Kno now Your our Tea eam! Identify ALL members of the team Sr. - - PDF document

2/1/2017 1

Chal allenges s of

• f Lac

Lactation Reim eimburse sement

in in th the

Acu cute Car are Se Setting

Jason Silvas, RN Pediatric Program Coordinator January 27, 2017

Kno now Your

• ur Tea

eam!

• Identify ALL members of the team
• Sr. Director Managed Care – Provides oversight to entire operation
• CMD Coordinator – Manages CMD’s and pricing with Biller
• Biller/Charge Master – Manages insurance contracts
• Coders – Validate lactation charges
• Revenue Integrity Specialists – Verify charges and documentation
• Decision Support – Responsible for monthly reports
• Lactation Manager – Responsible for lactation staff
• Correct documentation
• Correct charges
• Updated certificates/licensing
• Lactation Specialists – Perform education (CLE)/consults (IBCLC)
• CLE’s focus in Labor & Delivery and Postpartum Units
• IBCLC’s focus on inpatient consults for entire hospital and outpatient referrals

2/1/2017 2

Bill llin ing an and Revenue Cycle le

• DRG vs Individualized Contracts
• MediCal – DRG, fixed payment
• Internal agreement
• Other Insurances
• Reimbursement based on % of charges (negotiated, written contracts)
• Examples: Kaiser, HMO/PPO’s
• Financial Class Breakdown at SJCH:

Cha harge Des escrip iptio ion Mas aster (C (CDM)

• Comprehensive listing of items that could be billed to a patient, payer
• r healthcare provider
• Lactation CDM’s used at SJCH and base price:

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Ad d Hoc

• c Cha

harge She heet Form

• rm
• Created by Coders
• Charges are Lactation responsibility
• May only charge once a day for

total education

• Lactation work flow:
• Daily report sheet
• Hand off
• Charges entered (about 30

minutes)

Revenue In Integrit ity Spe pecia ialis ists

• Have ability to approve or deny charges
• Verify charges and documentation (education)
• Must have current list of all lactation staff
• Send verified charges to Patient Financial Services for billing
• Was 100% chart audit for 6 months, reduced to 50%
• Currently, 30% of charts are audited

2/1/2017 4

Edu ducatio ion Doc

• cumentatio

ion

• Must Document:
• Topics taught
• Individual(s) taught
• Teaching method
• Teaching evaluation
• Language used
• Interpreter (if used)
• Barriers to learning
• Must document in consistent location

Edu ducatio ion Doc

• cumentatio

ion

• Revenue Integrity Specialists
• Updated staffing list
• No specific CLE or IBCLC roles

2/1/2017 5

Cha harge Brea eakdown by Unit nit

• August, 2015:

Tot

• tal

l Cha harges vs s Tot

• tal

l Wag ages

• August, 2015:

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Revenue Col

• lle

lected

• Approximately 3-4 month reimbursement cycle
• August, 2015:

Ben enefits of

• f Lact

actatio ion Ser ervic ices

• Breastfeeding is normal needs to be supported
• Long-term health benefits for mother and baby
• Important role for the Baby Friendly Hospital Initiative
• Increased HCAHPS scores
• Higher reimbursement rate
• Patient loyalty
• It’s the right thing to do!

2/1/2017 7

Bab aby Fri Friendly Das Dashboard

Jason Silvas, RN Pediatric Program Coordinator

73% 70% 81% 82% 76% 80% 78% 88% 80% 77% 61% 56% 40% 50% 60% 70% 80% 90% 100% Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15

Baby Friendly Dashboard

Exclusive Breastfeeding Rate

SJCH - Current California - 2013 Kern County - 2013 SJCH - 2013 Trend

64.6% 54% 58.4%

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86% 83% 87% 90% 85% 91% 87% 96% 93% 91% 90% 86% 80% 82% 84% 86% 88% 90% 92% 94% 96% 98% 100% Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15

Baby Friendly Dashboard

Any Breastfeeding (Formula Supplemented)

SJCH - Current California - 2013 Kern County - 2013 SJCH - 2013 Trend

92.9% 87.6% 90.3%

93% 91% 94% 94% 92% 92% 92% 93% 93% 92% 93% 90% 80% 82% 84% 86% 88% 90% 92% 94% 96% 98% 100% Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15

Baby Friendly Dashboard

Feeding Plan Documented

Trend

2/1/2017 9

78% 84% 81% 77% 85% 81% 73% 78% 68% 75% 80% 82% 0% 20% 40% 60% 80% 100% Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15

Baby Friendly Dashboard

Skin to Skin Rate: Vaginal Delivery

Trend 49% 45% 61% 40% 44% 35% 40% 33% 29% 29% 53% 45% 0% 20% 40% 60% 80% 100% Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15

Baby Friendly Dashboard

Skin to Skin Rate: C-Section

Trend

2/1/2017 10

68% 73% 75% 67% 71% 70% 64% 67% 58% 64% 74% 72% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15

Baby Friendly Dashboard

Skin-to-Skin Documented

Trend 29% 25% 23% 24% 27% 24% 28% 25% 25% 25% 21% 24% 15% 20% 25% 30% 35% 40% Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15

Baby Friendly Dashboard

Monthly C-Section %

SJCH 2014 National Average Trend

32.2%

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220 236 223 197 244 218 212 201 226 253 247 224 91 79 66 62 89 67 81 66 76 83 66 71 50 100 150 200 250 300 350 400 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Total Births Delivery Type

Baby Friendly Dashboard

Monthly Delivery Report

Vaginal C-Section References: California Department of Public Health, Center for Family Health, Genetic Disease Screening Program, Newborn Screening Data, 2013 Martin JA, Hamilton BE, Osterman MJK. Births in the United States,

• 2014. NCHS data brief, no 216. Hyattsville, MD: National Center for

Health Statistics. 2015.