Issue link: https://beckershealthcare.uberflip.com/i/633033
1. Revenue cycle assessment worksheet Quick assessment of your revenue cycle performance 2. Best practice revenue cycle KPIs Market indicators to monitor your revenue cycle performance 3. Financial clearance and charity checklist Your readiness for charity and 501(r) requirements 4. Best practice revenue cycle workflow How you stack up vs. best practicing health organizations 5. High-balance self-pay financial clearance workflow Steps to determine who needs assistance and who can pay Try the TransUnion Charity Care and Bad Debt Prevention Toolkit These five tools will change how you handle charity care and bad debt 8 Best practice revenue cycle workflow Next, the workflow below outlines where best-practicing organizations focus their efforts to ensure that their revenues are maximized within the revenue cycle. It establishes a process that will let you put into place standard work and ensure that you and staff aren't missing key steps as patients access care within your organization. Each step and decision is a critical component of the financial clearance process. Financial Clearance Workflow Medical Service Requested Self-Referral/Physician Order Add'l info from MD Office Meets Criteria? Financial Assistance Screen (FPL/P2P) Bad Debt Charity Care Yes Insurance? Yes Eligible? NO Medicare? Yes Auth Obtained? Yes Benefits/ Estimate Calculated? Payment $$$ NO NO NO YES YES YES YES NO YES Financial Assistance Required Requirements Met? Assess Medical Necessity NO NO Document ICD-10 AUTH add'l clinical info in HIS NO NO NO YES Execute ABN / Waiver NO Escalate with internal workflow (<72 hours) Self Pay Patient Yes Yes NO Afford Portion? Afford Portion? Pay? Eligible Insurance/State program found? Needs-based Discount? Complete FA Application and refer to Financial Advisor Qualify for Charity Care (501r)* NO NO NO Bad Debt Document ICD-10 AUTH add'l clinical Yes NO Pay? 8 Best practice revenue cycle workflow Next, the workflow below outlines where best-practicing organizations focus their efforts to ensure that their revenues are maximized within the revenue cycle. It establishes a process that will let you put into place standard work and ensure that you and staff aren't missing key steps as patients access care within your organization. Each step and decision is a critical component of the financial clearance process. Financial Clearance Workflow Medical Service Requested Self-Referral/Physician Order Yes Insurance? Yes Eligible? NO Medicare? Yes Auth Obtained? Yes Benefits/ Estimate Calculated? Payment $$$ NO NO YES Assess Medical Necessity NO NO Document ICD-10 AUTH add'l clinical info in HIS NO Escalate with internal workflow (<72 hours) Yes Afford Portion? Complete FA Application and refer to Financial Advisor Document ICD-10 AUTH add'l clinical Add'l info from MD Office Meets Criteria? Financial Assistance Screen (FPL/P2P) Charity Care NO NO YES YES YES YES Financial Assistance Required Requirements Met? NO NO Execute ABN / Waiver NO Self Pay Patient Afford Portion? Eligible Insurance/State program found? Needs-based Discount? Qualify for Charity Care (501r)* NO NO NO Assess Medical YES refer to Financial Advisor Best practice revenue cycle workflow Next, the workflow below outlines where best-practicing organizations focus their efforts to ensure that their revenues are maximized within the revenue cycle. It establishes a process that will let you put into place standard work and ensure that you and staff aren't missing key steps as patients access care within your organization. Each step and decision is a critical component of the financial clearance process. Financial Clearance Workflow Medical Service Requested Self-Referral/Physician Order Add'l info from MD Office Meets Criteria? Financial Assistance Screen (FPL/P2P) Charity Care Yes Insurance? Yes Eligible? NO Medicare? Yes Auth Obtained? Yes Benefits/ Estimate Calculated? NO NO NO YES YES YES YES NO YES Financial Assistance Required Requirements Met? Assess Medical Necessity NO NO Document ICD-10 AUTH add'l clinical info in HIS NO NO NO YES Execute ABN / Waiver NO Escalate with internal workflow Self Pay Patient Afford Portion? Afford Portion? Eligible Insurance/State program found? Needs-based Discount? Complete FA Application and refer to Financial Advisor Qualify for Charity Care (501r)* NO NO NO Detailed workflows guide adoption of best practices. TransUnion Healthcare Solutions Download your toolkit today healthcare.transunion.com/bad-debt-toolkit Going to HIMSS Feb. 29? See us in action at booth #11318. Start your self-assessments today Download your copy at healthcare.transunion.com/bad-debt-toolkit