| The revenue cycle of a physician group can be an | | | | process is a Cause and Effect Diagram. This is a |
| amazing process. Especially when the process is | | | | simple tool that will allow you capture all the potential |
| simple, efficient and measurable. Unfortunately in many | | | | causes for a particular effect. Causes are categorized |
| cases the management of the revenue cycle is not | | | | by using the Six M's: Man, Machine, Method, Mother |
| simple, efficient or measurable. How well does your | | | | Nature, Materials, and Measurement. |
| group manage the revenue cycle? | | | | Example: |
| There are 3 major components of the revenue cycle. | | | | Effect = Lost Bill |
| Charge capture which includes the gathering of | | | | Potential Causes of Lost Bill: |
| procedure and diagnosis codes. Claim processing | | | | * Man: 1) physician misplaces index card, 2) billing |
| which ensures the claim is formatted with the correct | | | | offices misplaces index cards |
| charges and patient demographics and sent to a | | | | * Machine: 1) fax transmission failed 2) scanned image |
| clearinghouse. And lastly, collection of funds, from both | | | | corrupted |
| payers and patients. | | | | * Measurement: 1) manual reporting of activity, 2) |
| Process Engineers have a saying that pertains to the | | | | incorrect manual reconciliation |
| flow of a process, "Garbage In Equals Garbage Out". | | | | * Method: 1) current process does not validate receipt |
| In other words, if you do not perform the first step of | | | | of transmission of bill 2) Process does not regulate |
| the process well, the following steps will not have a | | | | security of index cards. |
| good result. For this reason we will focus this | | | | IMPLEMENT IMPROVEMENT ACTIONS TO YOUR |
| discussion on the first step of the process,charge | | | | CHARGE CAPTURE PROCESS |
| capture. | | | | Now that you have analyzed your process it is time to |
| DEFINE YOUR CURRENT CHARGE CAPTURE | | | | implement changes to that process. This can range |
| PROCESS | | | | from simple tweaks to a complete overhaul of the |
| The first step to improving your current charge | | | | process. Once again, let your findings lead you to |
| capture process is to DEFINE it. I know you are thinking | | | | develop a step by step plan that outlines each of the |
| is this a joke? No. This is not a joke. I can not be more | | | | changes you want to make. For instance, you may |
| serious. It is the most important step you can take. | | | | determine from your analysis that a primary reason |
| Taking the time to define your process from beginning | | | | for lost charges is that you are currently on a paper |
| to end will allow you to quickly identify points of | | | | based index card system and that bills are lost due to |
| weakness, breakdowns in communication and | | | | physicians and/or billing office staff misplacement of |
| immediate opportunities for improvement. Defining your | | | | the index cards. Your primary improvement action |
| process can be achieved through the use of a | | | | could be as simple as providing a secure lockbox at |
| process flow chart. | | | | the hospital for the physicians to drop their index cards |
| MEASURE YOUR CURRENT CHARGE CAPTURE | | | | or it may be a complete overhaul of the process to |
| PROCESS | | | | include implementation of an electronic charge capture |
| This step may sound easy, but potentially, this is where | | | | system. |
| you will have the most difficult time. The reason you | | | | Each improvement action should have an assigned |
| will have a difficult time is that most practices do not | | | | accountable owner. Each improvement action should |
| have the ability to measure their charge capture | | | | also have projected start and end dates. It is vital that |
| process. The important thing to remember here is | | | | you have tollgate reviews during the improvement |
| what the process is trying to accomplish,and that is to | | | | phase to mark the progress of change implementation. |
| capture the appropriate procedure and diagnosis | | | | CONTROLING YOUR IMPROVEMENTS FOR YOUR |
| codes then ensure they are delivered to the next step | | | | CHARGE CAPTURE PROCESS |
| of Claims Processing. Below are some basic | | | | Process improvement is a never ending adventure. |
| examples of measures this process should provide. | | | | You must constantly measure your performance. This |
| Example Measures: | | | | will be much easier now that you have defined your |
| * Number of Encounters = billable patient visits | | | | measurements. You can utilize simple tools like trend |
| * Number of Bills Submitted = bills submitted by | | | | charts to measure data points prior to your |
| physician (should equal patient visits) | | | | improvements and then trend your performance after |
| * Physician Time = time spent on charge capture | | | | the improvements. This is such an important step |
| activities (filling out index cards, justifying codes, etc..) | | | | because it allows you to determine very quickly if you |
| * Lost Bills = number of encounters minus number of | | | | are driving toward your expected outcomes. You may |
| bills submitted | | | | need to revisit your analysis and improvement actions |
| * Coding Errors = number down/up coding Events | | | | to determine where the process still needs to be |
| * Cost of Coding Errors = dollar amount associated to | | | | tweaked or if you need to contact your boss and ask |
| coding errors. | | | | for a raise because you just saved the company |
| * Cost of Lost Bills = dollar amount associated to lost | | | | money and improved revenue. |
| bills | | | | In summary, charge capture is the most important step |
| ANALYIZE YOUR CURRENT CHARGE CAPTURE | | | | in the overall process of the revenue cycle because it |
| PROCESS | | | | is the first. If you put garbage in the first step of the |
| This is where the fun begins. It is very important that | | | | revenue cycle you will get garbage out of the last step |
| you follow where the data leads you. Don't fall into the | | | | which is collections. Improving your charge capture |
| trap of thinking you know the problem. Yes, there will | | | | process can be very easy if you follow 5 simple |
| be some obvious issues that jump out at you and you | | | | steps. 1) DEFINE your process, 2) MEASURE your |
| need to take action on them. But, you can't afford to | | | | process, 3 )ANALYZE your process, 4) IMPLEMENT |
| stop there. You may have a severe process issue | | | | IMPROVEMENT ACTIONS to your process and |
| that is costing your practice money and it is imperative | | | | 5)CONTROL your improvements for the new |
| that you keep digging. | | | | process. |
| One of the most common tools for analyzing your | | | | |