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ACTUAL FINDINGS
HOSPITALS ACROSS THE
STATE……WHAT IS HAPPENING?
DO YOU REALLY KNOW???? UPFRONT COLLECTIONS? BILL HOLD/ERROR? SECONDARY CLAIMS? RTP REPORTS? BILLERS REAL KNOWLEDGE? CONTRACTS? HOW TO READ YOUR AR SUMMARY AND
DETAILS?
ACTUAL FINDINGS ARE YOU REALLY GETTING THE REAL
TRUTH FROM YOUR STAFF? WHAT IS LOST IN THE BLACK HOLE? WHAT DO WE DO NOW? WHY DID WE GET HERE? HOW DO WE GET OUT OF HERE?
FINDINGS:NO UPFRONT CASH COLLECTIONS $0.00 TO $1200.00 MONTHLY WE DON’T KNOW HOW TO ASK FOR
MONEY OUR BOARD WILL NOT LET US ASK FOR
MONEY OUR PATIENTS WILL GO TO ANOTHER
HOSPITAL OUR PHYSICIANS GET MAD WHEN WE
ASK OUR PATIENTS FOR MONEY
UPFRONT COLLECTIONSHOW DO WE START? EDUCATE PATIENTS/COMMUNITY EDUCATE BOARD EDUCATE PHYSICIANS EDUCATE EMPLOYEES NOT AN OPTION TO COLLECT EVEN COLLECTED ON OLD BILLS FROM $0.00 TO $64,000.00
WHAT UPFRONT COLLECTIONSCAN DO FOR YOU REDUCE BAD DEBT REDUCE AR DAYS INCREASE CASH FLOW REDUCE THE COST OF DOING
BUSINESS ON THE BACK END
FINDINGS:BILL HOLD/ERROR 60 BED HOSPITAL APPROXIAMATELY 1500 OUTPATIENTS
MONTHLY APPROXIAMATELY 450 ER VISITS APPROXIAMATELY 80 ADMISSIONS A
MONTH STAFF RUNNING REPORT FOR CFO AND
“TWEEKING” THE REPORT BEFORE SENDING IT TO THE CFO
FINDINGS:BILL HOLD/ERROR
BILL HOLD FOR DIAGNOSIS NOT COMPLETE
BILL ON HOLD FOR “COMPUTER” ISSUES
BILL HOLD FOR CLAIMS ON HOLD FOR ERRORS
NO PRECERT ON CLAIM, OR EVER OBTAINED
FINDINGS:BILL HOLD/ERROR MORE THAN $2,000,000.00 SOME CLAIMS ON LIST WERE OVER 1
YEAR OLD CLAIMS ON HOLD FOR “OTHER
DEPARTMENT” INFORMATION
HOW TO CORRECT:BILL HOLD/ERROR WEEKLY STAFF MEETINGS GOAL SETTING PHYSICAN EDUCATION BILLING EDUCATION IDENTIFY AND CORRECT “COMPUTER”
PROBLEMS TRAINING DEFINING WHO GETS AND WHEN TO
GET A PRECERT
FINDINGS:SECONDARY CLAIMS NOT FILED OVER 650 MEDICAID CROSSOVERS NOT
PAID COMPUTER ISSUES DID NOT KNOW HOW TO FILE A
SECONDARY CLAIM
HOW TO CORRECT:SECONDARY CLAIMS DESIGN A PROCESS MONITOR SECONDARY CLAIMS EDUCATION FOR STAFF CORRECTION OF COMPUTER PROBLEMS
FINDINGS:BILLERS KNOWLEDGE DID NOT KNOW THE DIFFERENCE
BETWEEN AN INPATIENT CLAIM AND AN OUTPATIENT CLAIM
DID KNOW WHAT A CONTRACT WAS OR WERE THEY WERE LOCATED
DID NOT KNOW WHAT THEY WERE SUPPOSED TO BE PAID ON A CLAIM
LIMITED KNOWLEDGE OF THE COMPUTER SYSTEM
FINDINGS:BILLERS KNOWLEDGE LIMITED ACCESS TO WHAT THEY REALLY
NEED IN THE COMPUTER SYSTEM LIMITED OR NO UNDERSTANDING OF
HCPC’S OR CPT’S LIMITED OR NO UNDERSTANDING OF
MODIFIERS DID NOT EVEN KNOW WHAT AN APPEAL
WAS
FINDINGS:BILLERS KNOWLEDGE LIMITED ACCESS TO THE INTERNET NO EDUCATION NO TRAINING
WHAT IS THE ANSWER??THE BILLERS KNOWLEDGE
WE SPEND ALL THE TIME WE CAN GENERATING REVENUE FOR OUR HOSPITAL
WE SPEND COUNTLESS $ ON COMPUTER SYSTEMS TO CAPTURE ALL THE INFORMATION WE CAN
WE SPEND COUNTLESS $ RECRUITING PHYSICIANS
WHATS THE ANSWER??THE BILLERS KNOWLEDGE WE SPEND LITTLE ON NO $ ON
EDUCATING OUR BILLERS WE HIRE AN EMPLOYEE BECAUSE THEY
CAN USE EXCEL OR WORD WE “PROMOTE” THEM BECAUSE THEY
WERE NEXT IN LINE
WHATS THE ANSWER??THE BILLERS KNOWLEDGEWHAT IS REALLY THE ANSWER?
EDUCATIONCONTINUING EDUCATION
TRAININGMORE TRAINING
YOU GET WHAT YOU PAY FOR
EDUCATION AND TRAINING
WHAT DO WE DO? EDUCATE YOUR STAFF EDUCATE YOUR “CUSTOMERS” GIVE YOUR STAFF THE TOOLS THEY
NEED MEET WITH YOUR STAFF EVALUATE YOUR STAFF LEARN TO RUN AND READ YOUR
REPORTS IF YOU CAN’T “TRUST” A MEMBER ON
YOUR “TEAM”, THEY USUALLY AREN’T A MEMBER OF YOUR “TEAM”.