Futuristic Gigatech Pvt Ltd

1. The Revenue CycleWhat is it?

2. Where does the Revenue Cycle Start?

3. Physician’s Office Or Emergency Room • Physician writes an order • To admit patient • To observe patient • For tests, procedures, lab, radiology, etc • For surgery • SDS • Inpatient surgery

4. Scheduling • Referrals • Authorizations • Pre-cert or pre-auth must be obtained from insurance prior to treatment • Pre-cert or pre-auth number must be included on claim • Notifications • Some insurances do not require authorization. • Some insurance request to be notified.

5. Pre-Registration • Verify Insurance Coverage • Verify Authorization • Verify Patient Demographics • Determine Patient Responsibility • Co-pays, deductibles • Co-insurance • Obtain Patient Responsibility up front • Collect deposits

6. Financial Counseling • Meet with patients to review their financial obligations • Scheduling / Pre-registration process • Registration • Prior to discharge – inpatients • During discharge process – in and out patients • Once they are out the door the chances of collecting diminish dramatically

7. Registration’s Turn • Verify any missing data • Verify Identity • Scan Insurance Cards and documentation • Obtain co-pays & patient responsibility $$$ • Patient Signs required documents • Permission to treat, guaranty of payment, assignment of benefits • Other consent forms

8. And More …… • Advance Directives • Notice of Financial Responsibility • MSP Questionnaire • Rights as a Medicare patient • ABNs • HIPAA – Privacy Notice • Red Flag Regulations • Etc.

9. Bed Management • Bed Accommodation • Private • Semiprivate • Verified at Midnight • Charged at Midnight • Patients holding in ED for a bed

10. Case Management • See every observation or inpatient • Case management monitors inpatient and observation patients’ care to ensure admission meets admission criteria • Interqual • Milliman Care Standards - used by insurances • Works with physicians to discharge the patient in the appropriate amount of time or ensure patient still meets inpatient criteria. • Monitors and works on delays to recovery. • Review patients status: • Medicare and Medicaid – every 3 days • All others - daily

11. Discharge Planning • Performed by case management. • Begins when patient is admitted. • Goal is to only keep patient in house as long as is medically necessary to provide excellent quality of care while maximizing reimbursement. • Discharge to appropriate community resource • May arrange transfer to SNF, Home Health, contact family, etc. • Work with physician and family • Consider what insurance will pay for

12. Charges are Entered • Charges are maintained in the charge master (CDM) • A unique charge code identifies each service and test performed or supply provided • Many charges have CPT-4 or HCPCS codes attached, required for billing • Charges connect to Revenue Codes, required for billing • Charges are billed on UB04 and HCFA 1500 claim forms

13. Services are Documented • Documentation must exist in the Medical Record to support all procedures performed and supplies used. • Physician and Clinical staff signatures are critical • Verbal orders must be signed • Documentation must be complete and legible

14. Electronic Medical Record • Automate as much of the medical record as possible. • Eliminates filing issues • Allows for instantaneous access to medical record • Reduces storage space • Much of our medical record is electronic

15. Patient is Discharged • Financial Counseling • Outstanding balances, co-pays, co-insurance, deductibles, bad debt, non-covered services • Discharge Planning • Discharge disposition – can affect reimbursement • Another facility • SNF • Home • Home health

16. Medical Records – “HIM” • Manages the medical record • Scans and files loose documentation • Verifies electronic records • Ensure physician, nurses and clinical staff have signed where necessary • Monitors, reports and obtains chart deficiencies • Coding and abstracting • DNFB management

17. Medical Records Coding • Medical records chart reviewed by certified coder • Physician, nursing and ancillary documentation is critical • ICD- 9 codes: diagnoses, procedures • CPT-4 codes: procedures performed • Greatly impacts reimbursement • Heavily regulated

18. Insurance Processes Claim • Pays claim • Denies claim • Immediately • After processing • Line item denials • Pends claim • Doesn’t notify hospital • Timely filing

19. Contact Us Futuristic Gigatech 46/4, Novel Tech Park,GarvebhaviPalya , Kudlu Gate,Hosur Main Road, Bangalore, Karnataka – 56 00 68. E-mail : info@futuristicgigatech.comIndia Office: 0091 80 4093 4093India Mobile: 0091 903 500 4530

20. QUESTIONS ???