Briefing: Cosmetic Surgery Policy Challenges for the Billing Office

1. Briefing: Cosmetic Surgery Policy Challenges for the Billing Office Date: 23 March 2010 Time: 1510–1600

2. Objectives Overview of Cosmetic Surgery MSA business processes Analyze and prioritize risk areas Develop a plan to monitor and close risk exposures Discuss effective communication when interacting with other stakeholders Share Best Practices from the field

3. Overview of MSA Business Cycle Processes • Organizational resources available • TMA User Guide – Process Flow chart • Service guidance • Internal policies and established procedures • Divide entire business and revenue cycle into three parts • Pre-procedural processes • Post-procedural reconciliation and billing • Annual updates including resource distribution and training • Determine internal resources available and then prioritize • Inadequate staffing often cited as a barrier • Experience and authority of MSA staff has an impact • Know what you can control and what you can’t • How do you identify and prioritize to improve your processes?

4. Identify Risks in the Business Cycle • Use the Process Overview from the User Guide to start • Categorize distinct activities in your business cycle • Pre-procedure, Reconciliation, Annual, for example • Determine primary stakeholder and other participants • Identify risk areas by asking yourself what could go wrong with each activity • List risk factor flags by reviewing each step, looking for gaps that may not be defensible if someone says “What if...?”

5. Analyze and Prioritize Risk Areas • Now that the risks are identified, map out the results to develop a plan • Some risks are intertwined, and addressing them all at the same time can be overwhelming • Target each component of the overall assessment methodically • You’ll know what’s being done well and which need attention • Quantify the risk by stratifying then prioritize

6. Take Action With a Gap Closure Plan • This is not a one-person undertaking – it takes a team! • Start within your department;1-2 people develop framework • Team meeting(s) to add detail and prioritize implementation • Great start to developing a comprehensive compliance plan • Tickler files, whether manual or electronic, or both, are great gap closers • Implement “quick hitters” to start out • Known factors, like staffing issues, can change risk priority • Provides a great starting point for strengthening communication with other stakeholders in your facility

7. Interaction with Other Stakeholders • One last area that is likely a frustration • MSA staff are integral to Cosmetic Surgery policy compliance • But not intended to be the policing authority • Clinical interpretation of what is cosmetic vs. medically necessary or reconstructive surgery varies across the enterprise • Refer policy questions related to clinical justification through the MTF and/or Service organizational chain • Elevate policy questions via UBO Helpdesk for assistance to support MHS Enterprise consistency with Cosmetic Surgery policy compliance

8. Helpdesk Assistance & Resources • UBO.Helpdesk@altarum.org • Include “Cosmetic Surgery” or “CS” in subject line • Queries that are policy centric (e.g., physician requests, pricing exceptions, medical necessity clarification) will be elevated to the UBO Program Manager and Deputy Program Manager for coordinated response – a ticket will be opened and tracked • You should cc your Service Manager on Helpdesk questions • Technical issues like download issues or program navigation challenges are responded to quickly • Together with the strong MSA staff and leadership across the MHS enterprise, we will continue to “define and refine”

9. Sharing Best Practices from the Field • Courtesy of MSA Business Office at Madigan AMC

10. Sharing Best Practices, Cont’d

11. Questions / Answers / Discussion? Thank you for your help. I appreciate it! Goal Setting Best Practices Communication Is Key