Presentation hosted by Conventus outlining specific strategies for adapting to new quality-based payment plans to boost revenue and cash flow. Features Ron Sterling of Sterling Solutions
2. Sterling Solutions, Ltd.
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3. Sterling Solutions, Ltd.
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4. Sterling Solutions, Ltd.
Today’s Expert
Ronald B. Sterling, CEO of Sterling Solutions, Ltd., is a
nationally-recognized thought leader on leveraging EHRs to
boost practice revenue through smart selection and
implementation of electronic health record and practice
management systems.
Ron has advised healthcare organizations and practices across
the country. Ron has analyzed software from over 150
vendors.
Ron publishes the popular EHR Blog,Avoid-EHR-
Disasters.com and authored the HIMSS Book of the Year
Award winning Keys to EHR/EHR Success - Selecting and
Implementing an Electronic Medical Record. Ron has
contributed hundreds of articles to a wide range of
publications including the widely used MarketingYour Clinical
Practice.
6. Sterling Solutions, Ltd.
RCM Focus Changes to
Support Evolving Payment Models
From -
E&M
Charge Capture
To -
Maintaining Quality and Performance
Patient Service
Proving Quality
Patient Centered Specialty Practice
Patient Centered Medical Home
7. Sterling Solutions, Ltd.
Issues that Influence RCM Strategy
Meaningful Use
HIPAA Security Standards
Accountable for Integrity
Assure Accessibility
ACA Effect
Higher Deductible
Health Insurance Exchanges
“Cloning” Records
8. Sterling Solutions, Ltd.
Preserve Information to Support RCM
Notes
New Service Documentation Tools
- Clinical Messaging
- Patient Remote Patient Monitoring Systems
Patient Quality and Service Objectives
- Coordinate Patient Populations
- Track Patient Care
Performance Standards
- Quality Improvement
8
RCM Support Is Complicated
9. Sterling Solutions, Ltd.
RCM Support Is Complicated
Payers/ACOs MayVary
Sustain an Audit of Supporting Documentation
Requests for Documents
Examination of EHR Based Records
- Computer Assisted Review Tools
- Review of Audit Trails
- Review Context of Care
9
10. Sterling Solutions, Ltd.
Evolving RCM is Complicated
EHR May Not Accommodate
Tracking of Key RCM Measures
Relevant Status Over Activities
May Require Changes to EHR Use
Activities Measures
Documentation toTrigger RCM Requirements
11. Sterling Solutions, Ltd.
May Require Additional Documentation
Meaningful Use Like Attestation
Global Reporting
Performance Tracking
Payment May Not Be Associated with a Patient
Quality Incentive
“SGR Fix” Payments
Evolving RCM is Complicated
12. Sterling Solutions, Ltd.
EHR Records areVulnerable
Payer Patient Service Expectations
First Response
Final Resolution/Recommendation
Due Diligence to Protect Patient Records
Avoid Degradation
Maintain Accuracy and Consistencyy
EHR Challenges Related to RCM
13. Sterling Solutions, Ltd.
EHR Challenges Related to RCM
ICD10 Starts October 1, 2015
Not Just About Coding
- Clinical Decision Support (MU)
- Health Maintenance Items
- Classification of Plans,Visits and More
ICD10 Specificity
- Site
- Laterality
- Visit Type
- More
14. Sterling Solutions, Ltd.
Clinical RCM Objectives
Verify Record Standards
Maintain Integrity of Patient Records
Protect Against
Unsubstantiated Services
Quality Lapses
Claim Fraud
Support Contractual, Professional and Industry Standards
15. Sterling Solutions, Ltd.
Agree on Operational Standards
Standards Based on
EHR Features
Product Use
Payer/ACO
Practice
Services
Doctors
16. Sterling Solutions, Ltd.
RCM Checklist Items
Notes Signed Within X Hours/Days
Regular OfficeVisits
eVisits
Evolving Activities (Ex.ACO Support)
EHR Interface with PMS/Billing
Accuracy
Timeliness
ICD9/10 Coding
Changes
Substantiation
18. Sterling Solutions, Ltd.
RCM Checklist Items
Patient Portal Traffic
Patient Submission of Information
- New Patients
- Follow Up
Turnaround Time
Follow Up on Undelivered Messages
Documentation Supports Care Standards
19. Sterling Solutions, Ltd.
EHRPatient Portal Patient Request
Response
Information
Messages – Sent to Inbox and Information Entered into EHR.
Information Accepted – Information Flagged and Posted to Patient Chart.
Patient Portal
20. Sterling Solutions, Ltd.
RCM Checklist Items
Outgoing and Incoming Electronic Traffic Check
Rx
Transition of Care
Lab Results
Patient Orders
Other Results
Workflow Management
Patient Appointments Cleared and Completed
To-dos and Messages Completed
21. Sterling Solutions, Ltd.
RCM Checklist Items
Internal Messaging
Part of Patient Service Strategy
Status and Response byType
Workflow Issues
Incoming Documents/Images
Status of Items to be Indexed
Routing of Indexed Items
Documentation of Decisions
Changes to Care Plan
Document Patient Notification
23. Sterling Solutions, Ltd.
RCM Checklist Items
Quality Patient Services
Test Results Follow Up
Procedure/Surgery Follow Up
Referral Follow Up
ReminderTransmission
Reminder Follow Up
Health Maintenance Items
Outstanding Orders
Obsolete Orders
24. Sterling Solutions, Ltd.
RCM Reporting
Maintain Statistics to Prove Performance
Payer
Patient Population
Provider
Location
Report on Standards
Performance
Trends
25. Sterling Solutions, Ltd.
Supporting Claims and Collections
In addition to copy of notes to match
E&M code with documentation….
Includes proving care standards
Depends on operational performance
Requires timely and accurate records
Meaningful Use reporting and Clinical
Quality Measures are a window into
the future of RCM
26. Sterling Solutions, Ltd.
RCM and EHR Cases
PMS receives charges for office visits from EHR but EHR does
not post transactions for patient advice, RPMS monitoring and
other activities that are billed/paid under a quality initiative.
What are the RCM issues?
What are the RCM problems in light of an ACO environment?
What is a workaround to maintain financial information?
27. Sterling Solutions, Ltd.
RCM and EHR Cases
Practice receives a quality incentive payment for
managing an at risk patient population. The PMS only
posts fee for service charges.
How and where should the payment be posted?
Can the payment be posted directly to the accounting system
and bypass the PMS?
How will realization reports be affected?
28. Sterling Solutions, Ltd.
RCM and EHR Cases
EHRVendor advises practice to not sign
patient notes in case the doctor wants to
change the document.
What are the fee for service issues?
What are the professional liability issues?
What are the RCM problems in light of an ACO
environment?
29. Sterling Solutions, Ltd.
RCM and EHR Cases
EHR Messages are not included as part of the
patient record according to the EHR design.
How does this design complicate quality patient
care?
What are the operational accommodations needed
to support quality care based RCM?
30. Sterling Solutions, Ltd.
Go Forward Plan
Monitor EHRVendor tools to
support RCM under evolving
payment and performance systems
Meaningful Use as a Start
Maintain EHR Documentation and
Performance Standards to take
advantage of EHR and align your
practice with evolving revenue
models (ACO, Shared Savings, PCSP,
etc.)