What CFOs Want

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What CFOs Want

• Paula Bruce, RHIT, CCS
• Coding Manager
• Halifax Medical Center
• Daytona Beach, FL

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CASH..

• MORE CASH TODAY THAN YESTERDAY!!

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Halifax Medical Center

• 700 bed non-profit acute care facility
• Level II trauma unit, one ED on campus and 2 UCC
  in different locations in the County
• 2004 Hospital of Distinction for Healthgrades
• 8 in Top 100 Companies for Working Families in
  2005 for Volusia County
• Among top hospitals in the U.S. for clinical
  quality excellence according to Healthgrades.
  Received Hospital Award of Clinical Excellence in
  2005
• Visits - 33,000 annual inpatient discharges

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Halifax Medical Center

• 140,525 ED/UCC visits a year
• 19,000 OPS visits a year
• 147,000 outpatient ancillary visits a year
• Coding Staff
• 4 Inpatient coders
• 2 OPS coders
• 8 Ed/Ancillary coders

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Our Systems

• Meditech Abstracting
• Quantim Coding and Outpatient Compliance
• Medstat/QMS
• CDM Focus
• PBFS-Patient Business and Financial Services
• Admitting
• Patient Acct-Scheduling, Pre-Reg, Billing,
  Financial Counseling, Collections
• Health Information Management
• Resource/Case Management

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ChallengesWe all know what CFOs want. How do we
get it for them?

• Develop trust with the finance department and
  PBFS staff
• Register patients with accurate demographics and
  insurance
• Verify
• Authorize
• Certify

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Challenges

• Collect patients responsibility up front
• Determine up front if patients are eligible for
  charity or other assistance programs
• Obtain ABNs for Medicare outpatient services that
  have a NDC/LCD policy

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Challenges

• Clinical departments that are accountable for
  entering charges the same day of the service and
  verification
• Code all accounts within the facilitys bill-hold
  days
• Work the DNFB daily
• Coding accurately and consistently
• Providing education on coding and billing
  guidelines

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Challenges

• Improve and move the CMI
• Ensure money received today is money you never
  have to pay back
• Monitor LOS and high dollar accounts daily

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Challenges

• Keep AR days down
• National average is 49.62 in fourth quarter 2004.
  How low can you go?
• Aggressive collections and denial management team
• Active multidisciplinary Revenue Cycle Management
  Team

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Challenges

• Aggressive Case Management Team
• Aggressive Resource Management Team
• Radical contract strategy
• Terminate Manage Care contracts if necessary
• Reducing uncompensated care
• Knowledge of state and local funding programs

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Challenges

• Maintain CDM with valid CPT/HCPCS codes, valid
  rev codes and up to date prices
• Charge verification for outpatient services.

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How to Meet these Challenges

• Registration

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How to Meet these Challenges

• Registration
• Provide the staff systems to verify patients
  authorization, co-pays and what their policies
  cover prior to the patient coming into the
  facility
• Demand patients make their co-pays at the time
  of registration
• Job shadowing with other PBFS areas

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How to Meet These Challenges

• Registration
• Provide the registration staff information from
  the coding department as to which patients coming
  in that day need an ABN obtained.
• Coding department to run report for the next day
  of all scheduled Medicare accounts.
• Determine if medical necessity has been met and
  document if an ABN is needed.

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How to Meet these Challenges

• Coding

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How to Meet These Challenges

• Coding
• Implement Clinical Documentation Program with
  Coding and Case Management
• Review inpatient admission list from prior day of
  Medicare patients with a particular diagnosis

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How to Meet These Challenges

• Coding
• Coder reviews the patients EMR and enters
  comments
• Case Manager reviews comments, queries physician
• Complete documentation while patient in the
  hospital

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How to Meet These Challenges

• Coding
• Maintain coding accuracy of 97 by using Quantim
  Compliance Module
• Provide constant education to coding staff
• Develop internal DRG QA Program to perform
  pre-bill internal coding audits

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How to Meet These Challenges

• Coding
• Quarterly review of random sample charts with a
  principal diagnosis of a sign or symptom
• Move the CMI
• Better documentation without increasing the
  average LOS and total charges

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How to Meet These Challenges

• Coding
• Build CDM hard coded CPT/HCPCS codes to
  Abstracting interface.
• Interface to Quantim to allow the outpatient
  compliance module to run CCI, OCE edits with all
  CPT/HCPCS for all hard and soft coded codes on
  the account

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Code Connection Edit
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Code Connection Edit 2
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Custom Rule Drug charge without administration
charge
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OCE Device Edit
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OCE EDIT
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LCD Example Code Record
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Record Selected for Review
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Review Medical Necessity Policy
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Revise Record
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Return to Coding
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How to Meet These Challenges

• Coding
• Use Quantim Compliance
• Medical Necessity, CCI, OCE edits
• DRG optimization
• Custom rules and user-defined edits based on
  state guidelines specific to your hospital
• Real time self-review in Quantim for coding staff
• Use Quantim References for Coding Clinic, CPT
  Assistance, Lab and Drug dictionaries, medical
  dictionary and anatomy references

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How to Meet These Challenges

• Coding
• Quantim encoder provides book based coding vs.
  logic base coding for accurate coding. This
  allows new coders to train more accurately
  because they are using the ICD-9-CM code book and
  not answering a series of questions that could
  lead them down the wrong path without them
  knowing this, which could create wrong code
  assignment and DRG assignment

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How to Meet These Challenges

• Coding
• Use Quantim Code Connection for coding accuracy
• Coding staff to verify charges as they are coding
  the charts for outpatient services

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How to Meet These Challenges

• Coding
• Empower coders to make corrections prior to
  billing
• Establish strong relationships with the billers,
  collectors and CDM experts
• Review on-line Medicare bulletins in Quantim
  Compliance

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How to Meet These Challenges

• Coding
• Contact physicians office for more dx that could
  cover the services
• Coder to query physician for documentation to
  support these dx to cover services
• Append modifiers GA, GY and GZ to NDC/LCD that
  are not covered.

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How to Meet These Challenges

• Coding
• Send financial impact reports to the CFO from the
  reporting function in Quantim. This includes APC
  and DRG Detail and Frequency Reports, Payer
  Detail Reports and Executive Summary Reports.

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How to Meet These Challenges

• Coding
• Build pro-ration and claim checks in the billing
  module to flag and hold accounts if charges
  and/or ICD-9-CM codes are missing.
• Using the Quantim product allows CCS to very
  easily take their annual CCS Self Assessment
  exam. This ensures coders are keeping up to date
  with Coding Clinic guidelines

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How to Meet these Challenges

• Transcription

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How to Meet These Challenges

• Transcription
• Make sure all dictation is transcribed with in 24
  hours
• ROI-All requests from Insurance Companies or
  Patient Accounting are processed the same date
  the request is received

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How to Meet these Challenges

• Resource/Case
• Management

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How to Meet These Challenges

• Resource/Case Management
• Review any new services
• Ask the questions
• Will we be losing or making money from this
  service?
• Discharge Planning done within 24 hours of
  admission

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How to Meet These Challenges

• Resource/Case Management
• Frequent Flyers in the ED/UCC are being alerted
  to Case Management while in the ED and are
  greeted by a Case Manager to counsel the
  patient
• Dont be afraid of We cannot perform this
  service due to loss in revenue. Requires
  Administrations support.

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How to Meet the Challenges

• Revenue Cycle Management

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How to Meet These Challenges

• Revenue Cycle Team
• Team should consist of the Department Head of
  each clinical area, Coding, Billing,
  Registration, Resource/Case Management,
  Compliance, Finance and CFO
• Clinical departments to assign and train an
  employee to be responsible for their CDM

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How to Meet These Challenges

• Revenue Cycle Team
• Use a computer program that allows the clinical
  departments to keep up with their CDM
• Coding and Billing Managers to ensure all
  clinical departments are trained on the OPPS and
  DRG system.
• All Revenue Cycle Team members should be included
  in all education services

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How to Meet These Challenges

• Revenue Cycle Team
• Medicare bulletins and APC tables available to
  departments
• Provide feedback to the clinical departments as
  to what services are not being paid for and why
  these services are being denied

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How to Meet These Challenges

• Revenue Cycle Team
• Perform annual CDM reviews with each clinical
  department
• Perform biannual charge verification reviews with
  clinical areas. Use Medical Record and itemized
  statement for verification
• Make the clinical departments accountable for
  their late charges

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How to Meet These Challenges

• Patient Accounting
• Aggressive Billers responding to Medicares RTP
  list daily
• Provide the Billing department a scrubber
• Billers question failed charges and coding from
  scrubber

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How to Meet These Challenges

• Patient Accounting
• Collectors question accounts that have been
  denied and refer these accounts to the Denial
  Management Team
• Create an Information Systems department within
  the Revenue Cycle group

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How to Meet These Challenges

• Collections/Denial Management
• Provide a computer program that can validate
  expected reimbursement to actual reimbursement
• Go after the payers that have not paid you what
  their contracts state should be paid
• Use Clinical staff to appeal denials due to
  medical necessity

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End Results

• CFOs want money and lots of it!!
• Every employee is affected by the cash flow
• Take advantage of the clinical and financial
  resources in your facility
• Revenue Cycle is being managed vs. it managing
  you
• CFOs are confident every dollar is being charged
  correctly, billed correctly and collected
  aggressively

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• CFOs know that
• revenue is being captured
• and converted into CASH!!!

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Thank You

• Please feel free to contact me
• Paula Bruce, RHIT, CCS
• Coding Manager
• Halifax Medical Center
• 386-254-4000 Ext 3749
• Paula.Bruce_at_halifax.org