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Enhancing
Operations for Revenue Cycle Optimization
Enhancement
of internal managed care operations has emerged as an opportunity for
decreasing the number of pended and rejected claims a hospital incurs.
Therefore, hospitals must ensure that they have the systems and infrastructure
to respond effectively to managed care contractual demands. Presscott
Associates will present opportunities for improvement relative to managed
care information flow in all functional departments from the point of
origin (patient registration) to the point of destination (the production
of a bill).
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2000
Connecticut Chapter of the Healthcare Financial Management Association
Presentors: Neil M. Pressman and David A. Gregory
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2000 New York Chapter of the Healthcare Financial Management Association
Presentor: David A. Gregory
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2000 New Jersey Chapter of the Healthcare Financial Management Association
Presentor: David A. Gregory
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2001 American College of Healthcare Executives Annual Congress
Presentors: Neil M. Pressman and David A. Gregory
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2002 Connecticut Chapter of the Healthcare Financial Management Association
Presentors: Neil M. Pressman and Molly Fuchs
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2003 American Association of Integrated Healthcare Delivery Systems
Presentor: Neil M. Pressman
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2004
Healthcare Financial Management Association - Annual National Institute
Presentor: David A. Gregory
Strategic
Renegotiation of Hospital Managed Care Contracts
The
presentation begins with an overview of the local managed care marketplace.
As managed care contracting arrangements mature, both payors and providers
are challenged to meet their contractual obligations. Therefore, during
periods of renegotiation, the parties are reevaluating financial/non-financial
terms and whether to continue certain relationships. Developing a proactive
posture requires a strategic orientation toward managed care contract
renegotiation. Participants will be able to identify the elements of
an overall strategy for assessing managed care competencies, selecting
the right partners and succeeding in a maturing market.
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2000
American College of Healthcare Executives Annual Congress
Presentors: Neil M. Pressman and David A. Gregory
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2001 Connecticut Chapter of the Healthcare Financial Management Association
Presentor: Neil M. Pressman
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2001 Healthcare Financial Management Association – Teleconference
Presentors: Dr. Dennis J. Scotti and David A. Gregory
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2001 Healthcare Financial Management Association - Annual National
Institute
Presentor: David A. Gregory
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2002 Healthcare Financial Management Association - Annual National
Institute
Presentor: David A. Gregory
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2003 University of New Haven Healthcare Symposium
Presentor: Neil M. Pressman
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2004 Healthcare Financial Management Association - Annual National
Institute
Presentor: David A. Gregory
Effective Strategies for Reducing Managed Care Denials
For
many hospitals and healthcare systems, claim denials may exceed 10-15%
of expected reimbursement. Management and reduction of denied claims
present significant opportunities to improve revenue cycle efficiency
and increase revenue. This presentation offers important ”how
to” information encompassing claims generation and submission,
and claims denials and appeals. This presentation provides an overview
of revenue cycle components, discusses reasons for inpatient and outpatient
denials, and offers pre-denial and post-denial solutions for operations
and management intervention.
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2002
American Association of Integrated Healthcare Delivery Systems
Presentor: Neil Pressman
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2003 Healthcare Financial Management Association - Annual National
Institute
Presentor: Neil M. Pressman and David A. Gregory
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2003 New Jersey Chapter of the Healthcare Financial Management Association
Presentor: David A. Gregory
Enhancing
Outpatient Service Revenue in the Managed Care Era: Reimbursement Follows
Structure
This
presentation lists reasons to focus on outpatient services, as well
as the characteristics of the current outpatient environment as compared
to characteristics of an ideal outpatient environment. Functions within
the revenue cycle (e.g., scheduling, pre-certification, registration,
coding, billing) are discussed relative to incremental integration options.
An ideal integration model is offered, and challenges to integration
and also “keys to success” are enumerated. Some industry
“benchmarks” are presented. Conclusions support the title
that reimbursement follows structure.
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2002
New Jersey Chapter of the Healthcare Financial Management Association
Presentor: David A. Gregory
Managing Customer Service Requirements of Healthcare Stakeholders:
The Expectation – Performance Link
Healthcare
organizations (HCO) serve two types of customers, external customers
(e.g., patients and payors), and internal customers (e.g., clinicians
and administrative staff). Both external and internal customers expect
SERVICE – Safety, Expertise, Reliability, Validation, Information,
Compassion, and Equity – from their encounters with HCOs. The
nature and determinants of such expectations will be examined as the
foundation for developing tools to measure and manage customer service
outcomes resulting from the service delivery process. The presentation
will also address the role of managers as facilitators of customer service
excellence.
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2002
American College of Healthcare Executives - Annual Congress
Presentors: Neil M. Pressman and David A. Gregory
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2002 Healthcare Financial Management Association - Annual National
Institute
Presentor: David A. Gregory
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2002 Healthcare Financial Management Association – Teleconference
Presentors: Dr. Dennis J. Scotti and David A. Gregory
Physician
Contracting Strategies
This
presentation was designed to assist the audience in understanding
the New York managed care marketplace. HMO enrollment by payor (i.e.,
commercial, Medicare, Medicaid) was presented, indicating a 34% penetration
rate. Market penetration by the top six downstate HMOs was displayed.
A case study of member per month reimbursement ranges by payor was
discussed, providing net income ranges. Average commercial provider
reimbursement ranges were given for HMO and PPO.
Key
leverage points for physicians were enumerated, as well as guidelines
to developing a contracting strategy, understanding a managed care
contract and reviewing how contract requirements effect key operations.
Obligations of the managed care organization were provided as a checklist
for physicians in reviewing managed care contracts, and ideas were
presented for ongoing contract maintenance. Suggestions for optimizing
revenue were offered. Finally, physician contracting was discussed
in consideration of antitrust laws and joint negotiations.
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2002
Metropolitan New York Chapter of the Healthcare Financial Management
Association
Presentors: Neil M. Pressman and David A. Gregory
Contract Implementation Strategies
The
presentation is intended to assist providers in their preparation for
implementing and managing managed care contracts, and thereby enhancing
their operations and increasing opportunities to maximize revenue. Being
pro-active is the key to successful contract implementation, and the
presentation proposes several requirements to set the stage, e.g., performance
measures and staff accountability, and critical assessment of contract
terms. Payor and provider operational weaknesses are discussed. A proactive
multidisciplinary approach is described that addresses all functional
areas whose processes are affected by managed care contractual obligations.
Key performance indicators for the revenue cycle are presented. A formula
for success, resulting in minimal claim denials is discussed. Finally,
a contract implementation agenda is proposed to guide providers in preparing
for contracting with managed care organizations.
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2004 New York Chapter of the Healthcare Financial Management Association
Presentor: David A. Gregory
Managing
Reimbursement Issues for Emerging Medical Technology
Advances
in medical and surgical technology and the growing demand for new medical
and surgical products and devices have altered the process of how new
technology is introduced into the marketplace, approved for use in hospitals
and reimbursed by payors. In order to succeed in a highly competitive
marketplace, medical technology companies need to understand hospital,
sponsor and payor needs. In this seminar, payors and sponsors refer
to Medicare and Medicaid, national and regional HMOs, Workers’
Compensation insurance entities, and third party administrators for
large self-insured groups. Hospitals and health systems include academic
“Centers of Excellence” (i.e., teaching hospitals), non-academic
centers (i.e., tertiary hospitals) and community hospitals. This seminar
provides information to assist payors and providers in understanding
how new technologies are introduced into the marketplace and what their
roles and leverage points are in the process.
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2003
Cardiovascular Managers Conference
Presentors: Neil M. Pressman and David A. Gregory
Contract with the Consumer: The Impact of Consumer
Choice Health Plans
This seminar addresses the impact of consumerism on healthcare. As more
of healthcare costs are shifted to consumers, consumers are becoming
more concerned about the quality of healthcare services they are receiving
along with the price they are paying for healthcare services. Consumerism
brings new health plan designs to the marketplace, with high deductible
plans and flexible benefit designs offering employers and consumers
varied premiums and coverage. The Medicare Modernization Act paved the
way for consumer choice health plans (CCHPs) by defining the provisions
of health savings accounts (HSAs). During 2005 it is projected to be
a significant growth year for HSAs, with major health insurers developing
and launching new product/plan offerings. Enrollment in HSAs is “skyrocketing”,
in particular, in the individual and small group market. By 2007, Forrester
Research predicts that for all markets there will be 12 million HSA
accounts with $87.8 billion in funds.
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2005
Metropolitan New York Chapter of the Healthcare Financial Management
Association
Presentor: David A. Gregory
A
Successful Case Study: Reengineering the Revenue Cycle to Improve Outpatient
Operations
Upon
performing an operations review of ambulatory operations, Presscott
Associates identified opportunities for improvements in workflows, staff
training and workloads, communication of revenue cycle components, and
the enforcement of existing policies.
Improvements
in the revenue cycle were achieved through the promotion of structure
and accountability in the reengineering of operations within the ambulatory
care departments. The characteristics of the outpatient environment
at the inception of the project are compared to the characteristics
of an ideal outpatient environment (i.e., opportunities identified for
improvement). Analysis of operations had indicated that the lack of
integration of revenue cycle functions yielded inconsistent procedures
and workflows. Each function within the revenue cycle from the point
of origin (patient registration) to the point of destination (generation
of a bill and payment, and/or claims denial and appeal management) is
examined relative to incremental integration options. An ideal integration
model is offered, and challenges to integration and also “keys
to success” are enumerated. Some industry “benchmarks”
are presented. Conclusions support the title that reimbursement follows
structure.
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2005
Healthcare Financial Management Association Revenue Cycle Conference
Presentor: David A. Gregory
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