Practice Pulse RCM Analysis and E.H.R. HealthCheck

Angela Jarrett, CPC, CMPA

Senior Professional Services Consultant

RCM Analysis Overview

Increase productivity, increase staff knowledge, increase revenue, modify workflows, increase staff measurements and outcomes

• Analysis• Professional Consulting • Living RCM

RCM Analysis Agenda

• Overview• Revenue Cycle Management Analysis

Report• System Work Flow Analysis and

Design• Professional Consulting and Support• Goal

Revenue Cycle Management Analysis

This information is intended to provide the staff with an analysis of overall system status as well as a review of system usage and overall performance.

Administration – Exclusive Review of specific Admin Tables

Financial PerformanceSystem MaintenanceManagement Goals and Outcomes,

Measurements and Expectations

A Peek Behind The Curtain

$ Squeezing the Sponge $

Stay In the Bell Curve

HRSA Top 5 Financial Classes: Medicare, Medicaid, Slide Fee, Self Pay

and Commercial. Are the providers coding ALL patients the SAME way? With the RCM ANALYSIS Report…

you will know!

Workflow, workflow, workflow!

A workflow consists of an orchestrated and repeatable pattern of business activity enabled by the systematic organization of resources into processes that transform materials, provide services, or process information.

System Workflow Analysis and Design

Identify workflow, system functional weaknesses and staff competency

Front Desk Staff ObservationBilling Department Staff ObservationEDI Database Review Development of Optimized Workflows

Plan

Professional Services Consulting and Support

Identify required maintenance, staff re-training and overall optimization RCM to “Living RCM Standards’

Administration TrainingSystem TrainingBilling/Patient Financial Services TrainingPayment Entry - Insurance/PatientReports TrainingClosing Date Procedures Training

RCM ANALYSIS Tier 1, 2, 3 and beyond

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Administration – Exclusive Review of specific Admin Tables

EDI Database Review

Tier 2 Tier 3Visualutions Revenue Cycle Management Consulting Services

Billing/Patient Financial Services Training- All aspects of billing, training adding EDI Transmission and Response refresher

Management Goals and Outcomes, Measurements and Recommendations

Staff Observation and Discussion End User- Registration, Scheduling, Pre/Post Payment Collections, etc.

Billing/Patient Financial Services- Charge Entry, charges management, processing, EDI Sub/Resp., Claims management, follow-up, payment posting

Administration Training

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System Training (Super/End User Training)- Include Gap areas, UDS deep dive, etc.

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Tier 1

Development of Optimized Workflows Plan

Financial Performance - Report and Dashboards Created

System Maintenance

Name Plan Duration Assigned Total Hours

Revenue Cycle Management Analysis

Day 1

Financial Performance - Report and Dashboards Created 2hrs Online 2

Administration – Exclusive Review of specific Admin Tables 4hrs Onsite 4

System Maintenance 4hrs Onsite 4

Management Goals and Outcomes, Measurements and Expectations 2hrs Onsite 2

System Work Flow Analysis and Design

Day 2

Observation Front Desk 4hrs Onsite 4

Observation Billing/Patient Financial Services4hrs Onsite 4

Day 3EDI Database Review 4hrs Onsite 4

Development Optimized Workflows Plan4hrs Onsite 4

Implementation and Post implementation Support

Beyond

Admin Follow Up Training2 Days Onsite Training 16

System Training (Super/End User Training)2 Days Onsite Training 16

Billing Training16hrs Onsite Training 16

Payment Entry - Insurance/Patient4hrs Remote Training 4

Reports Training4hrs Remote Training 4

Reports Training Follow Up/Scoping2hrs Remote Training 2

Closing Date Procedures Training2hrs Remote Training 2

Collections Training4hrs Remote Training 4

Our Goal

WHAT IS… The E.H.R. HealthCheck

The objective of this program is to assist customers that find themselves still struggling with how to implement the changes required by CMS, Government etc…

The overall goal is to help practices change their concept and thought process regarding the software by accepting change in their workflow.

The key initiatives for this service are: Analyze our customers’ workflow Fabricate a systematic workflow process Create benchmarks for each process Ultimately generate revenue

PROCESS FOCUS

1. Evaluation – Evaluate the overall office processes to include the current roles of the staff and utilization of EHR system during the day-today operations.

2. Analysis – Analyze the efficiency of the tools within the EHR system as it relates to the client's EHR vendors best practices.

3. Recommendations – Consultation on the discoveries found during the analysis as to find mitigation on broken processes.

4. Implementation – Based on the recommendations agreed upon, we will incorporate the needed workflows as well as introduce new products and functionalities to move towards Meaningful Use compliance. (i.e. Patient portal, HL7 interfaces, etc...)

5. Evaluation – Perform a post-evaluation of the overall office processes to include the current roles of the staff and utilization of the EHR system during daily operations as comparison to your initial evaluation.

Benchmarking ExamplesCheck-In Process• Has check in lag time improved?• Is the end user capturing all necessary MU Information at Registration? • Are demographics being updated? • Decrease in No Show Rate?

Clinical Process• IIs the Clinical Support Staff managing the encounter types, scheduled visit and LOC correctly? • Did the clinical staff capture the Meaningful Use data?• Is tasking/orders tracking used correctly?• Lag Time Improvement • Services and referral follow-up lag time improvement.

Provider Process• Are providers documenting HPI and CPOE A@P thoroughly for ICD-10 standards. • Are providers completing note during the visit, after the patient leaves or later?• % of On Hold, In Progress, Completed Orders. • Are all charges captured. • Are the providers creating an Append and documenting this correctly? • Are providers completing prescriptions, ordering labs and x-rays procedures?• Are providers scheduling the patient’s next appointment?

What to Expect When We Arrive

1st •We will examine and analyze your front office, clinical staff, and provider processes.

2nd •Based on our findings, we will deliver a strategy that will allow your agency to employ Best Practices based to assure your success.

3rd •We will help you modify your workflows, as needed, and introduce you to any new product functionality that has been evolved since your implementation.

4th •We will conduct an Exit Interview to discuss finding and recommendations.

5th •A written evaluation and recommendations will be provided for future improvements. We would like to keep track of your progress with a follow up call 30 to 60 days from the Check-up visit.

CRITICAL CLINICAL ASSESSMENT AREAS: EHR Implementation Team Workflow Design

Appointment Scheduling

Patient Check In

Clinical Check In

Provider Process

Orders/E-Rx /Referral/Pt Education

Clinical Check Out

Office Check Out Billing

Investment

There’s an investment on the client’s part for this to be successful:• Time – The practice has to invest in the time

to learn. • Adjustment – To the changing times and

regulations of CMS • Attitude – How you react will affect your staff• Concepts – We need to be open to new ideas• Workflow – A re-training or new workflows

and concepts

Who is our target audience?

• Our Customers• Our clinical support staff• Our providers

YOU!

DECIDE…..COMMITT….ACHIEVE!

Questions and Answers

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