Integrating Care Coordination in the Revenue Cycle

100 %
0 %
Information about Integrating Care Coordination in the Revenue Cycle
Healthcare

Published on May 7, 2014

Author: TraceByTWSG

Source: slideshare.net

Description

West Jefferson Medical Center expert, Darlene Gondrella, reviews strategic initiatives for hospitals to integrate care coordination and revenue cycle teams for better outcomes across the organization.
•Engage care coordination in the revenue cycle process
•Integrate clinical and revenue cycle teams
•Bridge communication gaps across the organization
•Reduce readmissions through an integrated approach to patient discharge and follow-up

TraceCommunication.com “Integrating Care Coordination in the Revenue Cycle” May 6, 2014 | 1pm ET, 10 am PT Thank you for joining today’s webinar. The presentation will begin at 1pm EST.

TraceCommunication.com “Integrating Care Coordination in the Revenue Cycle” May 6, 2014 | 1pm ET, 10 am PT

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Today’s Webinar Agenda • Housekeeping Items • Introduction of Speakers and Presentation • Q&A Session

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Housekeeping Items • Welcome to Today’s Webinar! – Phone lines will be muted – For technical support, please contact: WebEx Technical Support 866-229-3239 or support@webex.com

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Webinar Playback • Today’s presentation will be recorded. • View past recordings on our website: TraceCommunication.com/Webinars

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Asking Questions • Submit questions at any time using Q&A box in the bottom right hand panel • Questions will be addressed at the end of the presentation

TraceCommunication.com “Integrating Care Coordination in the Revenue Cycle” Darlene Gondrella VP of Care Coordination West Jefferson Medical Center

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Today’s Presenter Darlene Gondrella, RN, BSN, CCM Vice President, Care Coordination West Jefferson Medical Center

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Today’s Agenda Engaging care coordination in the revenue cycle Integrating clinical & revenue cycle teams Bridging communication gaps Reducing admissions

TraceCommunication.com Care Coordination Strategies for Improved Performance Care Coordination at WJMC Integration with the Revenue Cycle Processes to Improve Rev Cycle Performance Darlene Gondrella

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. West Jefferson Medical Center 427-bed, not-for-profit community hospital in Marrero, LA, close to New Orleans Medical staff of more than 400 and employee/volunteer base of 1900 National awards for clinical excellence across many of our subspecialties

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Care Coordination at WJMC • Case managers • Social workers • Discharge planners • Discharge expeditor Inpatient • Case managersOutpatient

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Care Coordination in the Revenue Cycle Chief Administrative Officer • Patient Access • Case Management (Inpatient and Outpatient) • Patient Business Services • Health Information Management • Physician Clinics • Hospitalists • Cardiac/Neuro/Oncology /Palliative Care Service Lines • Marketing • Retail

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Integration with Care Coordination Bridging communication gaps Decrease unnecessary denials Reduce readmissions to prevent reduction in pay penalties

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Revenue Cycle Team •Patient Access Services •Case Management •Patient Business Services •Health Information Management •Service Line Development Meets monthly with CAO

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Revenue Cycle Team Coding Denials Trends RAC audits Training needs New CMS rules and regs

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Bridging Communication Gaps Monthly meetings Education, Education, Education Access to transparent, timely patient information and data

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Education Physician office lunch & learn sessions Monthly hospitalist meetings Articles in physician newsletters re: upcoming regs/changes that affect the Medical Staff Interdisciplinary team meetings for new service line development

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. CM in Relation to the Revenue Cycle

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. CM Challenges •Number of days approved, level of care •Lack of clinical Medical Necessity Denials •Inaccurate or incomplete documentation •Missing information Documentation Failures •Rework, inefficiency •Payment delays, underpayment Time Constraints •Duplication •Manual, paper-based process Medicaid Notification •Time intensive •Back and forth Discharge Planning

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Technology Implementation Real-time recording of all conversations Ability to send transcripts of recordings to insurance companies Reduced denials, less time spent preparing appeals Complete record of information coming in and going out Improved workflow and time savings Savings in paper record storage Capture and save information in a single click Less time spent printing, scanning and filing Reduced medical necessity denials

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Patient View

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Coordinate daily CM activities

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. CM in Relation to the Revenue Cycle

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Pre-Admission Patient class for ED Admissions Inpatient only procedures

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Admission Document clinical reviews for urgent/emergent admissions Record precert and eligibility calls Record admission notification

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Concurrent Record concurrent review calls with payers Capture clinical information and fax electronically

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Discharge Blast fax discharge placement Fax orders/discharge summaries to HH agencies

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Post-Discharge Insurance logs/denial letters Denial Appeals Process Patient Follow-up

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Denial Appeals Follow-up More efficient use of time • Proof of authorization • Proof of notification • Proof of clinical info sent Proof of authorization lead to decreased denials

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Initial Outcomes Avoided initial denials from payers by showing documented proof of calls Improved turnaround time on claims payments by 30 – 60 days Increased percentage of medical necessity denials overturned from 56 percent to nearly 83 percent Reduced number of medical necessity denials Allowed case manager previously handling appeals to take on full case load

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Patient Follow-up Outpatient Care Coordination • Phone calls post discharge – recorded • Early identification of symptoms – early intervention • Review calls for quality • Teachback • Customer service • Complaints • OP can resend information that was previously sent to HH agency with click of a button

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc.

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Reduce Readmissions CTC Clinic • Free service – appt in 24-48hrs. • Assists PCP when they do their follow up visit in 3-5 days Dispo codes for planned readmits – CM working with HIM to ensure correct coding Dispo codes for AMA

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc.

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc.

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Conclusion Important to involve patients and caregivers in Plan of Care Will lead to: Better outcomes Reduced denials Reduced penalties Improved transitions of care Integration of Care Coordination in the Revenue Cycle is essential to hospital success.

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Questions? Please submit questions using the Q&A section in the participant panel.

TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Thank you! Blair Wright The White Stone Group, Inc. blair.wright@twsg.com Darlene Gondrella West Jefferson Medical Center darlene.gondrella@wjmc.org

Add a comment

Related presentations

Trabajo de democracia

Trabajo de democracia

October 23, 2014

TRABAJO DE DEMOCRACIA

Confrontando mitos mari

Confrontando mitos mari

November 6, 2014

CONFRONTANDO MITOS

Mitos y realidades de las sustancias psicoactivas

Mitos y realidades de las sustancias psicoactivas.

Confrontando mitos

Confrontando mitos

November 6, 2014

Confrontando mitos

Related pages

Webinar: Integrating Care Coordination in the Revenue ...

Trace captures and manages revenue cycle communication across the healthcare continuum. Tracking communication is essential for hospitals to achieve strong ...
Read more

INTEGRATING CARE COORDINATION IN THE REVENUE CYCLE

INTEGRATING CARE COORDINATION IN THE REVENUE CYCLE . West Jefferson Medical Center VP of Care Coordination, Darlene Gondrella, discusses strategies to ...
Read more

Integrating Care Coordination in the Revenue Cycle | Trace ...

Why is it important to integrate care coordination in the revenue cycle? Because it leads to better outcomes, reduced denials, reduced penalties and ...
Read more

The White Stone Group

The White Stone Group hardwires best practices ... System Executive Revenue Cycle/Patient ... Integrating Care Coordination in the Revenue Cycle ...
Read more

Integrating the Revenue Cycle for Improved Health System ...

Revenue Cycle; Careers. Career Center; ... an IRC involves the coordination of revenue cycle activities ... integrating revenue cycle activities presents ...
Read more

Revenue Cycle Management | Healthcare Finance News

... s revenue cycle is its ... with most showing a real drop in charity care and bad ... efforts have been concentrated on coordination among ...
Read more

Quick Overview - HealthLeaders Media Insider: Revenue Cycle

Quick Overview. This downloadable ... Integrating the Health System Revenue Cycle; ... Care Coordination & Population Health ; Healthcare Analytics: ...
Read more

integrating the revenue cycle for improved health system ...

... including a higher continuity of care, a stabilized ... integrating revenue cycle activities ... structure tends to promote improved coordination
Read more

Integrating the Health System Revenue Cycle

Integrating the Health System Revenue Cycle ... the need to engage clinicians from across the continuum of care in the revenue cycle ...
Read more