4 Ways To Juice Up Your Revenue Cycle

Posted on May 23, 2013 by Danyell Jones

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It is no secret that many hospitals are struggling with less than stellar bottom lines. Healthcare reform, ICD-10 implementation and shifting healthcare environments are making it more difficult to remain fiscally healthy and financially viable. But some organizations are thriving during this complex time of changes and they all have one thing in common, despite changes and the heavy obligations of daily tasks they focus on continuous revenue cycle improvement utilizing 4 tried and true strategies that not only juice up the revenue cycle, but lead to sustained financial improvement over time. Here is what they do:

1. Focus on Pre-Authorization and Pre-Certification

Revenue cycle optimization begins at point of entry, when a patient or client first presents for treatment. This crucial step in the revenue cycle process eliminates a separation of the clinical and the business aspects of a practice, and can lead to improved patient satisfaction. Determine multiple ways to obtain pre-certification for services, these can include online registration options such as email or web portal, but should also include personal service options to make sure that you serve all demographics. Knowing that a patient is pre-certified for care can eliminate revenue cycle hassles down the road such as denials or appeals. Pre-certification also allows the clinical side to be more informed regarding care options available to patients. Part of making patient care successful, is having it focus on patient preferences, which for many, includes affordability. Pre-certification can eliminate payment confusion down the road and will help the patient be informed regarding the care they are getting and the costs they can expect.

2. Set Revenue Cycle Benchmarks and Goals

Does your billing department have goals and benchmarks in place currently? If not, now is the time. Staff are more informed and perform better if they are aware of a goal that their department is trying to reach. Common revenue cycle goals are % of clean claims submitted, or IBNR (invoiced, but not received) goals. One practice has a goal of trying to ensure that all services are processed and payment is received within 180 days. Here are some effective tips when setting Benchmarks and Goals for your Billing/Revenue Staff

Make sure that staff are aware of the goals/benchmarks including where they currently stand
provide up to date reporting on how effective staff are at reaching their goals at regularly scheduled intervals (such as weekly or monthly)
Make the goal attainable, but challenging. Start with a small goal and work your way up consistently to ensure buy-in and encourage morale
Incentivize the goals – give staff greater motivation by creating an incentive program surrounding the goals and benchmarks you hope to achieve
Involve staff in benchmarking and goal discussions. Often someone who deals with the issue directly can provide greater insight into where the obstacles in your revenue cycle are. Is there a bottleneck in communication? Are there common processing errors? Are front desk inefficiencies detrimentally impacting the revenue cycle? Chances are your staff will have the answers and some bright ideas on how to correct the issue

3. Optimize Your Organizational Structure

Do you currently see a lack of communication between departments such as clinical and non clinical associates? Are Billing and Collections handled by separate teams with little interface? How is the flow from a front desk operations perspective? These areas should be assessed and optimized as part of a plan to juice up your revenue cycle.

Ensure that you are facilitating communication between all departments whether through flash meetings, newsletters, or dedicated leadership meeting
Put in place tools that allow for effective communication and collaboration across departments
send standard updates regarding the progress of the revenue cycle to teams/departments in other areas so that everyone is informed of performance and impacts
look for duplication and waste in the processes regarding revenue cycle improvement

4. Manage Your Denials

Organizations can see a dramatic increase in their bottom line by simply managing denials more effectively. BHM recommends a denial management strategy based on the following CORE Principles of Denial Management. For full information on how to manage denials and recoup losses please click here: MANAGE DENIALS TODAY

Healthcare Financial Analysis – Want To Be More Profitable?

Posted on May 3, 2013 by Linda Ringquist

Summary: Many healthcare organizations are facing financial issues due to changes in the economy, changes to federal, state, and local legislation, and paradigm shifts caused by reform. What can providers and hospital organizations do to improve their profitability? How does an organization begin to recognize and implement changes to positively affect the bottom line?

Have you completed a healthcare financial analysis lately? We have previously written extensively about the importance of completing an extensive review on health insurance claim denials. This is one area in which the data is relatively easy to obtain and fairly easy to correct or at least chip away at making corrections to positively affect the bottom line. We have also written about the importance of looking at scheduling alternatives to maximize efficiency and reduce the number of missed appointments. Finally, we have written about the importance of reviewing payer mix and contracting. Are you receiving the maximum reimbursement based on your payer mix? Have you reviewed your contracts? Have you reached out to your providers to negotiate better rates? All of these issues need to be addressed when embarking on healthcare financial analysis.

To further our discussion on financial analysis, today we will focus on billing/coding maximization, staffing ratios, costs per unit, costs per service, and insourcing versus outsourcing options.

Billing/coding maximization

Billing/coding maximization involves billing for the services you provide at the level you provide them. It is imperative to know what is billable and how to code and document. This is going to be especially important when ICD-10 is implemented. Those billing for ICD-9 codes after a certain point will automatically have their claims denied. It is of utmost importance to make sure the organization is fully versed and current on all billing and coding protocols and standards in order to receive the maximum reimbursement allowed, and the appropriate reimbursement that most accurately reflects actual services provided. Coding is changing constantly and the organization needs to adapt to and adhere to these changes in order to receive the maximum reimbursement. Special considerations when coding include:

Ensuring that the most appropriate up to date codes are utilized
Ensuring that coding is reflective of the services provided from a time perspective
Ensuring that the coding is reflective of the intensity/complexity of the services provided
Ensuring that staff know appropriate code modifiers to use to align treatment with invoicing and avoid confusion and incorrect and/or inefficient codes

Staffing ratios

Staffing ratios for medium and small organizations is especially critical. What we usually find is a non-clinical staff that is bloated and non-functional. Staffing ratios should be established to ensure maximum efficiency in all aspects of the hospital. This includes non-clinical staff. What is the ideal number and mix of staff for each department to provide excellent patient care and safety while providing little to no downtime? Example: you can’t have staff working 40 hours of overtime on a consistent basis as this is very costly and errors are more likely to occur. Conversely, you can’t have staff with an abundance of downtime as this is a waste of resources.

Costs per service

We need to be able to drill down to what the cost is for each service on a per unit basis. What does a single unit of service cost the organization? How much can we charge for the service? What is the service reimbursement in our primary contracts established as? This is the ratio between volume and price. Do you know what the ROI needs to be to be profitable? Drilling down to the cost per service provides an opportunity for apples to apples comparisons to determine inefficiencies and target areas to improve.

Insourcing versus outsourcing

Once you are able to obtain the cost per service, you can begin to look for opportunities to insource/outsource. Some services may be less expensive to insource while other services may be less expensive to outsource. A cost benefit analysis should be performed to identify areas in which cost savings can be obtained.

Conclusion

There are many ways to improve the financial profitability in any healthcare organization. It takes due diligence and comprehensive analysis to determine the areas of improvement as well as to prioritize which improvements can have the biggest impact.

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, financial management of health care, physician advisor/peer review, and organizational development.

Top 5 Healthcare Consulting Issues as a Result of the ACA

Posted on April 29, 2013 by Linda Ringquist

Summary: The Affordable Care Act and all of its complexities have given rise to several areas in which healthcare providers may need additional assistance.

Healthcare is changing faster than the blink of an eye. Healthcare providers are finding it more and more cumbersome and in some instances impossible to keep up with all the new legislation. The Patient Protection Affordable Care Act (PPACA) alone is enough to drive a provider mad. The PPACA is a 900+ page document filled with provisions becoming effective from 2010 to 2015. It is difficult to understand all of the provisions let alone know how to properly comply with them. The PPACA touches many different subjects in the healthcare realm.

In order to properly adhere to the PPACA, healthcare providers must have expertise in:

Financial Aspects

Reducing health insurance claim denials to offset some of the reductions in Medicare reimbursement
Reducing hospital readmissions to a level to avoid penalties and further reduction in Medicare reimbursement
Value based payment programs for physicians as opposed to the traditional volume based payment
Bundled payments for groups of services as opposed to the traditional pay for each individual service
Tax credits for small businesses
Additional fraud and abuse penalties

Have you had your healthcare financial analysis lately?

Health Insurance

As mentioned above, cutbacks in Medicare reimbursement
Covering children longer
Not being able to use pre-existing conditions as a basis for non-coverage
Expanding Medicaid to cover more consumers
Health Insurance Exchanges/Marketplaces
Preventative care and what that entails
Limits on administrative costs as a percentage of total cost

Health insurance appeals for denied claims

Do you find it difficult to manage the appeals process? Wouldn’t it be great to have a healthcare management consulting firm relieve this burden for you. Wouldn’t it be nice to utilize physician advisor services that is fully automated with medical necessity criteria built in and deadlines automated to comply with accreditation requirements? Visit our physician advisor services pages for more details.

Do you know all of the ins and outs of insurance from private to commercial and from medicare to medicaid?

Care Models

Patient Centered Medical Homes (PCMH) or Patient Centered Health Care Home (PCHCH)
Accountable Care Organizations (ACOs)/integrated health

Do you know all of the advantages of becoming a PCMH? Will you be left behind by not being armed with information as to how to implement? Are you interested in becoming a part of an ACO? Do you know how to start the process?

Accreditation

In order to be recognized as a PCMH, an organization must go through the accreditation process. The following organizations currently offer PCMH/PCHCH accreditation:

URAC accreditation
NCQA accreditation
CARF accreditation
TJC accreditation
AAAHC accreditation

Generally what differentiates these organizations is the type of organizations they accredit as well as the accreditations offered. Additionally, ACOs must be accredited. Currently only NCQA offers ACO accreditation. Look for details in the future to see if any of the other national accreditation organizations begin to offer this type of accreditation as well.

Do you need assistance with your accreditation needs?

Healthcare has become extremely complex and it is difficult for healthcare organizations to be experts on every aspect. Healthcare management consulting has expanded with the enactment of the PPACA especially. You don’t have to do everything on your own. You don’t have to reinvent the wheel. Turn to the experts who have already been through and established protocols for the healthcare issues you are experiencing.

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, financial consulting for healthcare, physician advisor/peer review, and organizational development.

What Are the Current Trends in Accountable Care Organizations (ACOs)?

Posted on April 25, 2013 by Linda Ringquist

Summary: What can we expect in 2013 in terms of Accountable Care Organizations (ACOs)? Where are we headed? What considerations need to be taken into account?

ACOs are continuations to the Patient Centered Medical Home (PCMH) model. PCMH places the patient at the center of all decisions regarding his health care and assigns responsibility to the primary care physician to coordinate care with all other care givers involved with the patient. These might include specialists, laboratories, imaging centers, etc. If a PCMH is like a home, an ACO is more like a neighborhood. It is a group of PCMHs working together in an accountable manner which is nationally recognized through organizations such as the Centers for Medicare and Medicaid Services (CMS).

ACOs began formally being recognized in 2012. As of January 2013, there are approximately 300 ACOs. They are really taking off – leaps and bounds.

So what are some of the trends we are seeing?

We would expect the Medicare Shared Savings Plan (MSSP) to nearly double in 2013 and continue the trend of expansion.
We would expect Medicaid ACOs to slow in growth a bit due to the impending healthcare exchanges and Medicaid expansion which are results of the Patient Protection Affordable Care Act (PPACA). We are in a holding pattern waiting to see what is going to happen with these. 2014 will probably provide more growth for Medicaid ACOs. Medicaid also has additional challenges of instability of the population and a large emphasis on long-term care which adds to the slower growth in Medicaid ACOs as compared to Medicare ACOs.
For states that decide to expand Medicaid, ACOs can provide additional monetary incentives which may encourage ACO expansion as well. States that have currently opted to expand Medicaid are: Arkansas, California, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Missouri, Nevada, Rhode Island, Vermont, and Washington.
We would expect a growth in the number of patient centered medical homes (PCMH). 2012 was a big year for PCMH and really was the turning point for health care and the focus on the patient.
States will begin to move dual eligible populations toward managed care and toward ACOs.
Beginning in perhaps 2015 or 2016, we may see ACOs as part of the exchanges.
We will begin to see the expansion of commercial ACOs.
Mergers and acquisitions should rise in 2013 with the cutbacks from Medicare and the move to accountable care.
NCQA accreditation in particular will take off in 2013. They will be accrediting ACOs and exchanges. The number of accredited organizations will grow in leaps and bounds this year.
One can hope with all of the emphasis on primary care that more physicians will begin to choose primary care as their profession. This still remains to be seen.

What are some particular organizations doing?

Crystal Run is glad that reimbursement has finally become a focal point when using patient centered care models. They have been practicing patient centered strategies since the 1990s and have had an EMR since 1999. They were just waiting for the rest of the country to catch up. Crystal Run just thought it was the right thing to do and didn’t do it for any other reason.
Colorado ACO program saved $20 million in unnecessary care, of which after expenses, they were able to give $3 million back. Colorado ACO program also saw a reduction in emergency room visits and hospital readmissions. A true success story.
North Carolina has had great success with their medical home model within Medicaid which of course is the prelude to any successful ACO.
Aetna is on the move expanding their ACO kingdom both through partnerships with providers as well as a data analytics subsidiary.
Kelsey-Seybold was named the first accredited ACO through NCQA

2013 and going forward are going to be very interesting and an opportunity for tremendous growth. Keeping up with all of the changes is a daunting task. What are your thoughts on ACO? Do you think they are a good concept? Do you think there are flaws? Do you think there are areas of improvement?

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

Checkout our PCHCH accreditation (patient centered health care home accreditation) services: http://www.bhmpc.com/accreditation/

BHM Welcomes New SVP, IRO Division Mike Forrester, PhD

Posted on April 15, 2013 by Linda Ringquist

Summary: BHM Healthcare Solutions is pleased to announce the appointment of Mike Forrester, PhD to the position of Senior Vice President of IRO (Physician Advisor Services). Dr. Forrester brings a wealth of expertise from both a clinical and business perspective.

BHM Healthcare Solutions (BHM) is excited to announce the appointment of Mike Forrester, PhD to the position of Senior Vice President of IRO Services. Dr. Forrester is a clinical psychologist who has been a leader in the managed care and disease management organizations for several years. Dr. Forrester received his PhD in clinical psychology from Kent State University. Dr. Forrester’s most recent experience includes working with Optum Health, Health Integrated and Magellan Behavioral Health.

Dr. Forrester will lead BHM’s Physician Advisor/Peer Review Division also referred to as Independent Review Organization (IRO). BHM’s IRO division has a panel of physician advisors who perform independent reviews of health insurance claim denials. BHM has received URAC accreditation for our IRO services. As such, this division is growing at a rapid pace more than doubling in one year in terms of reviews completed, number of clients, and number of physician advisors. BHM has a state of the art portal which enables clients and physicians the ability to collaborate in an efficient manner through an online portal which meets all of the standards of quality and excellence set forth by URAC. Dr. Forrester has stated, “BHM Healthcare Solutions is full service healthcare management consulting organization. The organization provides support to providers, integrated delivery systems, Health Plans, and others in effectively managing the delivery of behavioral health and other related areas.”

BHM’s IRO division is experiencing tremendous growth. Enhancements are continually being made on the automated portal system. Dr. Forrester’s background will provide the leadership and guidance needed to continue to expand our IRO division.

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, financial consulting for healthcare, physician advisor/peer review, and organizational development.

Patient Centered Care – the Building Block of PCMH and ACO

Posted on April 8, 2013 by Linda Ringquist

What has caused the emphasis on Patient-Centered Care, Patient-Centered Medical Homes, and Accountable Care Organizations?

In a nutshell, our healthcare system is inefficient. Healthcare costs are continuing to rise at a level higher than inflation, quality is less than optimal, and our coordination of care is fragmented and disjointed. Additionally, hospital admissions/readmissions are increasing and need to be controlled.

What is the solution or at least one solution to try to fix our healthcare system?

One such answer is a concept called patient-centered care. This is not a new concept. It was originally proposed by the American Academy of Family Medicine in 1967. The concept began to gain popularity in the 1990s and started to take off in 2002. Patient-centered care is exactly what the term infers. It is care that is focused upon the patient and involves the patient in all of his healthcare decisions.

Where does the Medical Home Concept come into play?

A medical home (sometimes referred to as patient centered medical home PCMH or patient centered health care home PCHCH) is the term used to denote an organization that has officially adopted the patient centered care concept. It is not really a place but a healthcare model. The model incorporates the focus on patient centered care and takes it a step further to include care coordination between the primary care physician and any others involved in the patient’s care such as specialists, laboratories, and imaging. It seeks to provide continuity of care throughout the full spectrum of healthcare providers. The Medical Home was introduced in 2007 as a collaborative effort between the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and American Osteopathic Association. The primary goals of the medical home are to provide better access, coordination of care, prevention, quality and safety.

What are the building blocks of a medical home?

The medical home is established based upon the following building blocks or principles:

Comprehensive Care
Patient-Centered Care
Coordinated Care
Accessible Services
Quality and Safety

Challenges to creating a PCMH

PCMHs are not setup overnight. It is a lengthy process in which certain barriers may exist:

This method is still a bit disjointed in terms of providers outside of the primary care physician. There aren’t any direct incentives for these providers and therefore little motivation to join efforts with primary care.
PCMHs can be costly to setup and even cost-prohibitive for smaller practices.

How are some of the challenges to becoming a PCMH overcome? Enter the ACO

What is an Accountable Care Organization (ACO)? An ACO is basically a network or neighborhood of medical homes. It is a collaboration of Patient centered health care home accreditation different organizations and practices working together which may include primary care physicians, specialists, hospitals, providers, payers, etc. The ACOs take medical homes a step further in emphasizing the alignment of incentives and accountability for providers across the continuum of care. There is a need for very strong leadership to address cultural, legal, and resource related barriers when creating an ACO.

Benefits of ACOs

Ability to manage a larger population with a larger budget (combined budget for participating organizations)
Better cost management
Less variation in the population
Ability to track and trend quality better
Receive fee-for-service payment
Share in cost savings through either risk-adjusted projecting spending targets and/or partial or full capitation

Types of ACOs

Currently there are several types of ACOs which might be created:

Large integrated delivery systems
Physician-hospital organizations
Multispecialty practice groups with or without hospital ownership
Independent practice associations
Virtual independent networks of physician practices

So where does accreditation come into play or does it?

In order to be considered either a PCMH or an ACO, the organization(s) must be accredited. Accreditation offers national recognition to ACO 2 organizations for achieving levels of excellence in areas such as quality, patient satisfaction, and safety. Accreditation provides piece of mind to those wishing to do business with an organization, which in turn provides a competitive advantage. Accreditation for PCMH is offered through the following organizations:

NCQA accreditation
URAC accreditation
TJC accreditation
AAAHC accreditation
CARF accreditation (new for 2013)

Accreditation for ACOs

Currently, the only organization authorized to provide accreditation for ACOs is NCQA. NCQA was on the cutting edge of medical home accreditation and standards became effective in 2008. Note this was before the Patient Protection and Affordable Care Act became effective in 2010. In 2011, NCQA revised their standards and these are still the most current regulations for NCQA. In January, 2012, NCQA launched their Consumer Assessment of Healthcare Providers and Systems as a part of their medical home accreditation. This takes patient centered care to the level of accountability and provides a mechanism for tracking and trending quality and safety initiatives for organizations while providing a means of comparing organizations to one another.

NCQA was again ahead of the curve in launching their ACO accreditation effective November 2011. To follow suit with their PCMH product, NCQA launched their Healthcare Effectiveness Data and Information Set (HEDIS) tool. This tool is used to measure quality for organizations and allow organizations to be compared. It is similar to HCAPS but specific to ACOs.

If you require any assistance in becoming a Medical Home or becoming accredited/re-accredited, please contact us.

BHM Healthcare Solutions – www.bhmpc.com We have URAC PCHCH consultants, TJC consultants, NCQA consultants, and CARF accreditation consultants ready to assist you with your accreditation needs.

Call us: 1-888-831-1171

Email us: results@bhmpc.com

BHM Participates in CMS Now Reimbursing for Care Coordination Webinar

Posted on April 2, 2013 by Linda Ringquist

Summary: BHM Healthcare Solutions recently participated in Newsflash: CMS Now Reimbursing for Care Coordination webinar which was hosted by Dorland Health. The webinar featured information about the new transition codes which provide additional reimbursement opportunities for physicians and other healthcare professionals.

BHM Healthcare Solutions is a healthcare management consulting firm providing a full range of healthcare services, including: managed care consulting, strategic planning and organizational analysis, accreditation consulting, financial management of health care, physician advisor/peer review, and organizational development.

Cynthia Young is a Senior Consultant with BHM. Cynthia has years of healthcare administration, medical practice development, practice transition experience, and management experience. For the last 10 years, she has provided quality healthcare management consulting services to the medical community and assisted physicians, healthcare facilities and ancillary providers with developing and optimizing their practice efficiencies. Ms. Young’s 12 years of primary source verification and credentialing experience, including TJC, NCQA, AAASC & AAAHC facilities, has enabled her to differentiate herself in the healthcare industry. Additionally, she has led successfully six TJC accreditation surveys, including Office-based Surgery, with each facility granted approval accreditation during the first survey.

Dorland Health recently hosted a webinar entitled Newsflash: CMS Now Reimbursing for Care Coordination Webinar. Cynthia Young was one of four panel experts who presented the advantages of the new TCM codes, which became effective January 1, 2013. Cynthia spoke from the perspective of the advantages to a physician’s practice. Transitional Care Management Services (TCM) is the transition from an inpatient hospital setting (including acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hospital, webinar2 or skilled nursing facility, to the patient’s community setting (home, domiciliary, rest home, or assisted living) in order to prevent re-admissions. They involve one office visit, plus care coordination, in the 30-day transition period when certain patients are discharged from an inpatient hospital or nursing facility to their home, community setting, or assisted living facility. The webinar explained the new codes, provided insight as to who can bill for the new codes, which patients are eligible, and when they should be billed. Care coordination has been an important aspect of healthcare, but up until January 1, 2013, these services were not eligible for reimbursement.

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, financial consulting for healthcare, physician advisor/peer review, and organizational development.

How Can Scheduling and Payer Mix/Contracting Affect Your Bottom Line?

Posted on March 29, 2013 by Linda Ringquist

Summary: As a result of the sequestration and other legislation such as the PPACA, it is more important now than ever to perform a healthcare financial analysis. Two items to consider are scheduling and payer mix/contracting.

A couple of the items which should be reviewed include scheduling and payer mix/contracting. One of the goals of the Affordable Care Act is to provide accessible care. This may include modified scheduling to allow more time to be spent with those patients with more acute conditions and reminders prior to an appointment. Missed appointments directly affect the bottom line. Additionally, payer mix and contracting can be a large expense affect the bottom line. There is almost always room for negotiation.

Scheduling

What is the ratio of missed appointments to total appointments? This is sometimes referred to as the no-show rate. If there is a high level of missed appointments, this can indicate inefficiencies in scheduling and may provide opportunities to improve follow-up processes and procedures. If no show rates are particularly high, the bottom line may very well be affected.

According to a case study, “Reducing Patient Missed Appointments (DNAs) Within a NHS Acute Trust”, http://www.mikkom.net/Documents/Acute%20case%20study%20v3-1.pdf, NHS Trust was experiencing a high level of missed appointments attributed to totally forgetting the appointment, forgetting the time, or feeling as though the patient didn’t need to keep the appointment since the situation had improved. The solution implemented included calling the patient 4 days prior to the appointment as a reminder. The solution provided a reduction of missed appointments (especially of those with mobile phones), an increase in patient satisfaction, and a reduction in the time spent dealing with reminders.

According to another case study, “Reduction of Missed Appointments at an Urban Primary Care Clinic: a Randomized Controlled Study”, http://www.biomedcentral.com/1471-2296/11/79, BHM Family Practice conducted a random study in which a phone call was placed 48 hours prior to the appointment, if no response – a message was left, if no phone number was available – a reminder was mailed to the patient’s address. This sequence of events significantly reduced the number of missed appointments.

Front desk efficiencies and the implementation of wave scheduling – Many organizations have a single time designated for a single patient. This provides a great deal of inefficiency in terms of missed appointments and provides little flexibility when patients show up late for appointments, or when a patient presents with a particularly complex issue that requires more face time with the provider. All of these obstacles are overcome when a practice switches from traditional scheduling and implements wave scheduling. Instead of scheduling for example a patient every twenty minutes, organizations may elect to schedule 3 patients at the top of each hour or 1 complex case at the top of the hour and 2-3 at the half hour.

Payer Mix/Contracting

Are you contracted with the right people for the right reimbursement rate? There is ample opportunity to negotiate with providers on Healthcare Financial Analysis reimbursement rates, at least currently. That may change once the Affordable Care Act (specifically health insurance exchanges) is fully implemented.

In a case study, “Case Study – Contract Negotiation”, http://www.primarypc.com/contentPages.cfm?id=97, 5 procedures were negotiated for a savings of more than $130,000.

More and more organizations are performing a healthcare financial analysis to identify additional revenue to be obtained/recouped and to identify expense items to be reduced/revamped. It is important to look at the entire organization and prioritize based upon the amount of savings versus the amount of time and effort required to accomplish. Every little bit helps. For more information on our healthcare financial consultant services, please view our website.

About us

BHM Healthcare Solutions is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of healthcare management consulting services including accreditation (URAC, TJC, NCQA, CARF, and COA), healthcare financial analysis, clinical operations, physician advisor services, quality improvement, and reducing claim denials.

Contact us

Call us 1-888-831-1171

Email us: results@bhmpc.com

Visit us: www.bhmpc.com

Follow us on Linkedin: http://www.linkedin.com/company/bhm-healthcare-solutions?trk=hb_tab_compy_id_386984

A Step-By-Step Guide to Establishing a Patient Centered Medical Home Part 7

Posted on March 28, 2013 by Patrick Christopher

Part seven of the seven-part series

Payment & Finance

Matching quality care and NCQA recognition with payment and value.

Optimally you have been able to benefit from the tools, resources and guidance in Sections 1, 2, 3, 4 & 5 and begin to build the capacity of your medical home. Once you successfully gain recognition for the level of “medical home-ness” at your practice (meeting the PCMH NCQA Accreditation standards) you are better positioned to advocate and negotiate for improved and appropriate primary care payment. As a “work in progress” these contract and other negotiations will be specific to the unique nature of your practice – whether you are a small/large independent group, a community health center or an integrated delivery network.

The tool in this section – Building Your Medical Home and Getting Paid Appropriately – helps you to understand routes to enhanced payment for the medical home and shows you some of the work already accomplished to help you achieve this goal.

Step 1:

The following link, Building Your Medical Home and Getting Paid Appropriately, contains information on:

Pediatric Councils
Medical Home payment reform
Coding resources to help you negotiate contracts with payers
Please review the Resources above before continuing to Step 2.

Step 2:

After reviewing the resources, honestly assess your familiarity with medical home payment and financing issues, note areas for development, NCQA Accreditation and take necessary action steps.

Congratulations! You have successfully completed the six Building Blocks of the Building Your Medical Home toolkit.

If you build it they will come.

A step-by-step guide to establishing a Patient Centered Medical Home

Do you have questions or comments about Medical Homes? We invite you to contact the NCQA Consultants at BHM Healthcare Solutions today.

About us

Contact us

Call us 1-888-831-1171

Email us: results@bhmpc.com

Visit us: www.bhmpc.com

Follow us on Linkedin: http://www.linkedin.com/company/bhm-healthcare-solutions?trk=hb_tab_compy_id_386984

Patient Centered Medical Homes: What it Takes for PCMH Accreditation Part 13

Posted on March 26, 2013 by Danyell Jones

Patient centered medical homes have become a very hot healthcare topic recently, and while there are multiple recognition, or PCMH Patient Centered Health Care Home Accreditation accreditation, programs to choose from there are commonalities in the guidelines of what must be met by any medical home seeking accreditation. So whether your organization is pursuing URAC PCHCH accreditation, TJC accreditation, NCQA Accreditation, or the recently launched CARF accreditation for medical homes, keep these general standards in mind:

Evaluations should be conducted by the Accrediting Agency to ensure that the effectiveness of its program is measured, and that improvements are made to the accrediting program over time

It is important for Medical Homes to understand that Accreditation standards and requirements are continuously evolving so that programs can improve over time based on industry recognized best practices. This is similar to the Medical Homes goal of continuing Quality Improvement, but from the perspective of the accrediting body. Changes in a rapidly evolving healthcare environment necessitate accreditation requirement changes, and these changes are made taking into account evidence, field testing, the experience of the stakeholders utilizing the program, public comment, and the general changes in the healthcare environment.

As such, organizations who have become accredited may be surprised to learn that when applying for re-accreditation some of the requirements have changed. This is why accreditation maintenance should be part of any ongoing accreditation implementation undertook by a Medical Home. Accreditation maintenance serves to ensure that your organization will be prepared for reaccreditation when the time comes, it will keep the organization on track with the latest in accreditation standards, and allow providers and administrative staff of the Medical Home to continuously work toward accreditation preparation in between accreditations, allowing for a smoother more efficient process.

Those who have begun an accreditation maintenance program have been pleased to find that they are able to actively prepare for re-accreditation over a period of years, rather than trying to cram accreditation prep work in over a few months. Furthermore, continuous maintenance of your accreditation means that your organization will remain in compliance with accreditation standards throughout the term.

For more information on Accreditation Maintenance packages offered by BHM please visit: http://www.bhmpc.com/accreditation/