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
WORK I NG GROUP: AMY AK BARI AN, ME L ODY DAVE NPORT
AUGHL I N, AMY F OST E R, MARY E L L E N K E L L Y, NYYA L ARK
L SON, JE P POON
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).
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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.
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he b illing pro c e ss is diffe re nt in e a c h spe c ia lty.
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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.
*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
Onc ology Infe c tious Dise ase , HIV Pr imar y and 9 Spe c ialty Clinic s Pulmonology Ne phr
Se r vic e s Pro vide r Visits a nd Pro c e dure s Pro vide r Visits a nd Pro c e dure s Pro vide r Visits Pro vide r Visits a nd Pro c e dure s Pro vide r Visits a nd 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 ZSF G Billing (F ac ility) ac tions by UCSF staff Pa tie nt Che c ke d I n X X X X X 1st Visit Only E nc o unte r fo rm Ge ne ra te d a nd g ive n to pro vide r X X X X X X 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 T e a m. Othe r c ha rg e s e nte re d b y DPH X Sta ff re c o nc ile E nc o unte r fo rms to I nvisio n Appt L ist X
DPH
nvisio n L ist X
X
vic e s Sta ff Print Pa pe r Co pie s Re po rt fo r Pro vide r X X
Pro c e dure s sub mitte d
Pro vide r Re vie ws a nd Sig ns X X
No te s a re b a tc he d a nd se nt to CPG X X
X Admitting a nd Co nsult No te s sub mitte d thru T e a m No te s X X X X X X Othe r syste ms use d Pro Va tio n a nd E K G Pro Va tio n
Pro c e dure s sub mitte d
Spre a dshe e t fo r Sle e p Studie s Spre a dshe e t use d fo r Physic ia n se rvic e s
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.
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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.
0.30 F
T E de dic a te d to pro fe ssio na l fe e b illing .
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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.
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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 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
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sub mit T re a tme nt Autho riza tio n Re q ue st (T AR) whe n ne e de d.
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.
to Clinic a l Pra c tic e Gro up (CPG) fo r sub missio n to va rio us pa ye rs.
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lo g o f the a c tivitie s.
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 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 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.
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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 .
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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.)
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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 .
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
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 .
Billing pro c e ss de ta ile d fo r e a c h pa rtic ipa ting spe c ia lty. I
mpro ve d c o mmunic a tio n with Clinic a l Pra c tic e Gro up (CPG) re g a rding diffe re nc e s in pro -fe e b illing pro c e ss fo r GI a nd Ca rdio lo g y.
Cro ss-tra ining o f Ca rdio lo g y Billing Ana lyst a nd o the r GI
a dministra tive sta ff o n GI b illing pro c e dure s to he lp with de la ye d b illing . Re sulte d in $650,000 in re ve nue fro m F Y17 pro c e dure s. Curre nt b illing la g in GI is le ss tha n 2 we e ks.