2014 WPHCA FALL LEARNING
SESSION
REVENUE CYCLE LEARNING PLAN: Bringing it full
circle
Zoe Wolf
Director of Revenue Cycle
Sixteenth Street Community Health Centers
Milwaukee, WI
CONFLICT OF INTEREST AND
COMMERCIAL INTEREST
None
REVENUE CYCLE LEARNING
SERIES
Sponsored by WPHCA

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Facilitated by WPHCA STAR Program Manager
Provided opportunity for organization leaders to gain
an understanding of all aspects of the revenue cycle
Used outcomes of SVA Consulting STAR Deep Dive as
initial discussion points
PURPOSE OF REVENUE CYCLE
LEARNING SESSIONS
To provide leadership who are not involved in
revenue cycle operations with knowledge of the
revenue cycle and revenue cycle processes using
operational modules
REVENUE LEARNING CYCLE
PARTICIPANTS
EXECUTIVE TEAM (E-TEAM)
CEO
Executive Vice President
CFO, Vice President of Finance
Vice President of Communications & Public Relations
Vice President of Human Resources
Vice President of Information Systems
SENIOR MANAGEMENT TEAM (SMT)
Directors and Managers reporting to E-TEAM members
Behavioral Health
Communication
Environmental Health Programs
Funds Development
Grants Development
Health Education & Community Programs
Information Systems
Medical Services
Nursing
Quality Improvement
Revenue Cycle
THOSE INVOLVED WITH REVENUE
CYCLE ON A DAILY BASIS
CFO, VP of Finance
Director of Revenue Cycle
Managers and Leads of:
Billing
Coding
Financial Counseling
Cash Posting
Collections
Registration
REVENUE CYCLE – PRESENTATION MODULES
Self-pay follow up,
payment plans and
collections
START:
Scheduling
and preregistration
Insurance follow
up and denial
management
Registration,
check-in, eligibility
Customer Service
Contract Management
Claim submission
and payment
posting
Financial
counseling
Charge review and
scrubbing
Kay Brewer, WHPCA
Patient care:
ordering, charge
capture or
creation, coding
PRESENTATION FORMAT
 One or two modules presented per session
 Each module is presented by billing office staff subject matter
experts
 Each presentation allows for open discussion
 Q & A at the end of each session
SAMPLE PRESENTATION FORMAT
Typical Front End Process
Appointment
Scheduled
Scheduler/Front
office
- Answer phone
- Schedules
appointments
- Cancels
appointments
- Reschedules
appointments
- Blocks schedule
- Appointment
reminder calls
Pre-registration (if
applicable)
Registrar/Front
Office
- Collect
demographics
and insurance
information
- Mails or calls
patient to
complete
paperwork
Depending on staffing, multiple
steps could be combined across one
role.
Kay Brewer, WHPCA
Registration
Registrar/Front Office
- Verify
Demographics
- Enter and/or verify
insurance
information (phone
or web)
- If in advance:
- Arrange for
interpretation or
special needs
- Schedule other
appointments
(ex. Financial
Counseling)
Insurance
Eligibility
Registrar/Front
Office
- Log into
insurance site
and enter
patient
information
- OR call
insurance
company
- Update in EHR
Check-in
Front Office
- Collect
paperwork and
copay
- Check that
insurance is
verified
- Indicate patient
arrival
- Reschedule late
patients and
follow up with
no-shows
SAMPLE POST-SESSION INFORMATION
Kay Brewer, WHPCA
HOW DID WE USE THE
INFORMATION?
 Cast votes to prioritize opportunity identified in learning sessions
 Determined top four priorities based upon votes
 Assigned work teams with both E-Team and SMT members on each
team
 Each work team develops a project plan
•
Implementation needs identified
•
Timeline identified
OUTCOME OF PROJECT PLANS
To be determined