Stre a mline Billing Pro c e ss in the De pa rtme nt o f Me dic - PowerPoint PPT Presentation

Stre a mline Billing Pro c e ss in the De pa rtme nt o f Me dic ine a t ZSF G WORK I NG GROUP: AMY AK BARI AN, ME L ODY DAVE NPORT -MCL AUGHL I N, AMY F OST E R, MARY E L L E N K E L L Y, NYYA L ARK -WI L SON, JE P POON

BACK GROUND  Wo rk g ro up me t with va rio us c o nstitue nts to b e tte r unde rsta nd the b illing pro c e ss. Ma ppe d o ut b illing pro c e ss fo r e a c h g ro up.  Q a nd A me e ting with Mo nic a Spa hr fro m DPH (Ma na g e r, Pa tie nt Ac c o unts).  T wo ro undta b le disc ussio ns with fro ntline sta ff dire c tly re spo nsib le fo r b illing in e a c h divisio n a nd ha d the m b re a k do wn the ir b illing pro c e ss. Ca rdio lo g y, GI , a nd Pulmo na ry sta ff re pre se nte d.

F I NDI NGS  T he b illing pro c e ss is diffe re nt in e a c h spe c ia lty.  L a c k o f sta nda rdiza tio n ma ke s c ro ss-c o ve ra g e diffic ult.  Witho ut c ro ss-c o ve ra g e , o r a flo a te r F T E fo r b illing , divisio ns ma y fa ll b e hind in b illing due to po sitio n va c a nc ie s a nd/ o r e xte nde d le a ve s.  DOM’ s re ve nue stre a m is a t risk whe n divisio ns fa ll b e hind in b illing . Re ve nue ma y b e lo st due to de la y in b illing o r no t a va ila b le fo r fisc a l ye a r whe n ne e de d.

DOM Cha rg e F lo w fo r Amb ula to ry a nd I npa tie nt Physic ia n Se rvic e s a nd Pro c e dure s *No te : T he DPH b ills fo r a ll a mb ula to ry se rvic e s with the e xc e ptio n o f Ca rdio lo g y, GI , a nd so me Pulmo no lo g y pro c e dure s. Re na l Outpa tie nt dia lysis is b ille d b y UCSF sta ff F OR T HE DPH. Car diology Gastr oe nte r ology He matology/ Infe c tious Dise ase , Pulmonology Ne phr ology Onc ology HIV Pr imar y and 9 Spe c ialty Clinic s Pro vide r Visits a nd Pro vide r Visits a nd Pro vide r Visits Pro vide r Visits a nd Pro vide r Visits a nd Pro c e dure s Se r vic e s Pro c e dure s Pro c e dure s Pro c e dure s Pro c e dure s He a rt Ca ths PF T s Outpa tie nt dia lysis Stre ss T e sts Bro nc o sc o pie s K idne y Bio psie s E c ho c a rdio g ra ms Sle e p Studie s Pro vide r Visits Ho me mo nito ring Clinic Visits E K Gs Pa tie nt Che c ke d I n X X X X X 1st Visit Only ZSF G Billing (F ac ility) ac tions by UCSF staff E nc o unte r fo rm Ge ne ra te d a nd g ive n to X X X X X X pro vide r Pro vide r Co mple te s fo rm X X X X X X Sta ff e nte r c ha rg e s to the L CR X DPH X P PF T s e nte re d b y PF T X T e a m. Othe r c ha rg e s e nte re d b y DPH Sta ff re c o nc ile E nc o unte r fo rms to I nvisio n X - X DPH - - Appt L ist Sta ff b a tc h e nc o unte r fo rms a nd I nvisio n L ist X - X - - - All se nt to DPH sto ra g e X - X - - - Pr ofe ssional Se r vic e s Sta ff Print Pa pe r Co pie s Re po rt fo r Pro vide r X X - - X Pro c e dure s sub mitte d o n pa pe r Pro vide r Re vie ws a nd Sig ns X X - - X No te s a re b a tc he d a nd se nt to CPG X X - - X X Admitting a nd Co nsult No te s sub mitte d thru X X X X X X T e a m No te s Pro Va tio n a nd E K G Pro Va tio n - Pro Va tio n Pro c e dure s sub mitte d Othe r syste ms use d o n pa pe r Spre a dshe e t fo r Sle e p Spre a dshe e t use d fo r Studie s Physic ia n se rvic e s

GAST ROE NT E ROL OGY  GI ha s 0.20 F T E de dic a te d to pro fe ssio na l fe e b illing fo r pro c e dure s.  F Y17 pro -fe e re ve nue $1,475,000. Divisio n fe ll b e hind 6 mo nths in pro -fe e b illing due to sta ffing sho rta g e .  Pro c e dure re po rts a re printe d a fte r the y a re sig ne d b y the pro vide rs.  Billing Assista nt must e nsure tha t re fe rring pro vide r a nd the re fe rring pro vide r’ s NPI numb e r is o n the re po rt. I f this info rma tio n is missing , it must b e re se a rc he d. T his c a n b e time c o nsuming .  Onc e re po rts ha ve a ll o f the ne c e ssa ry info rma tio n, the y a re b a tc he d in g ro ups o f 50 a nd se nt to the Clinic a l Pra c tic e Gro up fo r sub missio n.

CARDI OL OGY  0.30 F T E de dic a te d to pro fe ssio na l fe e b illing .  F ro nt de sk sta ff e nte rs pro c e dure a nd dia g no stic c o de s in L CR fo r DPH.  F Y17 pro -fe e b illing re ve nue $1,142,000  Pro c e dure re po rts a re printe d a fte r the y a re sig ne d b y the pro vide rs.  Billing sta ff must e nsure tha t re fe rring pro vide r a nd the re fe rring pro vide r’ s NPI numb e r is o n the re po rt. I f this info rma tio n is missing , it must b e re se a rc he d. T his c a n b e time c o nsuming .  Co mple te d re po rts a re se nt in b a tc he s o f 50 to CPG.

NE PHROL OGY  Ne phro lo g y ha s 0.5 F T E de dic a te d fo r pro fe ssio na l fe e b illing F Y 17 pro – fe e re ve nue is $ 914,221 o utpa tie nt se rvic e + $ 323,322 re na l c o nsult   F o r o utpa tie nt pro -fe e , the b illing a ssista nt: • c o lle c ts mo nthly physic ia n visit re po rt a t the la st da te o f e a c h mo nth • ve rifie s tha t a ll pa tie nts’ insura nc e c o ve ra g e s a re c urre nt; no tifie s the DM to sub mit T re a tme nt Autho riza tio n Re q ue st (T AR) whe n ne e de d. • e nte rs CPT c o de , DOS, insura nc e , pro vide rs a nd Ape x c a se I D o n a spre a dshe e t. • Sub mits to DM fo r fina l re vie w. DM fina lize s the spre a dshe e t a nd fo rwa rds it to Clinic a l Pra c tic e Gro up (CPG) fo r sub missio n to va rio us pa ye rs.  F o r Re na l Co nsult, the b illing a ssista nt: • c o lle c ts the pa pe r pro c e dure re po rts da ily fro m pro vide rs a nd ma inta ins a lo g o f the a c tivitie s. • re vie ws fo r c o mple te ne ss a nd c ro sse s re fe re nc e s pa tie nts who ha ve the sa me -da y c o nsults a nd pro c e dure s. Ba tc he s a nd sub mits to CPG twic e a we e k.

HE MAT OL OGY-ONCOL OGY  He ma to lo g y-Onc o lo g y ha s 0.40 F T E de dic a te d to F QHC b illing fo r the He ma to lo g y, Sic kle -c e ll a nd Onc o lo g y c linic s. No te - Bre a st c linic c urre ntly ho use d in the De pa rtme nt o f Surg e ry.  I n 2017, o ve r 4,600 e nc o unte r fo rms we re pro c e sse d a nd b ille d.  Bille r c o lle c ts pa tie nt e nc o unte r fo rms a fte r c linic a nd re vie ws fo r c o mple te ne ss b e fo re da ta e ntry. I nc o mple te fo rms a re re turne d to the pro vide r to b e c o mple te d.   Bille r re c o nc ile s e nc o unte r fo rms to L CR a ppo intme nt lists to e nsure a ll visits a re c a pture d a nd b ille d a c c o rding ly. Missing e nc o unte r fo rms ne e d to b e re se a rc he d b y the b ille r whic h c a n b e time -c o nsuming a nd de la y pa yme nt.  Bille r ha s 7 da ys to e nte r b illing info rma tio n in RUMBA (a sc he duling & c ha rg e e ntry syste m). Onc e re po rts ha ve a ll o f the ne c e ssa ry info rma tio n a nd re c o nc ile d, the y a re  b a tc he d b y mo nth a nd se nt to DPH sto ra g e e ve ry 6-mo nths.

RHE UMAT OL OGY  Rhe uma to lo g y c linic : Pro vide r utilize s e nc o unte r fo rms fo r pa tie nt visits.  I nfo rma tio n is e nte re d in to e CW a nd e nc o unte r fo rms a re de po site d in a de sig na te d b o x fo r pic k up b y the fro nt o ffic e DPH sta ff.  T he c linic b a c k o ffic e sta ff re c o nc ile s the info rma tio n in e CW with the e nc o unte r fo rms fo r a c c ura c y.  Pro b le m: Any disc re pa nc ie s o r missing info rma tio n de la ys the pro c e ss.  Pro b le m: T he fo rm tha t is g ive n to the pa tie nt to b ring to the fro nt o ffic e ma y b e po c ke te d a nd the pa tie nt le a ve s.  Billing : T he c le ric a l fro nt o ffic e sta ff ha s 7 da ys to e nte r b illing info rma tio n in RUMBA (a sc he duling & c ha rg e e ntry syste m).  Billing is pro c e sse d b y sta ff a t L a g una Ho nda .  All fo rms a re the n b a tc he d a nd se nt to Gre e n Mo unta in sto ra g e .

T HI S I S A ME SS  E a c h divisio n ha s its o wn pro c e ss a nd pa rtia l b illing F T E . So me g ro ups b a tc h re po rts to CPG, o the rs sub mit spre a dshe e ts with da ta .  No sta nda rdiza tio n (e .g . Ca rdio lo g y e nte rs pro c e dure c o de in L CR, GI do e s no t.)  E a c h g ro up is le ft to fe nd fo r its o wn.  Syste ms (i.e . Pro Va tio n) do no t inte rfa c e with CPG’ s E PI C b illing syste m, sig ne d no te s – so me o n pa pe r , o the rs e le c tro nic .

POSSI BL E CHANGE S  Ce ntra lize a ll b illing unde r DOM Ce ntra l a dministra tio n. T his will a llo w fo r a fe w o n-site b illing “e xpe rts”. I t will a lso a llo w fo r c ro ss- c o ve ra g e b e twe e n spe c ia ltie s.  With the inc re a sing impo rta nc e o f pro -fe e re ve nue to suppo rt o pe ra tio na l e xpe nse s, this a llo ws DOM to ta ke mo re c o ntro l o f re ve nue stre a m.  Cro ss-tra in b illing sta ff so tha t the y c a n c o ve r a ny spe c ia lty.  Sta nda rdize the pro c e ss so tha t b illing fo r e a c h type o f se rvic e is the sa me .  Dig itize c ha rg e sub missio n to e limina te pa pe r b illing .