Operational Process Review
ACE has experience with many engagements that evaluate and assess the current charge capture, coding and documentation review for the anesthesia services for a particular client. This review encompasses the entire revenue cycle and the associated documentation that is used to support patient care, billing and collection and will include reviewing your associated documentation related to:
1. Each of the facilities that provide patient services
2. Validation of the anesthesia record at each location
3. Review of the documentation and comparing this to the billing record
4. Review of the concurrency calculation process in the system
5. Review of employee actions to correct deficiencies and the reconciliation process
6. Review of work flow tracking and metrics utilized for the revenue cycle
Methodology for Process Reviews
We have extensive experience in reviewing anesthesia practices in hospital, university, ambulatory surgery, private practice and pain management settings. Our experience has taught us to segment engagements into a multiple step approach. We recommend this engagement be arranged under a simple scope that is circular in nature. We recommend performing a high level process review followed by a series of focused process audits on each phase of the revenue cycle. The review would focus on verifying and documenting the current process and the audits would follow the following general format:
What do I do?
How well do I do it?
How do I know I do it well?
Step One: Review the Process: The Process Review would evaluate the current revenue cycle process from the capture of charges through the collection and reporting of revenue. The primary focus of this step is to determine the efficacy of the revenue cycle processes and the ability to adapt to anesthesia industry standards. This would include a review of the roles and responsibilities of work groups throughout the revenue cycle. Recommendations would be developed for baseline performance standards and operational review reporting in addition to documentation of the overall work flow and work group responsibilities.
Step Two: Assessment of the current operations: In a series of quarterly reviews, ACE will conduct process audits to assess how the processes are currently performing and identify recommendations for improvement. The recommendation is to identify and work on one function in the revenue cycle at a time.
ACE will address the following functional areas of the revenue cycle:
• Charge Capture
• Insurance Filing and Statements
• Payment Posting
• Collection Efforts
• Financial Reporting
ACE will evaluate current Process Metrics: This step examines the indicators that identify how well the process is performing. We start with any measurements or log sheets you are currently using and then review and recommend other key performance indicators. ACE would review your weekly operations data, partner accountability data, and staff performance measurements. ACE would look for duplicate or inconsistent work and develop recommendations to improve the work flow and process management.
ACE will evaluate comparison measures for ongoing Process Metrics: This step encompasses identifying comparable process measurement data from published national statistics from sources like MGMA. ACE would recommend key performance indicators by process and a review process for the management team to manage ongoing process improvement.