Outpatient Consultation
Project
January 19, 2012
227 Bellevue Way NE | #70 | Bellevue, WA 98004 | USA | 425-646-2375 www.diligence.pro
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1. 6 Questions to Ask When 'Hunting' for Reimbursement
At a Glance
There are six questions negotiators for clinic practices should ask in trying to secure the right
level of payer reimbursement:
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Which CPT codes characterize the practice?
What codes are most valuable to the practice?
What fees are acceptable to the practice?
Which payers are paying acceptable fees?
How can payer schedules be made more acceptable?
What is the financial return from fee negotiations?
2. Leave No Money on the Table
At a Glance
Providers that are successful in managing their contracts with commercial health plans share
three characteristics:
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They use internal and external benchmarking data to set meaningful targets for revenue
from commercial health plans.
They evaluate the revenue they are receiving from commercial insurers on an ongoing
basis to see if targets are being met.
They make adjustments to their contract management plans to meet those targets.
3. Recover Costs of Care with Community Partners
At a Glance
Hospitals that partner with community agencies can take the following steps to obtain
Medicaid and Medicare reimbursement not available otherwise:
227 Bellevue Way NE | #70 | Bellevue, WA 98004 | USA | 425-646-2375 www.diligence.pro
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Contact agencies that assist homeless disability applicants
Assess whether the hospital will recover otherwise lost costs
Form and fund partnerships with community agencies that will reimburse much more
than costs
4. Centralizing Registration Boosts Collections, Patient Experience at Crozer-Keystone
When the four acute care hospitals in the Crozer-Keystone Health System operated their own
patient access departments, consistency was hard to find.
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Preregistration was handled on a catch-as-catch-can basis
Upfront collections rarely occurred
Incomplete insurance information resulted in unnecessary denials
Patients eligible for charity care were not identified until after discharge
Patients were sometimes scheduled for preadmission testing with only one day’s notice
5. Decoding Payer Contract Language
In healthcare getting appropriately reimbursed from managed care payers involves a complex
process that extends from providing and figuring the cost of the care to accurately capturing,
charging, and coding the cost of that care and sending the claim to the payer. Essentially,
however, how well that cost of care is reimbursed begins with one thing: the contract.
6. Transforming the Back Office With a Single Keystroke
At a Glance
Intelligent data capture is an application that can provide electronic access to data contained in
any type of document, including clinical records and financial documents, thereby reducing or
eliminating the need for manual data entry. Before implementing this technology, however,
healthcare leaders should:
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Evaluate technology in the context of a business case to ensure a measurable ROI
Communicate with employees throughout the process so they are prepared for and
embrace the inevitable changes that will come with automation
Implement the solution in phases, focusing on those document types that can deliver
for a safer, less disruptive approach
Achieve maximum benefit to the organization by reengineering business processes to
fully leverage technology rather than simply automating existing manual processes
227 Bellevue Way NE | #70 | Bellevue, WA 98004 | USA | 425-646-2375 www.diligence.pro
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7. The Value of Shared Services
At a Glance
A multisite shared services organization, combined with a robust business continuity plan,
provides infrastructure and redundancies that mitigate risk for hospital CFOs. These structures
can position providers to do the following:
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Move essential operations out of a disaster impact zone, if necessary
Allow resources to focus on immediate patient care needs
Take advantage of economies of scale in temporary staffing
Leverage technology
Share in investments in disaster preparedness and business continuity solutions
8. Transforming Revenue Cycle Processes in an Indigent Care Setting
At a Glance
Steps that Grady Health System in Atlanta undertook in transforming its revenue cycle include:
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Conducting a complete revenue cycle assessment
Enhancing staff skill levels and customer service techniques—and holding staff
accountable for errors
Automating processes that previously were performed manually
Validating applications for financial assistance electronically
Screening for Medicare/Medicaid eligibility among self-pays
Extras:
5 Questions Providers Should Ask Themselves Regarding Managed Care Contracts
With access to market data, hospital leaders can begin to ask the following questions related to
managed care contract performance:
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Where are we in the market compared with where we want to be?
How are our contracts trending over time?
How do our contracts compare with our peer group’s contracts?
Where are our top opportunities for contract revenue improvement by payer?
Where are our top opportunities for revenue improvement by service line?
-----------------------------------------------------------227 Bellevue Way NE | #70 | Bellevue, WA 98004 | USA | 425-646-2375 www.diligence.pro
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The Benefits of Automation
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Manual data entry has been widely shown to contribute to process inefficiencies and
increased costs in all industries, and health care, in particular. In almost every case,
automation provides a strongly viable solution. Consider the following findings.
A 2010 study by The Hackett Group, an international business advisory firm, finds the
median cost of processing an invoice among healthcare operations is $5.24, while those
achieving world-class performance spend $2.56. These findings suggest that an
operation with average performance that pays 1 million invoices annually could save
almost $2.7 million annually by achieving world-class performance—dollars better spent
on clinical care.
High costs are often due to inefficiencies resulting from paper processes. According to
Aberdeen Group, A/P specialists spend half of their time searching for documents. Costs
to recover misfiled
documents average $12, and costs to replace lost documents average $220.
Cost is only part of the problem, however. The Association for Work Process
Improvement finds that one in 40 keystrokes results in an uncorrected error, creating
problems or discrepancies in communication, payment, billing, or more.
Moreover, such errors can translate into payment errors. The International Office
Management Association (IOMA) estimates that 1.6 percent of all payments are
erroneous, resulting in underpayments (potentially straining vendor relations or
disrupting supply chain) or overpayments (i.e., loss of revenue). And International
Accounts Payable Professionals and The Institute of Management & Administration
estimate that for every $1 billion a business spends annually, $1 million in duplicate
payments are made.
Although these findings do not specifically attribute such problems to manual
processing, evidence strongly suggests that the pairing of automation and best practices
can go a long way toward eliminating these problems. In addition to streamlining the
process, freeing personnel from repetitive data entry routines allows them an
opportunity to specifically address anomalies—many of which can prove quite costly, as
the above findings suggest—as opposed to overlooking (or even inadvertently causing)
them.
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Developing a Communications Plan that Supports Business Continuity
A healthcare organization’s business continuity plan could include the following means of
communication:
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An electronic communication system for notifying leadership, managers, and employees
about an evolving situation and for providing periodic updates
A designated call-in number for staff to receive updates on the situation
227 Bellevue Way NE | #70 | Bellevue, WA 98004 | USA | 425-646-2375 www.diligence.pro
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A manual call list in the event of an electronic communications failure
An employee emergency helpline to provide information regarding benefits, payroll, and
more during an emergency and to facilitate connection to a representative for
assistance, as needed
A website to provide relevant information during and after a disaster
Predefined, event-based scripting to assist incoming call center representatives when
receiving calls from patients
---------------------------------------------------------------------------Key Elements of a Business Continuity Plan
An effective business continuity plan should be:
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Embraced by the business owner of daily operations
Documented for each business process
Developed with key roles defined and assigned with back-up resources
Reviewed, tested periodically, and revised as needed
Used to train employees in reacting to disaster scenarios and restoring business
operations
Developed to include plans for critical vendor partners
Located offsite and accessible from any Internet connection
227 Bellevue Way NE | #70 | Bellevue, WA 98004 | USA | 425-646-2375 www.diligence.pro
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