Tools to Strengthen Your Revenue Cycle

October 26, 2015

Daryn Eikner, MS

Vice President Service Delivery Improvement

National Family Planning &Reproductive Health Association

2

Increasing Revenue

Strengthen the revenue cycle process

Maximize provider productivity

Increase operational efficiency and effectiveness

Today

Introduce the revenue cycle assessment tool

Introduce the revenue loss tool

Front-end Operations

Clinical Encounter

Back-end Billing Functions

Administrative

Components of Revenue Cycle

5

BarriersComponents of the Revenue Cycle

BarriersThe Revenue Cycle Assessment Tool

BarriersThe Revenue Cycle Assessment Tool

Revenue Cycle

Assessment

Staffing &

Functions

BarriersReflection

&Planning

BarriersThe Revenue Cycle Assessment

Section 1. Policies and Procedures

Section 2. IT Systems

Section 3. Front End Billing Processes

Section 4. Clinical Billing Processes

Section 5. Coding and Documentation

BarriersThe Revenue Cycle AssessmentSection 6. Claims Submission

Section 7. Remittance Reconciliation

Section 8. Accounts Receivable Management

Section 9. Analysis

Section 10. Third-Party Payer Contracts

Section 11. Provider Credentialing

Appointment scheduling

Pre-registration & authorization

Reminder calls

Registration/check-in

Eligibility verification

Handling of cash

Reconciliation Process

Section 3. Front End Billing Process

Barriers

• HIPPA Privacy Protections• HIPPA Security Protections• KPIs• Reports

Section 9. Analysis

BarriersFeedback

Current Practice Recommendations

Fee Schedules

Fees are set to Medicaid reimbursement rates and rather than the cost of services.

Revise fee schedule to reflect the cost of the services being provided.

Last cost analysis was completed in 2010. Conduct a cost analysis.

Cash

There are no formal, documented processes for the handling of cash received from clients.

Develop & document procedures for the handling of cash.Train staff on new procedures.

BarriersThe Revenue Cycle Assessment Tool

Rhonda Staley, MPHTitle X Sterilization Manager and Revenue Cycle EvaluatorSouth Carolina Dept. of Health & Environmental Control

Questions

Confidential & Covered: Revenue Loss Logic &

Tool

Funding for this project was provided by the Office of Population Affairs (Grant Number 1 FPRPA006059-01-00). The views expressed by this project do not necessarily reflect the official policies of the Department of Health & Human Services; nor does mention of trade names, commercial practices, organizations imply official endorsement by the U.S. Government.

Revenue Logic

• Logic to analyze revenue data to determine unrealized revenue due to an inability to submit claims because of a client request confidentiality.

• Identify visits by patients confidential billing

• Access to relevant claims information for those visits

• Organizations adapted screening processes and retrained staff to implement

Revenue Loss Tool

C&C SAMPLE REPORT11/1/2015 - 11/30/2015

$

29

6

5

Total Revenue

Total number of visits made by clients who have insurance and request not to use it due to need for confidential billing services GO TO TAB #2

Total number of visits made by clients who have insurance but request not to use it

REPORT NAME:REPORT PERIOD:

Total number of visits made by clients

CLAIM

ID

SERV

ICE MONTH

TYPE

OF I

NSURA

NCE

OTHER

INSU

RANCE

TYPE

ALL C

HARGES

(DOLL

ARS)

SLID

ING FE

E SCALE

?

SLID

ING FE

E

PLAN

Amount

Paid

(Doll

ars)

LOST

RE

VENUE (

DOLLARS

)

CPT/H

CPCS

Code (

1)

CPT/H

CPCS

Charg

e (1)

ICD-10

DIAGNOSIS C

ODE (1)

ICD 10 D

IAGNOSIS (1

):

DESCRIP

TION

PATIE

NT

AGEPA

TIENT

SEX

Revenue Loss: Illustration

Peggy, a 19 year-old female, visits her family planning provider. Peggy lives with her parents and is covered by their insurance.Peggy does not want them to know that she was in the clinic today.

Peggy wants to initiate contraceptives today but is not sure which method she wants. The clinician counsels her for 13 minutes on her options for contraceptive methods. Peggy decides to initiate oral contraceptives today and leaves the clinic with a 3 month supply of combined oral contraceptives.

The clinician collects a specimen for a CT/GC screening and sends it to an outside lab.

The entire visit was 18 minutes.

Revenue Loss Tool

Revenue Loss Tool

Evelyn KieltykaSr. Vice President of Program Services

Rhonda WoodmanMedical Billing Manager

Questions

www.nationalfamilyplanning.org

National MeetingMarch 5-8, 2017