Fy07 emcf game plan specific action steps to improve collections
This presentation is the property of its rightful owner.
Sponsored Links
1 / 7

FY07 EMCF “Game Plan” Specific Action Steps to Improve Collections PowerPoint PPT Presentation


  • 66 Views
  • Uploaded on
  • Presentation posted in: General

FY07 EMCF “Game Plan” Specific Action Steps to Improve Collections. Re-Route EMCF Staff to Edits & Denials. Document Imaging Faster AR follow up vs. paper retrieval Scan charges from encounter forms Eligibility Extend beyond 60 day GHS interface Charge Scanning Complete ED project MedEx

Download Presentation

FY07 EMCF “Game Plan” Specific Action Steps to Improve Collections

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Fy07 emcf game plan specific action steps to improve collections

FY07 EMCF “Game Plan” Specific Action Steps to Improve Collections

Re-Route EMCF Staff to Edits & Denials

Document Imaging

Faster AR follow up vs. paper retrieval

Scan charges from encounter forms

Eligibility

Extend beyond 60 day GHS interface

Charge Scanning

Complete ED project

MedEx

Reviewing use for portion of EMCF patients

Call To Action

Continued emphasis on correction batches

Error reduction to avoid TES

Studying TES for improvement ideas

Fee Schedule

Capitalize on “EHC updraft” for UHC? (3%)

More TES Edits for CMOs

Reduce Claim Error Count

More access to info for direct dept. engagement


Fy07 emcf game plan specific action steps to improve collections1

FY07 EMCF “Game Plan” Specific Action Steps to Improve Collections

Re-Route EMCF Staff to Edits & Denials

Missing Revenue

Correction Batches – any opportunities?

How to tell if docs are not submitting?

TES Edits – reduce the volume

Medicaid Location of Service

Medicaid Category of Service

Missing Diagnosis

Non-Billable Report

Published by K Cook

Charge Lag

What are your expectations?

TES impact?

Volunteer Physician Issue

Still $350k tied up here – but dying

MVA Project expansion

Proceeds beginning to come in

Reduce Claim Error Count

Find revenue opportunities


Cause effect emcf

Low Revenues:

Missed Revenues:

Other:

Charge Lag

TES – which edits and why?

How to correct?

Correction Batch clues

TES edits:

Provider #s

Non-billables Rpt.

Volunteer Faculty

Credentialing Rpt

Scan-able forms project

Chief engagement on issues

Cause & Effect: EMCF

Weekly / Monthly

Reports

Direct Mgt. engagement

More CMO TES edits are coming: so we need to have a plan of attack


Appendix

Appendix


Emcf budgeted monthly charges 9 8m

TES Snapshot: EMCF vs. TEC

Revenue held in edits – requiring work

EMCF BudgetedMonthlyCharges: $9.8M

Average Monthly Charges Hitting TES Edits: $1.8M (18%)

*Equivalent of $14M of TEC’s monthly

charges hitting TES*


Tes edits by category 6 month trend

TES Edits by Category6 Month Trend

42.71% Dx Not Coded

9.13% Missing Dx/ Procedure

2.65% Missing Referring Phys

2.07% Missing Medicare/

Medicaid Provider Numbers

The majority of EMCF revenue requires correction of billing-dependent data


What do these edits mean

What do these edits mean?

  • Diagnosis Not Coded –

    • encounters received with written diagnosis instead of code

      • Takes coders approx 7 days to code and confirm

      • Are physicians missing a box to check?

      • Are forms needing to have more codes based upon MD utilization?

      • Correction batch sent back to departments – “can’t read” the handwriting

  • Missing Diagnosis/Procedure Code –

    • encounters received without a diagnosis and/or procedure indicated

      • An essential item required to bill anyone and maintain compliance

      • “Nothing on the form” – correction batches sent back to departments

  • Invalid Diagnosis/Procedure Code –

    • encounters received with an invalid diagnosis and/or procedure code

      • Handwritten / outdated codes

      • Is there a training need here? Are physicians aware of these issues?

      • Requires a correction batch (internal to billing office) to fix

  • Missing Referring Physician –

    • encounters received without a referring physician where the payer is Medicaid, Medicare or Blue Cross/Blue Shield

      • An essential item required to bill these payers and maintain compliance

      • Have to fill item in on form to get paid


  • Login