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Revenue Cycle All-Stars

Revenue Cycle All-Stars. Kenny Koerner MBA, CPAM President, Illinois AAHAM On behalf of Illinois AAHAM. Today’s All Star Line Up. CGH Medical Center Overview Revenue Cycle by area Community partnering Measuring Success Employee Management The Future.

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Revenue Cycle All-Stars

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  1. Revenue Cycle All-Stars Kenny Koerner MBA, CPAM President, Illinois AAHAM On behalf of Illinois AAHAM

  2. Today’s All Star Line Up • CGH Medical Center Overview • Revenue Cycle by area • Community partnering • Measuring Success • Employee Management • The Future

  3. CGH MedicalCenter’sIT infrastructure

  4. The Traditional Revenue Cycle

  5. The Impact of the Traditional Revenue Cycle

  6. Post - Service Time of Service Pre - Access The Upside Down Revenue Cycle

  7. Integrates Financial & Clinical Processing & Quality Reduces Management levels and involvement Brings customers in to direct contact with process-owners and vice versa Benefits of the Upside Down Revenue Cycle

  8. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

  9. Central Scheduling • 5 RN’s • 1 LPN • All located in the same office within hospital registration

  10. Central Scheduling • Schedule 90% of all outpatients • Medical Necessity checking • Education and Training

  11. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

  12. Pre-Authorization • 2 FTE’s • Located within the hospital registration office

  13. Pre-Authorization • Work Que’s that come directly from scheduled accounts • Hospital and clinic both • Web based authorization

  14. Pre-Authorization • Receptionist/Nursing Education • Authorization Denial Lists • Utilize Cerner and Passport iAgent

  15. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

  16. Financial CounselingFront End • 1 FTE • Passport PPE software • Charge estimates and patient out of pocket estimates to all scheduled outpatients

  17. Financial CounselingFront-End • Claims history • Validate Charge Estimates • Validate Patient out of pockets

  18. Financial CounselingFront-End • Charity Care • Presumptive Charity • Illinois Charity Care Laws • Contracted employee for active Public Aid enrollment

  19. Financial CounselingFront-End • Affordable Care Act • Health Insurance Exchanges • Public Aid Expansion • 2 FTE’s

  20. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

  21. Registration • 2 offices (outpatient and ED) • 1 Assistant Director • 1 Supervisor • All certified through NAHAM • Front line registration pay equal to biller pay

  22. Registration • Cerner Millennium for • Electronic Eligibility • Imaging insurance cards and driver’s licenses • Photos of patients taken at each registration • Esignature utilized for quality

  23. Registration • Bed Side in ED • Press Ganey Patient Satisfaction • Mandatory Patient Accounts training for all employees • Combined Unit Meetings

  24. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

  25. Health Information • Coders • Coders work bill edits by logging in to electronic billing vendor • Each coder works their specific DNFB report daily to identify high dollar accounts not yet coded • New job descriptions in preparation for I-10 that include pay raises and retention bonus

  26. Health Information • Revenue Integrity Coordinator • One person ultimately responsible for the additions, deletions, changes to our charge master—weekly meetings • Meets with department managers and supervisors to discuss revenue and new service lines • Proactively audits potential OIG risk areas to protect revenue • Unique skill set –LPN, Certified Coder, CPAT

  27. Health Information • RAC Coordinator • Logs, Analyzes, Reports all RAC requests and appeals • Utilize Executive Health Resources • for appeals • PEPPER report summary • Observation/IP Status Confirmation

  28. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

  29. Patient Accounts • Utilize NEBO Systems for electronic billing and remittance posting • Electronic follow up and billing system notation on claim status • All certified CPAT’s through AAHAM

  30. Patient Accounts • Partner for expertise • MRA for MVA • Esolutions for Medicare follow up • NEBO for discharge disposition • Utilization of volunteers for manual follow up • Payment Analyst position validates every insurance payment to contracted rate • Telecommuters

  31. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

  32. Financial CounselingBack End • Currently 1 FTE dedicated to calling patients • On-line web portal accepts payments and patient questions • Partner with local bank for pre approved loan program

  33. Financial CounselingBack End • Written collection policy known by all staff • Ability to handle hospital and clinic accounts • Utilize 2 collection agencies for bad debt

  34. Community • Monthly Community Focus Group Meeting • Quarterly Insurance Broker Meetings • Board and Physician Education • Deal or No Deal Presentation • Community Education • Medicare and You Presentation

  35. Measuring Success • Track Everything, Manage what needs attention • Shared goals with other revenue cycle areas • Examples of what we report

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