# Presentation: 005470

## Division of Business Office Enhancements

_***>You Are The Essential Piece<***_

## <<<Partnership Themes>>>

- “Preparing for Challenges in Third Party Claims Processing, 1999”
-  “Building the Foundation, 2000”
- “Together Everybody Achieves More,2001”
- Strengthening our Partnership for Healthier Indian Communities, 2002
- “Partners for Compliance, 2003”
- “Bring the Partners Together, 2004”
- “Planning Solutions to Improve Business Process, 2005”
- “101 Management Meeting/Training “Raising Health Status by Effective and Efficient Third Party Revenue Management, 2003” & CEO/BOM in 200

**Notes:**
  How many in the very first one in OK....

Denver
Nashville....
Reno
Scottsdale
Reno

## OFFICE OF RESOURCE ACCESS AND PARTNERSHIPS

## DBOE STAFF

- Elmer Brewster
- Sandra Lahi
- Balerma Burgess
- John Rael
- Kris Kirk
- Leah Tom and Roland Todacheenie, Chair and Vice Chair of NBOC
- Support Staff, Gerald Moses, Tina Connors, Sharon Sorrel, DLR and BOC

**Notes:**
names so you can ask them questions---they area very smart and have many years of experience...so please use them and while they are here ask them questions and give them your card...and also tap other BOC from some of the Areas....that is what I do frequently because they are much smarter then I about the 15 steps in the revenue cycle

## IHS Total Collections by Major Payer 1995-2005

**Notes:**
Includes Tribal projections, accept PI....Clearly Medicaid largest payer....the total is $671.3 million which represent about 30-60% of hospital and clinic facilities operating budgets.

Overall, the collection percent increase on the average for the first five years of this decade was 18%--this was due to major increases in rates and changes in business practices.  The Second 5 years the rate of increase was 9-10%.  Given minor rate increases, collections have been consistently greater then the rate increases due to business process changes ie. Enrollment in M & M, better documentation  coding and timely data entry, updated fee schedules, accurate billing and improved accounts receivable management. 

The past 2 years about 7 and 8%. What will be the average the next 5 years.....can we expect big increase as in the past?

The next slide identifies the major impacts on our collections---.

## IHS 3rd-Party Collection:1995-2005

**Since 2001, Average %** **Chge** = **9%**

- 191.3

- 672.3

- 431.6

## Why Revenue Levels Go up & Down

_**Big Picture Impacts**_
-  National, State (Laws, Regulations, Policy)
- Coverage/Eligibility
- Payer Fee schedules
- New programs (MMA Diabetes, Part B, Part D Drugs, SCHIP)
- Medicaid Reform
- Medicare and Medicaid negotiated  rates
- MC Plans/Networks
- Tribal Self Insurance
_*>>>LESS CONTROL>>>*_

_***Business Process Investments***_* *
*that optimize 12-15 steps in 3**rd** Party revenue  Business Process (Rev Cycle)---ROI*
- Enrollment in Alt Resources
- Provider Documentation, Coding, Data entry
- Accts. Receivable Follow-up
- Facility Capacity, space, equipment
- IT Support & improvements ie., user support, capturing all CPT Procedures
- Training to Incr Knowledge, Skills and Abilities ie. “Partnership”
- Access/Alternate Resource Enrollment
- Return on Investment Mgt Mindset
_*	*__*>>>>>>MORE CONTROL>>>>>___*_

## Revenue Cycle/Business Process/Key Functions?

- Triage (check-in)
- Patient Registration, admissions Appointments
- Third Party Benefits Coordination
- Documentation of Provider Services (including Ancillary)
- HCPC Coding
- Data Entry
- Accurate Billing
- Timely Collections
- Accounts Receivable—Denial Management
- Medical records
- Financial Management
- SU Leadership/Management
- Systems Development

## 2004 OBLIGATIONS, Third Party Revenue

**2004 OBLIGATIONS, Third Party Revenue**

## Annual Percent Chge in IHS  Collections, 1995-2004

## SUMMARY OF COLLECTIONS 

- Big Picture Impacts and local Business Process impacts collection levels-- +  or --
- By analyzing 3P BP we know what effects our revenue levels---given trends on flat appropriations, minor rate increases, focus must be on BP improvements
- Collections % Increase is greater then rate % Increases
- OVERALL, not substantial changes in rates in past 3 years; as IHS completes cost reports in 2006 at all facilities the rates will continue to stabilize.

## Program Break-Out

- Key Information specific to your program.
- Opportunity to Ask Questions
- Pick your brains via the planning
- Best Practices
- Problem Areas
- Recommendations
- Top Training Recommendations

## Slide 13

## Cascade of IHS 2006 Performance Objectives

**DBOE will be reporting on**...
- Requirements for 100% Accreditation of Federal Facilities
- A 3% increase in third party collections or.......
- Implementation of Third Party Accounts Mgt. and Internal Control Policy
- ROM, Revenue Operations Manual
- Medicare Part D enrollment

## 2006 Priorities/Action Items

- Management of Third Partly Revenue for IHS
- 2005 Cost reports to be completed at all 46 hospitals & 10 Areas to set 2007 M & M rates
- Assess CAH pros and cons—at least 1/3 applicable to IHS hospitals
- National Partnership Training---Medical Records, CHS and Business Office Partnership Training April 17, 2006 in Reno, NV.......8 years running—User Focus!
- Leadership/Management Training---101 in past, in 2005 CEO/BOM, in 2006 Third Party & Internal Controls
- Revenue Operations Manual, ROM, 2006
- Development/Implementation of PAMs software

## 2006 Priorities/Actions

- Workgroups on patient registration, 3rd Party Billing & AR, Reg,Revenue Operations Manual,
- Training on Third Party Internal Control policy
- PAMs Training/implementation
- MMA Medicare Part D Prescription Drug Benefit, 1/2006---May 15, 2006
- HQs Mgt Control focus...Accreditation Status, Accounts. Rec Mgt, Internal Control Policy, BMP/Commissioned Officers Payment Chge
- Part B FI Training, ie., “Putting it all Together”

## 2006 Priorities/Action Items

- Laws, Regs and Policy reviews ie., Medicaid Reform in 2006, Medicare Chges
- Tribal Technical Advisory Group & NIHB Medicare and Medicaid Policy Committee
- Support to InterAgency Agreements ie., CMS
- Controlled Correspondence

## BO and IT Projects

- PAMs...integrates 3rd billing and AR
- Pt Reg 7.1
- 3M bi-directional interface
- BO TAG workgroups
- POS
- MNT, DMTS, PT/OT, DME, MTM
- POD
- UFMS
- Part D
- MORE later.......

## IHS AND TRIBAL SPECIFIC MMA PROVISIONS

- Sec 506--- Requires Mcare participating Hosp to accept Medicare Like Rates for CHS payment for Hospital services.
- Sec 1011 Authorizes IHS to share in Federal reimbursement for emergency services provided to undocumented persons.
- Sec 630 Provides Authority for IHS to be paid for all Part B Services, 5 yr. limitation, effective, 1/1/2005--excludes home health care

## IHS MEDICARE BENEFICIARIES, 2005

- Total	115,558  3-YEAR ACTIVE USERS
- 65+					95,293 (82.5%)
- Mcare/AB				36,074
- AB/Mcaid				30,184
- AB/PI				30,709
- Mcare AB,PI,& Mcaid	 	7,126
- Mcare A			 	4,089
- Other		 	  	 7,376

## IHS ACTIVE USERS, 2005

- ACTIVE USERS*		Percentage
- 	Mcaid		402,093		28%
- 	Mcaid &PI		139,776		9.7%
- 	Pvt Ins		348,656		24.3%*
- 	NO Ins		417,478		29.1%
- 	Mcare		115,558		 8.1%
- 	Vet Only		  12,452		.87%
**	****TOTAL USERS ****	****1,435,993**		100.00%
- 	*3-YEAR DATABASE	(Adj Annual 3-yr active users @ 85%, *PI 50% not billable, Data non-official, need SU level comparison)

## IHS Eligibility, 1.435 Million Users  2005 

- IHS Eligibility, 1.435 Million Users  2005

## 2003 IHS Total Eligibility Categories By % 

## Management  Actions”Back to the Basics”

- Need SU plan 3rd party revenue generation
- Develop SU committees to evaluate and manage 3rd party business  process/issues
- Set revenue targets, establish Mgt reporting requirements, identify clinical and other improvements as a result
- The right investment in the business process will pay for itself—”Return on Investment Mindset”
- staffing, equipment, training, contracting, IT improvements, facility mods
- Recognize that training is key to building skills to  optimize third party revenue collections and compliance

## More Nuts and Bolts Management

- Connect with other IHS facilities to share Business Process innovations---avoid reinventing the wheel***....... “Duplicate Best Practices”***
- Appoint staff to stay abreast of Federal/State/ Private Managed Care Initiatives
- Support Information System development
- Pt Regis........Billing......Accts Receivable
- Third Party Accounts Management and Internal Controls implementation plan