Dilemma Solved: A/R Collections During a Billing System Conversion By Steven Lash

As a Revenue Cycle Director, it is likely during your career you will be faced with a Billing System conversion.  You have a daunting decision whether to convert the old A/R, use existing staff to work the old A/R and at the same time learn they need to learn the new Billing system.

This is a major undertaking fraught with operational and financial risk. It gets even more complicated if a new clinical system is going in at the same time. Supporting a seamless revenue cycle conversion requires extensive planning and training, along with laser-like focus on the operations and features of the new platform with the staff having to learn the tips and tricks along with functionality.

An initial decision to use existing staff to wind down collections at the same time as learning the new system exacerbates the major organizational effort that is required. Billing personnel will be pulled in multiple directions as they attempt to master the complexities of the new system while at the same time try to wind down aging accounts receivable linked to the legacy platform. Attempting to juggle these competing tasks can produce the worst of both worlds; outgoing claims submitted through the new system stall or decrease, while unresolved accounts in the old platform pile up. Cash flow erodes as days in AR and denials increase. And if unanticipated problems or delays emerge during the Billing System implementation, the financial problems can quickly snowball.

To mitigate these risks and preserve cash flow, a bifurcated approach to the revenue cycle transition should be strongly considered. By establishing a clean cut off after thorough testing and training of the new system the internal staff would handle new system billing activities, in-house personnel can submit claims in an accurate and timely manner after the cut off.  This is their sole focus.

Legacy accounts, meanwhile, can be outsourced to a qualified, third-party AR resolution vendor. Turning the old inventory over to external specialists not only allows internal staff to concentrate on current claims and the new system, it also ensures that aging denials will be worked methodically to resolution. This would result in cash being collected on accounts that most likely would have been written off due to divergent priorities by the in-house staff.

Under the best of circumstances, even with a flawless implementation (this has never happened) it’s not unusual for organizations undergoing new Billing Systems installations to experience an increase in both days in AR and denials, along with a commensurate reduction in cash flow critical that every step be taken to ensure a successful implementation. Partnering with a qualified third party to resolve legacy AR enables internal staff to focus exclusively on the new billing platform. It is safe to assume the odds for success are greatly improved if the in-house billing staff is not required to simultaneously work legacy denials while attempting to submit clean claims through the new system. Beyond the extra workload and inconvenience that juggling the two tasks entails, allowing personnel to continue to interact with the legacy platform can undermine acceptance of, and confidence in, the new billing process. This, in turn, can reinforce outmoded processes or behaviors and hinder the development of staff-wide competence with the new system. The net result is further financial risk. For more info you can visit here Steven lash San Diego.

Steven lash San Diego shared Best Practices on Value-Based Care Reimbursement

Payers have begun to transition to value-based care reimbursement from the more traditional fee-for-service payment system. Executives and financial experts are begrudgingly understanding that it will take longer than expected to adopt the new payment structures. Many obstacles will impact the timing and effectiveness of this transition. Payers should follow some key best practices.

 Evaluate the patient population

Steven lash San Diego explain how we can move to value-based care reimbursement effectively, payers will need to understand their subscriber base to understand the type of care and preventive services that will be required from the provider network. The results of this analysis can be communicated to relevant medical facilities to establish appropriate treatment for each patient.

Key strategies payers should include patient risk stratification and population health management analytics. Payers could help inform providers on which members are in need of greater engagement in their chronic disease management. Payers should follow Medicare’s lead and pay for a Chronic Care Management program.

Improvements in hypertension, weight management and sugar control show that it will have a positive impact on patient outcomes, but that usually takes years to benefit the patient and ultimately benefit the overall cost. This of course, is the payer conundrum since patients can change their health plans annually so the payer that has paid for these programs may not reap the benefit.

 Passing the financial risk to providers should be done slowly

An important component for moving to outcome-based care is to introduce financial risk gradually. A Carrot and Stick approach is a radical change for providers and cannot be rushed into the provider community. When providers partner with payers through a risk sharing model (aka value based reimbursement), they’re often required to assume more financial risk as opposed to payers taking on more risk in a fee-for-service model.

Quality measures should fit existing provider patient care goals

Healthcare providers often have their own quality improvement goals for their patient population and as of late a standardized set. Payers could effectively transition to value-based care by aligning their quality measures to fit existing goals of their providers. This means that instead of forcing providers to adhere to differing quality metrics between public and commercial health plans, payers would implement their quality measures to align with that of CMS and the MACRA regulations.

 Support healthcare delivery reform

Payers should follow Medicare’s lead and actively support changes in the healthcare delivery change. ACOs have been shown (when well run with good leadership and tools) to improve quality and reduce costs. In their infancy Medicare economically supported the formation of these ACOs. Additionally, models such as patient centered medical homes have also driven down costs and improved patient care.

Member engagement and empowerment

Steven lash San Diego explain how you can see the best results from value-based care reimbursement it will be necessary to invest in patient engagement and for patients to assume accountability for their health. Patients with the tools needed to make appropriate decisions in their healthcare shopping are more likely to choose more affordable options to the benefit of their wallet.

Chronic Care Management Conclusion by Steven Lash

It is evident based on the 2 earlier articles that Steven Lash published this is a very heavy lift for almost all practices. Even large practices will have to add significant staff to establish the program. This would lead to very low margins.

• The practice will have new fixed cost structures in the form of employees, computers, space, telephones, etc., with no assurance that the practice will be able to capture every patient every month for reimbursement from Medicare.

• A do it alone approach will impact/change in a very major way existing practice workflow. This will reduce office efficiency and either lead to longer workdays for the entire practice or a reduction of the number of patients coming into the office as time was taken up performing new workflow activities.
• One of the most important items is that the practice and the physician providers would be subject to compliance concerns and potential problems. No provider wants to have a Medicare audit and certainly not one where they are recouping tens of thousands in Medicare payments. More info Steven lash

Defining the new Alternative Payment Models by Steven lash

Steven Lash noted health advisor notes that the new MACRA legislation defines three payment models which will definitely qualify as APMs beginning in 2019: Accountable Care Organizations (ACOs), current APMs like the bundled payments currently operated by CMMI through the Bundled Payments for Care Improvement (BPCI) initiative, and medical homes. Additional models will be considered as APMs are defined. There are three basic criterion for participants in APMs:

• Use certified EHR technology
• Report on quality measures comparable to the MIPS quality measures, and
• Bear financial risk for monetary losses under the APM that are in excess of a nominal amount

The Secretary of HHS will define the other models which will qualify as APMs. The legislation creates a new entity to advise the Secretary and evaluate the development of alternative payment models, to be known as the Physician-Focused Payment Models Technical Advisory Committee (TAC). The committee will make recommendations to the Secretary as to whether the alternative payment models meet the criteria (the three points above and any others to be established by the Secretary) for assessing physician-focused payment models.

The HHS Assistant Secretary for Planning and Evaluation (ASPE) would provide technical and operational support for the committee, which could be by use of a contractor. The Office of the Actuary of the Centers for Medicare & Medicaid Services would provide actuarial assistance as needed.

According to noted healthcare advisor Steven Lash the proposals to the TAC and federal rulemaking will be the chief processes to define APMs moving forward. The legislation recognizes there will be other valuable value based models that should be classified as an APM.

The first milestone will be November 1, 2016, when the Secretary will write a rule to establish the criteria for physician-focused payment models which will be used by the TAC.

During the comment period for the proposed rule, MedPAC, individuals, and key stakeholders could submit comments to the Secretary on the proposed criteria. Individuals and stakeholder entities also could submit proposals to the TAC for models that they believe meet the criteria. The TAC will review models submitted on a periodic basis and provide comments and recommendations to the Secretary regarding whether the models meet the criteria. The Secretary has the ultimate authority to define the APM models.

 

Under MACRA there will be two new physician payment systems that will exist side-by-side by Steven lash

According to noted healthcare advisor Steven Lash “One system will be a “2.0 version” of the several pay-for-performance systems currently in place for Medicare physicians. It will be a melding of the Physician Quality Reporting System, the Value-Based Modifier, and Meaningful Use for EHRs’”.

The three systems will continue as currently constituted through 2018. In 2019, they will be melded together to form a new system called the Merit-based Incentive Payment System (MIPS). Steven Lash noted that “MIPS is intended to be the less-attractive path for physicians because—while upside rewards and bonuses will be possible for some extraordinary practices—low performance could be penalized by 4% and as much as 9% as the system matures.”

Three entities will be tending MIPS: Medicare Payment Advisory Commission (MedPAC), the Department of Health and Human Services (DHHS), and the Government Accounting Office (GAO). MedPAC will report on the impact of the 0.5% updates on physicians and the broader Medicare program in terms of total spending, quality, and access. DHHS will establish the quality measures from which MIPS-eligible professionals could choose, and which will serve as the basis for the MIPS bonus or penalty.

GAO will submit four reports, one of which will assess the burden of MIPS measurement, and two of which will assess the effectiveness of government programs to help physicians prepare for participation in alternative payment models. According to Steven Lash “The fourth GAO report, due January 1, 2017, would study the role of independent risk managers and examine whether such entities could pool financial risk for physician practices. Could risk managers support physician practices, particularly small ones, in assuming financial risk for the treatment of patients? What are the current barriers (practical, legal, otherwise) to assuming risk? What would such managers look like?”

To avoid 4-9% payment penalties and lock-in a 5% annual bonus, eligible professionals must participate in the second system, the Alternative Payment Models (APM). Physicians will be able to opt-out of MIPS and instead participate in the APM system if a sufficient share of their revenues is derived from APMs. In the first year, only Medicare revenue will count towards APM participation; however, in subsequent years, revenues could be pooled across Medicare and other sources to qualify for APM participation. This is intended to be the more attractive system and the 5% bonus is intended to reward the resources and effort required to participate in an APM.