West Virginia HFMA Conference Ways to Manage Your Aged Accounts - PowerPoint PPT Presentation

West Virginia HFMA Conference Ways to Manage Your Aged Accounts Receivable September 29, 2016 Dina Schardinger, Vice President of Operations Ginger McDonough, Director of Business Development 1

Objective: Ways to Manage Your Aged AR This session will discuss ways to reduce your aged accounts receivable by promoting cash resolution, reducing bad debt expense, and transferring patient balances timely. The use of claim scrubbing systems, 835 data, and timely filing guidelines help staff manage aged inventory by managing exceptions. 2

Biography Ginger McDonough • BS in Healthcare Administration • Over 30 years’ experience in the healthcare industry • First healthcare job as ED Hospital Registrar • Moved into Insurance Verification Supervisor and then Patient Access Manager • Became Patient Access/PFS Director • Moved into vendor arena; Vice President of Business Development 5 years ago 3

Staffing Needs for a Successful AR ü Take the time to train your Billing and AR follow-up staff ü Maintain a relationship with Coding and Patient Access ü Ensure knowledge of payer contracts and payer processing procedures ü Use technology and automation when available to feed accounts to the staff to work based on exceptions ü Continued professional growth with CRCS (Certified Registered Cycle Specialist) 4

Work Flow Methodology ü Complete an analysis of your Aged Accounts Receivable by payer and by aging bucket ü Focus on having no more than 2% of your aged inventory in over 365 days and no more than 10% of your aged inventory in over 180 days and older ü Have staff focus on specific payers to ensure there is consistency in follow up and the staff can determine trends in reimbursement, denials and potential contracting issues ü Try not to assign more than 750-1,000 accounts per FTE to ensure that staff can handle the volumes and work through the inventory ü Complete weekly performance-based metrics to ensure you are generating cash, resolving inventory and reducing aged buckets 5

Inventory Breakdown A tiered approach to working AR has proven beneficial as it increases cash collections, reduces bad debt expense, and resolves AR inventory quickly and efficiently. Identify accounts at risk of exceeding payer filing deadlines. Make determinations on aged inventory, while focusing on claims that are getting At Risk ready to go timely. This includes first bills and appeal guidelines. Determine those accounts having the highest potential for collections. These accounts represent insurance and patient due balances which are High Probability neither at risk nor qualify for immediate write-off but are being held from payment due to a denial, request for additional information, or rebill request. Evaluate all accounts with a partial payment to identify those that may warrant allowance, write-off, or patient transfer, in whole or in part, with no Potential Allowance further formal collection activity. Patient Liability 6

Receivables Management ü Manage clean claims, look for a rate of 95% or higher ü Fix claim edits with 24-48 hours ü Review acknowledgement/rejection reports ü Follow up on accounts not paid within the first 14-21 days of bill, use claim scrubbing software for first touch ü Follow up on denials, zero pays, and line item denials, though the use of 835’s ü Ensure allowances are posted correctly by maintaining contract management systems ü Manage credit balances through credit balance vendors that get paid by payers ü Ensure patient balances are moved timely ü Determine trends in inventory by payers 7

Insurance Process Map Daily account placements loaded into the Aurora RCInet Accounts triaged Triaged accounts system Work flows then into prioritized then processed 
 distributed to team categories 
 for proper work members by payer based on 
 flows to set & priorities Daily 835 files Staff Members’ Responsibilities payers and age priorities for staff imported to • Work a minimum of 50-60 trend denials accounts per day and implement • Choose a root cause for each into work flows Medicare & account referred At Risk MCare HMOs Zero Approaching • Update insurance and rebill as Payments Untimely appropriate Acknowledgement Medicaid & • Send administrative appeals sent daily — MA HMOs Reconciliations done • Post transfers, adjustments, High Secondary 
 weekly or monthly and denials Probability Blue Cross & or Patient • Report denials and Billing &F/U Blue Shield Balances underpayments to management for trending Aetna, Cigna, • Review contracts for UHC Partial Adjustments, underpayments; management Payments Patient Liability, Workers captures trends in Aurora 
 & Write-Offs Comp & Auto RCInet daily Multiple scrubbing 
 processes aid in reducing • Triage tended denials to new • Partial Payments with line item Commercial loss and maximizing daily workflows Other collections – and ensure that denials routed to denials team ALL accounts are worked • Partial Payments without denials regardless of balance routed to contract review team 8

Financial & Performance Metrics Financial and Performance Metrics to track the project’s progress: ü Daily collections – gross and net ü Days in AR ü Percentage of Inventory in aged buckets ü Clean claim rate and account resolution ü Percentage of write-offs, credit balances, and patient liability transfers ü Dashboard and productivity reports ü Monthly narrative report with knowledge transfer and trends 9

Questions . Ginger McDonough Director of Business Development 540-842-5878 virginia.mcdonough@bolderhealthcare.com 10