Business Office


Patient-Centric Prepayment and Quoting Process: 60 min

Has your organization kept pace with rising copays, deductibles and coinsurance? Does your bad debt ratio mirror your self-pay, underinsured or uninsured population? Many organizations have not shared self-pay concerns or strategies with users on the front line, and the result is a disconnected and ineffective POS collection model. In this presentation we examine processes to ensure medically necessary services are not denied based on the consumer’s ability to pay, consumers who have the ability to pay for health services do pay, and patients’ sensitive information is protected. With the skills learned, your patient and the organization will provide better management of uninsured and high-deductible health plan cost sharing processes to minimize burdens for all involved.

Accountability and Ownership – Developing and maintaining a dedicated and reliable team: 60 min

Many facilities lack clear guidelines governing the practices and production in Patient Financial Services. Vague job descriptions and expectations hinder objective evaluations and beneficial mentoring. Cultures are created which encourage the perception of favoritism. Unclear responsibilities and expectations cause confusion, dissatisfaction, unproductive practices, and costly errors that ultimately impact revenue, reimbursement and patient satisfaction. Opportunities for fair and attainable individual and team improvement are realized through a consistent culture of fair, attainable and consistent methodology. This presentation identifies the pitfalls of unclear expectations and inconsistent accountability. Methods to apply clear and consistent guidelines and foster a culture of ownership are discussed. Objective measurements and evaluation methods are provided. The tools provided can be used to create a roadmap to continuous quality improvement and employee satisfaction.

Business Office Involvement and Responsibilities within the Revenue Cycle: 60 min

How is your business office perceived within the institution? Are they one of “us” or are they one of “them”? The financial success of the facility depends on the successful integration of the business office into departmental revenue cycles. They must be considered one of “us.” Participants will receive specific strategies to incorporate the business office into the revenue cycle. The presentation identifies roles, responsibilities and expectations for business office participation.

Chargemaster 101: 60 min

Is your Chargemaster maintenance an art, not a science? Does your facility have clear, specific policies and procedures to govern Chargemaster additions and deletions? Who can request chargemaster additions? How are requests vetted and approved? Your Charge Data Master is your dictionary to the payors, and reimbursement hinges on payors understanding your interpretation of the services performed. More and more frequently, Medicare and commercial payors are diverging in requirements of HCPCS vs. CPT. This presentation discusses the need for consistent and easily understood policies surrounding Chargemaster elements such as naming conventions, alternate code assignments, revenue codes and pricing. Objective processes are developed to routinely audit the CDM and maintain consistent and accurate data elements, with the goal to improve internal understanding of the codes available in the CDM, develop consistent pricing across departments for like services, and reduce denials for alternate codes required by payors.

Designing Training Initiatives Based on Denial Trends: 60 min

In FY 2013, Medicare reported recoupment of 3.65 billing dollars. More and more commercial payors are developing audit processes to identify and recoup payment errors. RAC has expanded into Home Health, Medicaid, Part C (Medicare Advantage plans) and Part D. In spite of these burgeoning trends, few facilities are taking steps to understand their risk due to external audits. Many facilities lack an internal audit process to test their exposure, evaluate the risk and mitigate loss through internal process improvement. This presentation utilizes existing databases to identify the likely audits and evaluate potential risk. A case study identifies internal processes to isolate audit issues and develop a process improvement plan. Improvement plans are developed based on research performed, efficacy of the plan is assessed and evaluated. Internal process to repeat audits to ensure continued compliance, is implemented to ensure goals are realized. The process includes duplication of format for continuous audit programs.

How to Measure Your Business Office’s Knowledge Base: 60 min

Have you assessed the knowledge and capabilities of your business office personnel? Do you provide training and orientation to new hires on both internal expectations and Payor specific billing and processing guidelines? Do you assume someone else is providing this valuable information to your team? The financial health of most institutions rely largely on the ability of the business office to compliantly and accurately report services and pursue reimbursement, yet few organizations evaluate their current state of preparedness, or provide routine training and support for improvement. Minor investments in business office training and evaluation can reap tremendous benefits in real and timely revenue capture and reimbursement. Improvements can reduce rework, improve cash flow and mitigate compliance exposure. This presentation evaluates the current state of the business office. Methods of assessing production, effectiveness of process, and individual and departmental knowledge are examined. Objective measurements are designed to both evaluate current state and promote a culture of fair and attainable improvement opportunities. The contributions and responsibilities of revenue-producing departments to business office accuracy and efficiency are also examined.

Maximizing Self-Pay – Minimizing customer complaints: 60 min

Does your facility know the success rate and compliance for emergency room copay collections? Likewise, how efficient are your physician practices at collecting office copays? Do you have a process to ensure accurate and timely patient quotes for self pay or high deductible services? Most facilities do not have effective policies and procedures to govern the collection of money from patients. The financial viability of the organization is dependent on the effective communication of expectation and responsibilities to patients. Participants receive guidelines for creating expectations, policies and procedures to govern all aspects of patient self pay communication. Parameters are provided to facilitate the creation of situation specific scripts for registration staff, financial counselors and business office colleagues.

Policies and Procedures to Ensure Consistent Adjudication of Accounts: 60 min

Does your facility have clear, specific policies and procedures to govern the compliant adjudication of accounts within the business office? If yes, do you have the protocols in place to ensure that they are consistently followed? If no, how can you be certain that the results provided from the business office are correct or complete? The consistent adjudication of accounts within the business office impacts all aspects of hospital financial viability. Participants will be exposed to policies and procedures to govern contractual adjustments, bad debt assignment, payment plans and denial management. These guidelines can be quickly implemented into business operations to increase compliance and accountability.