OPERATIONAL PROCESSES

 

CUSTOMER SERVICE – 2 hours

 

  1. Personnel - Key personality traits – multi-tasking, think on feet, quick, organized
  2. Attitude and aptitude – customer is always first
  3. Quality versus quantity – complete and accurate orders – qualifying the patient
  4. Segregating responsibilities – payer, product mix or generalists (respiratory)
  5. Retail, phone, fax, and email orders
  6. Documentation
  7. ABNs, WOPDs and other pre-order musts – CMN related questions
  8. Training – retraining – Experienced versus newcomers to industry
  9. Customer service as negotiator, social worker and salesperson

 

 

ORDER INTAKE – 2 hours

 

  1. Checklists
  2. Order edit list management
  3. Accuracy and competency
  4. Qualifying orders – who and how and in what timeframe
  5. Retail showroom sales (non-assigned cash transactions)
  6. Collecting copays
  7. Accountability

 

GENERAL MATTERS – 2 hours

 

  1. Database management –Inventory, Payers, Physicians, etc…
  2. Training – a common weakness turned into core development  – cross-training essentials – mentoring program
  3. Medicare guidelines as a core competency –
  4. Charity care – how much is too much and how little is too little?  Find the middle ground and manage it
  5. Maximizing use of software – avoid manual tasks – ask how the system can handle each function – what should system do that is often neglected? Modify your processes around the software

 

HELD REVENUE/DOCUMENTATION – 2 hours

 

  1. The Process – A step-by-step approach
  2. Accountability – set standards up front and make goals achievable Days of Held
  3. Stay on top of recerts and reauths for ultimate control
  4. eCMNs - efax
  5. Training the doctor’s office to be your ally, not your adversary
  6. Measure by time frame – what is reasonable? Initials versus recerts
  7. Authorization and reauthorization process – how does this work best?  Who and when?

 

BILLING  PROCESS – 90 minutes

 

  1. Pre-billing edit checklists – manage and monitor
  2. Electronic claim acceptance reports – accuracy is key
  3. Electronic versus paper – availability – process
  4. Payer websites – maximizing use
  5. Mailing procedures – attachments – manpower
  6. Secondary claim submission – hardcopy, cross-over, EOB retrieval
  7. Billing amounts – financial viability – primary/ secondary claims – know value
  8. Accountability – time frames

 

CASH COLLECTIONS/RECEIPTS  - 60 minutes

 

  1. Electronic Remittance Notices (ERN) – autoposting
  2. Denials – documentation and tracking
  3. Staffing – how many? – system issues
  4. Adjustments/write-offs – process, authority, tracking and reporting
  5. Small balance write-offs
  6. Timing – accurate A/R

 

ACCOUNTS RECEIVABLE – 2+ hours

 

  1. Segregating billing and A/R
  2. Old and new A/R – track separately  - expect to collect >100% of billed old A/R
  3. Managing Medicare denials – Top 10, outsourcing (RemitData, MRN)
  4. Correspondence, returned mail, and deceased patient process
  5. Private pay billing and A/R – statements, collection letters and agencies, evaluate worth of receivable, discount for payment
  6. Medicaid process – top denials – statute of limitations
  7. Managed care and other third party payers – contractual obligations, goals, top denials, timely filing issues
  8. Hospice and other institutional customer  receivables
  9. Audits – various types – tracking and preparing
  10. Refund and credit processes
  11. Staffing breakdown – expectations

 

MANAGEMENT FIGURES FOR QUICK MEASURE – 60 minutes

 

  1. DSO (rolling 3 months)
  2. DSO held billing (no parent claim) and with parent
  3. Net Revenue billed
  4. Net Revenue unbilled
  5. Total revenue
  6. Cash collections
  7. Aged trial balance – date of service versus date billed – aging buckets % over 120 days
  8. Open order edit list - $ and days
  9. Billed to collection percentage (use lag time)

 

PERSONNEL DEVELOPMENT – 2+ hours

 

  1. Hiring
  2. Discipline
  3. Firing – turnover ratio
  4. Assessment tools
  5. Coaching
  6. Coaching and management styles
  7. Respectful confrontation
  8. Leadership styles and activities – what makes you a good leader?
  9. Developing a team
  10. Team dynamics
  11. Personal and staff goal setting
  12. Job descriptions
  13. Personality types
  14. Metrics for staffing, order entry, qualifications, A/R, held revenue ???
  15. Accountability – objective measurements key