, and thepatient, guarantor, and insurance information is obtained and/or updated as required. Time-of-service - for scheduled patients, a final account review is completed prior to the patient’s arrival. Post-service - coding claims are prepared and submission payment processing and balance billing is done.4
HFMA - The Revenue Cycle5
CCH Revenue Cycle Journey, Successes & Challenges6
Revenue Cycle LookbackGeneralIllinois EarlyAccess CMS 1115WaiverOak Forest CBOEstablished1/12Revenue Cycle Initiatives200801/08200920102011201211/089/10 12/1003/12MedAssets ‘Rev. OptimizationPublic ConsultingGroupCountyWide ERPImplementation(STEP) - IBMLawson ERPLive (ACS)12/12Lawson ERPStart (ACS)1/10Professional Building(PB) OpenedHMA 014Dr. R. SumterCIO06/18 01/1910/18E. AkpanCFO12/15 01/167/142013OIG Report201501/15201612/15Medical BusinessAssociates ‘Charge 19 01/20IL-MedRCATIodine CDIMentalFormedProgramHealth06/19Advisory BoardCert.12/18Rev erner08/19AssessmentESM CleanupLIVEDentrix05/1812/19LIVE Advisory BoardCerner MedBOS LIVENecessity LIVECerner nCodeCerner PriorLIVEAuth LIVE03/1808/183M EncoderLIVE7
The Journey - Successes & Challenges Consistent year-over-year growth in gross charges capture a 3% growth to 1.74B inFY2019 from 1.69B in FY2018 Consistent year-over-year growth in cash collections a 7% growth to 409M in FY2019 from 383M in FY2018 Sustained growth in Case Mix Index by an average of 6% in FY2019 vs FY2018 Ongoing Improvements in Initial Claims Denials Sustained Improvements in “Allowances for Bad Debt” and bad debt write-offs in FY2018vs. FY2017 a trend likely to sustain in FY2019 audited reports8
Cerner Patient Accounting Project Status9
Program GovernanceInformation TechnologySteering Committee (ITSC)Physician AdvisoryGroupEmergency ing InformaticsOrthopedicsObstetrics & GynecologyAdvanced Practice ProvidersPerioperative ServicesLaboratoryResident (all major programs)PediatricsRadiologyAll Add nl SpecialtiesExecutive SponsorsCook County HealthExecutive SponsorCerner CorporationExecutive SponsorExecutive Steering CommitteeDirector of Rev. CycleProgram ManagementCFODirector of PFSCIOSolutionWorkgroupsRCATDirector of HIMDirector of Mgd. CareDirector of Rev. CyclePatient Access :SchedulingHealth InformationManagementPatient FinancialServicesPatient Access mationTechnologyFinance Project ManagerPatient Access :Financial ClearanceBusinessIntelligenceACHN Rev Opt. ManagerCMIORevenue IntegrityInsurance ContractManagementTraining /AdoptionDirector Central SchedulingClinicalDir. Financial ApplicationsCase ManagementFinanceDirector of FinanceDirector of Nursing Clin. AppsCMIOCerner Client Account Executive
Committee Details & ObjectivesInformation Technology Steering Committee Committee Chair – CIO Objective - Interdisciplinary Executive representation across all IT projects.Executive Steering Committee Committee Chair - CIO & CFO Objective - Executive oversight of Revenue Cycle Program.HIS Clinical Advisory Counsel Committee Chair - CMIO Objective - Clinician only, bidirectional collaboration of IT based initiatives.Revenue Cycle Action Team Committee Chair - Finance Project Manager & Financial Alignment Executive Objective - Execute system-wide revenue cycle initiatives and drive optimization by identifying whereopportunities exist, determining best practice, and driving to implement standard process for hospital,outpatient clinics and physician groups.11
2019Q3SepOctNovRevenue Cycle GanttEMPI & Process ImprovementCerner Medical NecessityDecJanFebAprMarAugSepOctNovDec2020Mar 2712/1702/25Mar 24Sep 12-Cardio-Radiology-Lab-RehabMar 31Nov 25Surgical CAPD (Vincari)Feb 0312/17Cerner Prior AuthorizationJulTodayOct 10Cerner Premium Eligibility & Address ValidationJunMayMay 0505/1203/0306/25Jun 25Sep 12-Rehab-Sleep Lab-Cardio-Radiology-Oncology-Pain*Not Scoped-Inpatient - 15,691,080-Outpatient, Not Mgd Care - 3.2M-Surgical OPCDI Initiative (Iodine)May 05Charge Master (Optum)Invision ReviewMar 02Dec 02May 05Feb 28Pt Access Req. Changes - ProdApr 06Jul 03Cerner Facility Charge Ticket (ED)Apr 06Jul 03Rev Int. & Charge RequirementsApr 06Jul 03Contract ManagementMay 3103/3105/31CPA ( AI Claims & Prof Billing)Phase 2-ARRundown-2360-ProfeeBillingDec 0112
CCH Financial Metrics (as of January 2020)Metric*HFMABenchmarkActualCCH TargetDescriptionCash CollectionN/A 34.5M 37MGross amount of cash Collected Monthly from CCH Servicestransmitted to payersAccounts Receivable 90 Days as a % ofBilled AR 20%47%40%Accounts Receivable (AR) is the gross dollar amount of patientaccounts that have been billed (transmitted) to the payer but not yetpaid.(Unpaid Patient bills Transmitted to the payer 90 or more days/Totalnumber of Unpaid patient bills transmitted to the payer AccountsReceivable% 90 daysDNFB Days7 Days8 Daysor 26.4M5 DaysDischarged not Final Billed (DNFB) is a term used to define unbilledaccounts where the patient has been discharged and the account iseither not coded, or pending charges, service documentation or claimholds to be released into the final billed receivable.Late Charges 2%12%7%CCH has a target to transmit bills to the payer within 5-7 days afterthe patient’s last service date. Bills transmitted after 5 days are late.(Charges with postdate than 5 days from the last service date/ TotalGross Charges) Late ChargesTotal AR to dateNot Applicable 421.9MNot ApplicableAccounts Receivable (AR) is the gross amount of patient accountsthat have been billed (transmitted) to the payer but not yet paid areclassified as receivable.Accounts ReceivableDays (AR Days) 40 Days88 Days60 – 65The average length of time, in days, that patient accounts areoutstanding: billed to the Payer but not yet paid.(Net A/R/ Average Daily Net Patient Service Revenue) Net A/R DaysDays Cash on Hand60 Days(nonHFMA)-60 DaysThe number of days that an organization can continue to pay itsoperating expenses, given the amount of cash available.* Source Healthcare Financial Management Association (HFMA) Key Hospital Statistics and Ratio MarginsCurrentStatusFutureStatusNot ApplicableTBD13
Patient Access Status - People, Process, Technology14
Pre-Service In Perspective15
The Revenue Cycle Program: SchedulingGo BackFunctionProblemPatient scheduling ensures appropriate reimbursement and/or significantresource coordination, such as reserving rooms and/or equipment, orderingdevices or supplies, and ensuring that professional staff, such as physicians,nurses, and/or technicians are available. Patient Access are ‘First line billers’. Lack of Standardization Lack of Accountability Limited Patient Contact! Limited Patient data collection due to established roles andresponsibilities Improper system usage - duplicate patients, overbooking.ProcessPeopleTechnologyStatusMary Sajdak / Ekerete AkpanMary Sajdak / Ekerete AkpanDr. Robert SumterOrg. structure alignment withIndustry Best Practice - schedulingfunctions across the Health System.Scheduling Clerks (Ward Clerks) inCentral Scheduling, at all hospital-basedclinics, at ambulatory/remote clinics.n/aThis has not yet been addressed. Determination made to focuson standardization but will not align under Finance (Finance willmonitor and advise on process).Job role expansion to mirror Industrybest practice including collection ofpatient demographic and financialdata at point of scheduling.Scheduling Clerks (Ward Clerks) inCentral Scheduling, at all hospital-basedclinics, at ambulatory/remote clinics.n/aProcess and people not yet addressed, waiting on org. structurealignment and associated contractual discussions.System-wide process standardization,with checkpoints and accountabilitystructure.Scheduling Clerks (Ward Clerks) inCentral Scheduling, at all hospital-basedclinics, at ambulatory/remote clinics.Cerner SchedulingAppointment TypeCleanup (primary &specialty care)In progress, Primary Care clinic appointments complete andready for direct booking. Specialty care in process.Process improvement during patientscheduling (i.e. CCH does notadequately contact patient duringscheduling process to confirmappointment).Scheduling Clerks (Ward Clerks) inCentral Scheduling.Luma Health PatientReminder SystemSolution will be evaluated to support patient contact efforts.CCH HIS will work with Luma Health to establish a Proof ofConcept.16
The Revenue Cycle Program: SchedulingGo BackFunctionProblemPatient scheduling ensures appropriate reimbursement and/or significantresource coordination, such as reserving rooms and/or equipment, orderingdevices or supplies, and ensuring that professional staff, such as physicians,nurses, and/or technicians are available. Patient Access are ‘First line billers’. Lack of Standardization Lack of Accountability Limited Patient Contact! Limited Patient data collection due to established roles andresponsibilities Improper system usage - duplicate patients, overbooking.ProcessPeopleTechnologyStatusMary Sajdak / Ekerete AkpanMary Sajdak / Ekerete AkpanDr. Robert SumterProcess improvement to reschedulepatients with insufficient financialverification/certification prior to visit.Scheduling Clerks (Ward Clerks) inCentral Scheduling, at all hospital-basedclinics, at ambulatory/remote clinics.Cerner Discern AnalyticsReports (identifyingpatients prior to arrival),Revenue IntegrityCCH must create a policy and procedure to incorporate into preservice activity. CCH has drafted a policy.Process improvement to provideAdvance Beneficiary Notice duringpre-service activity, ensuring Medicarepatient aware of non-covered service.Scheduling Clerks (Ward Clerks) inCentral Scheduling, at all hospital-basedclinics, at ambulatory/remote clinics.Cerner Medical NecessityCCH must create a policy and procedure to incorporate into preservice activity.Proper patient identification at pointof scheduling to avoid duplicate recordcreation (i.e. search existing personrecord through model system usage).Scheduling ClerksHIMCerner Enterprise MasterPatient Index Cleanup,Scheduling Flex Forms6M people records removed, in agreement with HIM,Compliance, & Legal.Patient self scheduling via onlineportal.Scheduling ClerksPatient Portal, LumaHealth Patient Reminders,Direct Booking17
The Revenue Cycle Program: Pre-RegistrationGo BackFunctionProblemPre-Registration is a pre-service activity meant to collect, validate, or completeinformation such as Insurance Verification, MSP screening, Medical Necessitycheck, managed care requirement resolution, and financial education & assistanceresolution. Target of 98% pre-registration rate. Patient Access are ‘First line billers’. Limited staff Due to poor data collectionupstream, inability to alwayscomplete full pre-registration.ProcessPeopleTechnologyEkerete Akpan / Mary SajdakEkerete Akpan / Mary SajdakDr. Robert SumterStatusInsurance Verification through BatchEligibility workflow, ensuring memberstatus active with payor.Pre-Registration ClerksRegistration Clerks (Clerk V)Cerner Premium EligibilityProject in design & build phase, targeted go-live of 3/31.Determination & communication ofpatient out-of-pocket liabilityincluding deductibles, co-pays, and coinsurance.Pre-Registration ClerksCerner Premium EligibilityProject in design & build phase, targeted go-live of 3/31. Processwill need to be determined to review how patient liability will becalculated and payment will be collected - integrated discussionwith time-of-service collection.Staffing analysis and expansion of PreRegistration team scope.Pre-Registration Clerksn/aSlotting activity, not yet in progress.Process Improvement to handle Outof-Network patients, determiningfinancial liability and routing toFinancial Counseling for non-essentialcare.Pre-Registration ClerksFinancial CounselingRegistration Clerks (Clerk V)Integrated Care - Managed Caren/aIdentified Out-of-Network volumes, drafted Out-of-Networkpolicy. Will review process, communicate and educate foraddressing patients with Out-of-Network coverage. Will workwith Managed Care group to evaluate contracting with payors.18
The Revenue Cycle Program: Pre-Certification (Authorization)Go BackFunctionProblemPre-certification is a pre-service activity in which a dedicated team (normallyclinical in function) works with Managed care plans to ensure there areagreements and those agreements (payor specific criteria for treatment) have aresatisfied. Limited staff Lengthy & complexrequirements to complete PriorAuthorizationProcessPeopleTechnologyDr. Claudia Fegan / Mary SajdakDr. Fegan / Ekerete Akpan / Mary SajdakDr. Robert SumterOrders-to-scheduling & proper PreRegistration (Phase 1 & Phase 2) willensure all required patient financialdata is captured for prior auth req’s.Ordering PhysiciansScheduling Clerks (Ward Clerks)Per-Registration TeamManaged Care Prior AuthOphth. & OMFS Image viewing accessfor Prior Auth submission.Managed Care Prior AuthOrders-to-scheduling & proper PreRegistration (Phase 3) will ensure allrequired patient financial data iscaptured for prior auth req’s.Orders-to-scheduling & proper PreRegistration (Phase 4) will ensure allrequired patient financial data iscaptured for prior auth req’s. Deficits in upstream data collection often requireStatusCerner Registration(specific conversation) /Prior AuthorizationWorklistStreamlining work effort for Prior Authorization team, ensuringproper upstream processes necessary. Phase 1 & 2 includesSleep Lab, Rehab, Cardiology, Radiology.Prior AuthorizationWorklist / CAMMProviding CAMM to Prior Auth team, will evaluate workflow forPayors requiring image as part of submitted data.Ordering PhysiciansScheduling Clerks (Ward Clerks)Per-Registration TeamManaged Care Prior AuthCerner Registration(specific conversation) /Prior AuthorizationWorklist / CernerOncology PowerPlansEngaging Cerner for an Oncology based gap analysis of existingPowerPlans and integration with Orders-to-scheduling.Ordering PhysiciansScheduling Clerks (Ward Clerks)Per-Registration TeamManaged Care Prior AuthCerner Registration(specific conversation) /Prior AuthorizationWorklistProject slotted. Phase 4 includes Pain.19
Time of Service Status - People, Process, Technology20
Time-of-Service In Perspective21
The Revenue Cycle Program: Patient Arrival, Validation & ActivationGo BackFunctionProblemRegistration is a time-of-service activity and the final checkpoint in which allpatient information is captured and confirmed prior to providing service forscheduled patients, and the process to complete full-registration for unscheduledpatients. Inaccurate data selection,collection & verification ofpatient information.ProcessPeopleTechnologyEkerete AkpanEkerete AkpanDr. Robert Sumter Limited adherence to required financial collection.StatusOrg. structure alignment withIndustry Best Practice - schedulingfunctions across the Health Systemreport to Finance.Registration Clerks (Clerk V) in acutesetting, all hospital-based clinics, andambulatory/remote clinics.n/aProcess and people not yet addressed, waiting on org. structurealignment and associated contractual discussions.System-wide process standardization,with checkpoints and accountabilitystructure.Registration Clerks (Clerk V) in acutesetting, all hospital-based clinics, andambulatory/remote clinics.n/aStandard registration workflow defined but not implementedacross org.Registration Process standardizationacross entire health system withcheckpoints and accountabilitystructure.Registration Clerks (Clerk V) in acutesetting, all hospital-based clinics, andambulatory/remote clinics.Cerner Patient ID inBanner BarPatient check-in & verification at timeof arrival via self check-in, biometrictools.Registration Clerks (Clerk V) in acutesetting, all hospital-based clinics, andambulatory/remote clinics.Patient Kiosk Expansion &Imprivata Palm VeinScannerAwaiting commitment on policy of patient identification captureand inclusion in patient’s chart. CCH will move forward withcapturing Patient Image and posting to Patient Chart.Implementation will need to include education, communication,and process review at check-in.Live at Core, scheduled rollout acrpss system wide clinics.22
The Revenue Cycle Program: Patient Arrival, Validation & ActivationGo BackFunctionProblemRegistration is a time-of-service activity and the final checkpoint in which allpatient information is captured and confirmed prior to providing service forscheduled patients, and the process to complete full-registration for unscheduledpatients. Inaccurate data selection,collection & verification ofpatient information.ProcessPeopleTechnologyEkerete AkpanEkerete AkpanDr. Robert SumterPoint-of-service collection via creditcard payment, determined througheligibility check either at check-in orprior.Registration Clerks (Clerk V) in acutesetting, all hospital-based clinics, andambulatory/remote clinics.Imprivata Kiosk / CreditCard Processing Vendor Limited adherence to required financial collection.StatusEvaluating tools for implementation, and will slot project oncevendors selected.23
The Revenue Cycle Program: Documentation & Revenue RecognitionGo BackFunctionProblemClinical documentation is a time-of-service activity which includes the processesrequired to accurately capture the services rendered through use of the ElectronicMedical Record. Revenue Recognition is triggered through key selection pointswithin the Electronic Medical Record. Timely documentationcompletion. Complete documentationProcessPeopleTechnologyDr. Claudia Fegan / Mary SajdakDr. Fegan / Ekerete Akpan / Mary SajdakDr. Robert SumterOrder-based Medical Necessitychecking and ABN discussion at timeof order between Physician andPatient.Ordering PhysiciansClinic Manager roles andresponsibilities expansion to includeCharge Reconciliation andrevenue/cost monitoring.Clinic ManagersProviders (all physicians)Infusion specific data including start &stop time, dose, etc.NursingHIMProvider clinical E&M documentationspecific to Evaluation andManagement for Outpatient Visits.Physicians Charge reconciliation processes not in place to supportmonitoring activity.StatusCerner Medical NecessityMultiphase project beginning at the point of physician orderentry - live in Lab, 2/24 in Cardio & Rad, 3/24 in Rehab.Revenue IntegrityInitiativeClinic Manager needing to be hired/staffed in order to initiatePilot project. Executive leadership team authorized kick-off.Infusion Management w/Infusion Billing Form &HIM PowerFormnCode expansionEnd User Training in progress with targeted go-live on 3/24.Project is currently on hold24
The Revenue Cycle Program: Documentation & Revenue RecognitionGo BackFunctionProblemClinical documentation is a time-of-service activity which includes the processesrequired to accurately capture the services rendered through use of the ElectronicMedical Record. Revenue Recognition is triggered through key selection pointswithin the Electronic Medical Record. Timely documentationcompletion. Complete documentationProcessPeopleTechnologyDr. Claudia Fegan / Mary SajdakDr. Fegan / Ekerete Akpan / Mary SajdakDr. Robert Sumter Charge reconciliation processes not in place to supportmonitoring activity.StatusProvider clinical surgicaldocumentation specific to Surgicalprocedures.Perioperative PhysiciansHIMSurgical CAPD (Vincari)Establishing business case to garner project authorization andslotting timeline / resources.Provider Clinical DocumentationImprovement initiative to addressPhysician doc. deficiencies.Documenting ProvidersIodineContinued engagement with Iodine and establishment of CDIdepartment under guise of Health Information Managementteam.25
Post-Service Status - People, Process, Technology26
Post-Service In Perspective27
The Revenue Cycle Program: Claim & Remit Processing, Denials MgmntGo BackFunctionProblemClaim & remit processing includes all activities required to send a request forpayment to a third-party payer for payment of benefits under an insurance policy,and the consequential review & balancing of payor payments. DenialsManagement includes activity to retro/proactively address claims issues. Poor data collection upstreamresulting in poor clean claimrate, increased claims edits, andtime spent working edits.ProcessPeopleTechnologyEkerete AkpanEkerete AkpanDr. Robert SumterArtificial IntelligenceClaims Processor / CernerPatient AccountingStatusClaim submission & residual editsreview/work for payorconsumption/review and remit.Patient Financial ServicesContracting, waiting on Purchasing to contact selected vendor.Cerner will work with AI vendor to determine technical specificsand begin reviewing integration for functional testing.Certify Health System forMedicare/Medicaid BehavioralHealth services to grant ability tosubmit and receive payment forservices rendered.Integrated Care / Managed CareBehavioral HealthCertificationCompleted, analyzing collections & denialsCertify Health System for PublicHealth Behavioral Health services togrant ability to submit and receivepayment for services rendered.Integrated Care / Managed CareBehavioral HealthCertificationCompleted, analyzing collections & denials28
The Revenue Cycle Program: Claim & Remit Processing, Denials MgmntGo BackFunctionProblemClaim & remit processing includes all activities required to send a request forpayment to a third-party payer for payment of benefits under an insurance policy,and the consequential review & balancing of payor payments. DenialsManagement includes activity to retro/proactively address claims issues. Poor data collection upstreamresulting in poor clean claimrate, increased claims edits, andtime spent working edits.ProcessPeopleTechnologyEkerete AkpanEkerete AkpanDr. Robert SumterCountyCare denial analysis toevaluate RARC / CARC codes toaddress existing edits and denialswhile implementing proactivemeasures for future submission.Patient Financial ServicesInvision RARC / CARC codes providing limited detailStatusEvolent (County Care Claims processer) & CCH are analyzing15,000 denied claims totaling 22 million. 1,600 outpatientaccounts valued at 1 Million have been found to overstate A/Ras the additional charges will not be reimbursed in these ‘splitbill accounts’ since the encounter rate has been paid.29
The Revenue Cycle Program: Payer Payment AnalysisGo BackFunctionProblemPayer Payment Analysis includes the ongoing review of payments to manageterms of existing payor agreements while at the same time identifying patientdemographics and insurance marketplace for expanding contractual agreements. No Contract Managementsolution in place today.ProcessPeopleTechnologyEkerete AkpanEkerete AkpanDr. Robert SumterManaged Care contractual variancemonitoring and reporting foridentifying short pay.Managed Care Contract SpecialistsCerner ContractManagementStatusTested using actual 837/835’s; rate sheets built reflect expectedreimbursement amounts, balancing accurately for ILMedicaid/Medicare.30
Next Steps & Discussion31
2019Q3SepOctNovRevenue Cycle GanttEMPI & Process ImprovementCerner Medical NecessityDecJanFebAprMarAugSepOctNovDec2020Mar 2712/1702/25Mar 24Sep 12-Cardio-Radiology-Lab-RehabMar 31Nov 25Surgical CAPD (Vincari)Feb 0312/17Cerner Prior AuthorizationJulTodayOct 10Cerner Premium Eligibility & Address ValidationJunMayMay 0505/1203/0306/25Jun 25Sep 12-Rehab-Sleep Lab-Cardio-Radiology-Oncology-Pain*Not Scoped-Inpatient - 15,691,080-Outpatient, Not Mgd Care - 3.2M-Surgical OPCDI Initiative (Iodine)May 05Charge Master (Optum)Invision ReviewMar 02Dec 02May 05Feb 28Pt Access Req. Changes - ProdApr 06Jul 03Cerner Facility Charge Ticket (ED)Apr 06Jul 03Rev Int. & Charge RequirementsApr 06Jul 03Contract ManagementMay 3103/3105/31CPA ( AI Claims & Prof Billing)Phase 2-ARRundown-2360-ProfeeBillingDec 0132
Optum Charge Description Master (CDM) Services & Software Background: Cook County Health awarded Contract #H18-0042 to Optum for a ChargeMaster assessment, a Charge Capture Audit and Charge Master Software that allows forinternal review and maintenance of the hospital Corporate Charge Master (facility andprofessional fees). Maintenance software allows a consistent review of coding and billingelements which are necessary for compliance with Medicare regulations, as well asoptimization of revenue and timely reimbursement. Purpose: Intended to identify charging deficiencies for improved Charge Capture, RevenueRecognition & Increased Reimbursement. Scope: CDM Assessment - review of CPT/HCPCS, Modifiers, Revenue Codes, Pricing, etc. Charge Capture Audit (Chart to Bill) - audit of 100 claims (20 Inpatient & 80 Outpatient). Enterprise Charger Master Expert (eCME) - software for continued analysis & maintenance.33
What to Expect by March 20th1. Kick-off of Revenue Integrity program2. Kick-off of Integration with Artificial Intelligence (AI) Claims Processing vendor3. Medical Necessity Phase 2 Go-Live4. Prior Authorization Phase 2 Go-Live5. Premium Eligibility Testing Completed34
Questions?35
Overview of the Revenue Cycle 4 The Healthcare Financial Management Association (HFMA) defines a revenue cycle as "All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue." 1 The Revenue Cycle begins with Medical Record / Encounter creation, and ends with Collection / Write-off.
Strategies to Optimize Your Pharmacy Revenue Cycle 9/2/2020 5 Presentation Outline 1. Optimal Revenue Cycle Management Program 1. Creating a case for a revenue cycle program 2. Revenue cycle program structure 3. Involving pharmacist leadership 4. Put a revenue cycle program to practice 2. Revenue Improvement and Preservation Strategies 1.
Revenue Cycle team Revenue Cycle Management Presented by: Kimberly Moore Director, Health Care Revenue Cycle Consulting 701.239.8673 . Cash Collection as a % of Adjusted net Patient Service Revenue: Indicator to accurately report effectiveness for converting Patient Service Revenue into
REVENUE CYCLE SOLUTIONS To request a custom scorecard for your facility, or to learn more, contact us today at: RCSAnalytics@AMNHealthcare.com AMNH1010023 rev 10-20 About AMN Healthcare Revenue Cycle Solutions AMN Healthcare Revenue Cycle Solutions is the industry's most experienced mid-revenue cycle provider. We use business intelligence
A successful revenue cycle is a complex process which involves multiple areas of your organization requiring constant interaction. THE REVENUE CYCLE. . Discharged Not Final Billed -DNFB 5 days of average daily revenue: Credit Balances 1 day of daily revenue: Denial Write-Offs 1% of monthly net revenue: Point of Service Collections
RFP - H21-0026, Revenue Cycle Service Provider H21-0026, Revenue Cycle Service Provider Page 5 of 16 4. Scope of Services CCH seeks to identify a competitive and qualified contractor to provide end-to-end revenue cycle services and detail reporting on performance and outcomes. This service will provide additional support in all areas of revenue .
the revenue cycle and identify the information needed to make those decisions. 3. Document your understanding of the revenue cycle. 4. Identify major threats in the revenue cycle and evaluate the adequacy of various control procedures for dealing with those threats. 5. Read and understand a data model (REA diagram) of the revenue cycle.
and automation as the technology solutions most needed, to improve revenue cycle management.1 The need for advanced technology is clearly evident in the middle revenue cycle. The most complex area to automate with the highest reward, the middle revenue cycle is where clinical and financial data merge, and the work done
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