1 Presented by Ron Sterling Sterling Solutions, Ltd. rbsterling@sterling- solutions.com Revenue Cycle Management and EHRs Wednesday, January 21 st , 2015 The information provided in AHC Media Webinars does not, and is not intended to constitute medical or legal advice. Opinions, references and links provided by our speakers are provided for your convenience and do not represent our endorsement of such opinions, products or services. RONALD B. STERLING, CPA Sterling Solutions, Ltd. Ron Sterling is a nationally recognized thought leader on electronic health records and an award winning author. Ron has advised healthcare organizations across the country. He has analyzed software from over 150 vendors. Ron is a frequent speaker on EHR issues and strategies as well as the author of over 250 articles on health information technology for dozens of publications including the widely used Marketing Your Clinical Practice. EMAIL: [email protected]Office: (301)681-4247 OBJECTIVES 1. Review the effect of technology on events that produce revenue. 2. Identify effects of evolving Revenue Cycle Management issues on EHR use and management. 3. Discuss techniques to maintain appropriate EHR records for the quality and patient service requirements under evolving payer relationships.
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Presented byRon Sterling
Sterling Solutions, Ltd.rbsterling@sterling-
solutions.com
Revenue Cycle Management and EHRs
Wednesday, January 21st, 2015
The information provided in AHC Media Webinars does not, and is not intended to constitute medical or legal advice. Opinions, references and links provided by our speakers are provided for your convenience and do not represent our endorsement of such opinions, products or services.
RONALD B. STERLING, CPASterling Solutions, Ltd.
Ron Sterling is a nationally recognized thought leader onelectronic health records and an award winning author. Ronhas advised healthcare organizations across the country. Hehas analyzed software from over 150 vendors. Ron is afrequent speaker on EHR issues and strategies as well asthe author of over 250 articles on health informationtechnology for dozens of publications including the widelyused Marketing Your Clinical Practice.
EHR Interface with PMS/Billing• Accuracy• Timeliness• ICD9/10 Coding• Changes• Substantiation
RCM Checklist Items Reconcile
• Charges• Appointments• Cancellations• No Shows
Supporting Documentation for Clinically Significant Events
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RCM Checklist Items
Patient Portal Traffic• Patient Submission of Information
New Patients Follow Up
• Turnaround Time• Follow Up on Undelivered Messages• Documentation Supports Care
Standards
Patient Request
Response
Information
Messages – Sent to Inbox and Information Entered into EHR.Information Accepted – Information Flagged and Posted to Patient Chart.
Patient Portal
Patient PortalServer
RCM Checklist Items Outgoing and Incoming Electronic
Traffic Check• Rx• Transition of Care• Lab Results• Patient Orders• Other Results
Workflow Management• Patient Appointments Cleared and
Completed• To-dos and Messages Completed
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RCM Checklist Items
Internal Messaging• Part of Patient Service Strategy• Status and Response by Type• Workflow Issues
Incoming Documents/Images• Status of Items to be Indexed• Routing of Indexed Items• Documentation of Decisions• Changes to Care Plan• Document Patient Notification
Maintain Statistics to Prove Performance• Payer• Patient Population• Provider• Location
Report on Standards • Performance
• Trends
Supporting Claims and Collections
In addition to copy of notes to match E&M code with documentation….• Includes proving care standards• Depends on operational performance• Requires timely and accurate records
Meaningful Use reporting and Clinical Quality Measures are a window into the future of RCM
RCM and EHR Cases
PMS receives charges for office visits from EHR but does not post transactions for eVisits, RPMS monitoring and other activities that are billed under a quality initiative.• What are the RCM issues?• What are the RCM problems in light of
an ACO environment?
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RCM and EHR Cases
Practice receives a quality incentive payment for managing an at risk patient population. The PMS only posts fee for service charges.• How and where should the payment be
posted?• Can the payment be posted directly to
the accounting system and bypass the PMS?
• How will realization reports be affected?
RCM and EHR Cases
EHR Vendor advises practice to not sign patient notes in case the doctor wants to change the document.• What are the fee for service issues?• What are the professional liability
issues?• What are the RCM problems in light of
an ACO environment?
RCM and EHR Cases
EHR Messages are not included as part of the patient record according to the EHR design.• How does this design complicate quality
patient care?• What are the operational
accommodations needed to support quality care based RCM?
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Go Forward Plan
Monitor EHR Vendor tools to support RCM under evolving payment and performance systems• Meaningful Use as a Start
Maintain EHR Documentation and Performance Standards to take advantage of EHR and align your practice with evolving revenue models (ACO, Shared Savings, PCSP, etc.)
This presentation is intended solely to provide general information and does not constitute legal advice. Attendance at the presentation or later review of these printed materials
does not create an attorney-client relationship with the presenter(s). You should not take any action based upon any information in this presentation without first consulting legal
counsel familiar with your particular circumstances.