Revenue Cycle Management and EHRs Wednesday, January 21 st, 2015 Presented by Ron Sterling Sterling Solutions, Ltd. rbsterling@sterlingsolutions.com The information provided in AHC Media Webinars does not, and is not intended to constitute medical or legal advice. Opinions, references and links provided by our speakers are provided for your convenience and do not represent our endorsement of such opinions, products or services.
RONALD B. STERLING, CPA Sterling Solutions, Ltd. Ron Sterling is a nationally recognized thought leader on electronic health records and an award winning author. Ron has advised healthcare organizations across the country. He has analyzed software from over 150 vendors. Ron is a frequent speaker on EHR issues and strategies as well as the author of over 250 articles on health information technology for dozens of publications including the widely used Marketing Your Clinical Practice. EMAIL: rbsterling@sterling-solutions.com Office: (301)681-4247
OBJECTIVES 1. Review the effect of technology on events that produce revenue. 2. Identify effects of evolving Revenue Cycle Management issues on EHR use and management. 3. Discuss techniques to maintain appropriate EHR records for the quality and patient service requirements under evolving payer relationships.
RCM Issues Revenue Sources Changing Fee For Service Decreasing Increasing Shared Savings Accountable Care Organizations evisits Patient Portal Services Patient Service Performance/Results Oriented Payments
RCM Focus Changes to Support Evolving Payment Models From To E&M Charge Capture Maintaining Quality and Performance Patient Service Proving Quality Patient Centered Specialty Practice Patient Centered Medical Home
New RCM Flows
Traditional HC Insurance Employer Payer PMPM Fee FFS Fee For Service PMPM Per Member Per Month Hospital Clinic
Alternative Payment Model - ACO Payer ACO Global Payment FFS Fee For Service PMPM Per Member Per Month Hospital/Clinic/Provider
Alternative Payment Model - Shared Savings Employer PMPM Fee Payer Shared Savings Refund FFS Fee For Service PMPM Per Member Per Month Claims FFS Payment Shared Savings Payment Hospital/Provider
Issues that Influence RCM Strategy Meaningful Use HIPAA Security Standards Accountable for Integrity Assure Accessibility
RCM Support Is Complicated Preserve Information to Support RCM Notes New Service Documentation Tools Clinical Messaging Patient Remote Patient Monitoring Systems Patient Quality and Service Objectives Coordinate Patient Populations Track Patient Care Performance Standards Quality Improvement
RCM Support Is Complicated Payers/ACOs May Vary Sustain an Audit of Supporting Documentation Requests for Documents Examination of EHR Based Records Computer Assisted Review Tools Review of Audit Trails Review Context of Care
Evolving RCM is Complicated EHR May Not Accommodate Tracking of Key RCM Measures Relevant Status Over Activities May Require Changes to EHR Use Activities Measures Documentation to Trigger RCM Requirements
Evolving RCM is Complicated May Require Additional Documentation Meaningful Use Like Attestation Global Reporting Performance Tracking Payment May Not Be Associated with a Patient Quality Incentive SGR Fix Payments
EHR Challenges Related to RCM EHR Records are Vulnerable Payer Patient Service Expectations First Response Final Resolution/Recommendation Due Diligence to Protect Patient Records Avoid Degradation Maintain Accuracy and Consistency
EHR Challenges Related to RCM ICD10 Starts October 1, 2015 Not Just About Coding Clinical Decision Support (MU) Health Maintenance Items Classification of Plans, Visits and More ICD10 Specificity Site Laterality Visit Type More
Clinical RCM Objectives Verify Record Standards Maintain Integrity of Patient Records Protect Against Unsubstantiated Services Quality Lapses Claim Fraud Support Contractual, Professional and Industry Standards
Agree on Operational Standards Standards Based on EHR Features Product Use Payer/ACO Practice Services Doctors
RCM CHECKLIST
RCM Checklist Items Notes Signed Within X Hours/Days Regular Office Visits evisits Evolving Activities (Ex. ACO Support) EHR Interface with PMS/Billing Accuracy Timeliness ICD9/10 Coding Changes Substantiation
RCM Checklist Items Reconcile Charges Appointments Cancellations No Shows Supporting Documentation for Clinically Significant Events
RCM Checklist Items Patient Portal Traffic Patient Submission of Information New Patients Follow Up Turnaround Time Follow Up on Undelivered Messages Documentation Supports Care Standards
Patient Portal Information Patient Request Response Patient Portal Server Messages Sent to Inbox and Information Entered into EHR. Information Accepted Information Flagged and Posted to Patient Chart.
RCM Checklist Items Outgoing and Incoming Electronic Traffic Check Rx Transition of Care Lab Results Patient Orders Other Results Workflow Management Patient Appointments Cleared and Completed To-dos and Messages Completed
RCM Checklist Items Internal Messaging Part of Patient Service Strategy Status and Response by Type Workflow Issues Incoming Documents/Images Status of Items to be Indexed Routing of Indexed Items Documentation of Decisions Changes to Care Plan Document Patient Notification
RCM Checklist Items Quality Assurance Documentation Standards Outlier Detection Treatment and/or Management Meaningful Use
RCM Checklist Items Quality Patient Services Procedure/Surgery Follow Up Referral Follow Up Reminder Transmission Reminder Follow Up Health Maintenance Items Outstanding Orders Obsolete Orders
RCM Reporting Maintain Statistics to Prove Performance Payer Patient Population Provider Location Report on Standards Performance Trends
Supporting Claims and Collections In addition to copy of notes to match E&M code with documentation. Includes proving care standards Depends on operational performance Requires timely and accurate records Meaningful Use reporting and Clinical Quality Measures are a window into the future of RCM
RCM and EHR Cases PMS receives charges for office visits from EHR but does not post transactions for evisits, RPMS monitoring and other activities that are billed under a quality initiative. What are the RCM issues? What are the RCM problems in light of an ACO environment?
RCM and EHR Cases Practice receives a quality incentive payment for managing an at risk patient population. The PMS only posts fee for service charges. How and where should the payment be posted? Can the payment be posted directly to the accounting system and bypass the PMS? How will realization reports be affected?
RCM and EHR Cases EHR Vendor advises practice to not sign patient notes in case the doctor wants to change the document. What are the fee for service issues? What are the professional liability issues? What are the RCM problems in light of an ACO environment?
RCM and EHR Cases EHR Messages are not included as part of the patient record according to the EHR design. How does this design complicate quality patient care? What are the operational accommodations needed to support quality care based RCM?
Go Forward Plan Monitor EHR Vendor tools to support RCM under evolving payment and performance systems Meaningful Use as a Start Maintain EHR Documentation and Performance Standards to take advantage of EHR and align your practice with evolving revenue models (ACO, Shared Savings, PCSP, etc.)
This presentation is intended solely to provide general information and does not constitute legal advice. Attendance at the presentation or later review of these printed materials does not create an attorney-client relationship with the presenter(s). You should not take any action based upon any information in this presentation without first consulting legal counsel familiar with your particular circumstances.
QUESTIONS AND ANSWERS
Thank you for attending!! EMAIL: rbsterling@sterling-solutions.com Office: (301)681-4247