ProActive

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Pro-Active
Revenue
Solutions
Your Pre-Bill solution to Revenue Cycle
Management
Un-billed Recovery
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Our Goal
Our goal is to analyze your system and processes
to identify problem cases/claims that impact your
bottom dollar. We will provide reports,
containing data that would enable us to identify
those problem cases and to track trends in your
claims processing. With problems and issues
identified, we will resolve on-going or
potential lost revenue for an institution.
The solutions we offer will help rectify and
stabilize the ever changing processes in the
healthcare industry, that cause costly billing
delays.
Let us show you the difference we can make, and
what separates us from other consultants that
claim they can help increase your revenue.
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What is the un-billed report ???
DNFB (Discharged Not final billed) MER
(Missing Elements for billing) OER (Outpatient
Exception Report) Alpha-di (Inpatient Discharge
Report) Many others
Named
Depending on the size of the hospital, this
report may contain between 2.5 Million to 18
Million in un-recovered or waiting to bill
revenue for your facility.. more importantly,
it contains revenue your institution cant afford
to lose.
The DNFB report is by far, the MOST misunderstood
financial report generated from your billing
system.
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What does the DNFB report contain?
Eye Ball View
All cases/claims that contain charges and that
have been discharged from your hospital system
(ie. Patients services are completed) but have
NOT been billed.
At A Detailed View
Contains cases that are months, even years,
old. Contains cases that may carry a individual
balance of over 20,000. Contains cases that have
passed their filing deadline. Contains cases that
contain all the information to bill but were
stopped due a system interface
issue. Contains duplicate cases for the same date
of service (one case was billed but the
other was not). Contains cases where services
were NOT rendered. Contains cases with charges
that belong on another case that has
already billed. Many many others
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What SHOULD the DNFB report contain?
All cases that have been discharged in the last
thirty days ONLY. There should be minimal cases
in your over 30 day post discharge, and there
should be NO cases in your over 60 or 90 day post
discharge bucket.
Of those cases that should be on the report, the
total outstanding balance on the report should be
no more than FIVE days of your facilities Days in
AR.
REALITY
IDEAL
Increasingly more difficult to recover
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What SHOULD the DNFB report contain?
One day in AR 700,000

7 Days
4.9 Million
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What SHOULD the DNFB report contain?
One day in AR 700,000

7 Days
4.9 Million
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What SHOULD the DNFB report contain?
One day in AR 700,000

10 Days
7.0 Million
Do you know what your DNFB balance is? Do you
know how much of that balance is over 10 Days in
AR? Do you know how much of that balance is
sitting in your over 60 day aged bucket?
Unbilled charges over sixty days old is like
delivering patient care for FREE.
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What SHOULD the DNFB report contain?
All cases that have been discharged in the last
thirty days ONLY. There should be minimal cases
in your over 30 day post discharge, and there
should be NO cases in your over 60 or 90 day post
discharge bucket. Of those cases that should be
on the report, the total outstanding balance on
the report should be no more than FIVE days of
your facilities Days in AR.
All cases that have been discharged in the last
thirty days ONLY. There should be minimal cases
in your over 30 day post discharge, and there
should be NO cases in your over 60 or 90 day post
discharge bucket. Of those cases that should be
on the report, the total outstanding balance on
the report should be no more than FIVE days of
your facilities Days in AR.
Why?
When a patients services are rendered, there is
a typical three day system bill hold to assure
all paperwork is completed and forwarded to
medical records to code and bill. This also
allows ample time for all charges to be entered
into the system before the claim is
generated. There is an additional two day
allowance for reasonable backlogs and chart
analysis. In reality, all cases should generate
a bill by the 5th day.
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How can I tell if my DNFB is a problem?
If you can answer yes to any of these questions,
you should have your DNFB report evaluated for
multiple process trends or problems.
Do you have cases on your report that are over 60
days old? Do you have cases on your report that
are over 30 days old with balances greater than
5000? Is the balance on your report greater than
10 days in AR? Do you have cases on your report
with negative balances? Do you have multiple
cases for the same patient on your report? Do you
have large quantities of cases with the same
service code? Do you have quantities of cases
with the same date of discharge? If you have an
assigned DNFB recovery staff member, do they
attack the report by high dollar cases and older
cases first?
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Typical Patient Path
Clinic Charge 65.00
Venipuncture 8.00 Chem 8 Lab
45.00
Total Clinic 118.00
Ultrasound 650.00
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Typical Patient Path
Clinic Charge 65.00
Venipuncture 8.00 Chem 8 Lab
45.00
Total Clinic 118.00
Ultrasound 650.00
768.00
768.00
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Typical Patient Path
Clinic Charge 65.00
Venipuncture 8.00 Chem 8 Lab
45.00
Total Clinic 118.00
Report not received in HIM - not coded
Ultrasound 650.00
768.00
118.00
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Typical Patient Path
Clinic Charge 65.00
Venipuncture 8.00 Chem 8 Lab
45.00
Total Clinic 118.00
Ultrasound 650.00
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Typical Patient Path
Clinic Charge 65.00
Venipuncture 8.00 Chem 8 Lab
45.00
Total Clinic 118.00
Ultrasound 650.00
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Typical Patient Path
Clinic Charge 65.00
Venipuncture 8.00 Chem 8 Lab
45.00
Total Clinic 118.00
Ultrasound 650.00
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Typical Patient Path
Clinic Charge 65.00
Venipuncture 8.00 Chem 8 Lab
45.00
Total Clinic 118.00
Ultrasound 650.00
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Frustrations of the DNFB Report

• Each case has a different story to tell

Different patients Different TYPES of patients
Different points of entry into the hospital
system Different paths the patients take when
discharged Different areas of treatment differen
t policies and procedures different
staff different turn over of staff (learning
curve) different outcomes of patient
care Different paperwork and different
departmental systems that feed information
into your main system Different days of the
weekdifferent shifts with different
employees that perform similar tasks differently
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Frustrations of the DNFB Report

• Each case has a different story to tell
• All the cases on the report DO NOT just need
• diagnosis or procedure codes applied to drop
  the bill, even though
• that is what it appears.

Groups of cases, such as mammograms, may be in
abundance on the DNFB report, and the dictations
can easily be printed and coded. But what
is the root cause that the individual cases
werent coded in the first place? Where did the
dictation end up? Majority of the cases in the
60 day or older bucket of the DNFB report have a
Non-HIM issue that needs to be resolved. If it
is a legitimate case that truly only needs
diagnosis/procedure codes to bill, it is likely
it was coded but the codes didnt cross the
interface, or the record wasnt received in
HIM to code, or the case was received, but
removed from HIM prior to coding. None the
less, a procedural or process problem exists and
needs rectified.
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Frustrations of the DNFB Report

• Each case has a different story to tell
• All the cases on the report DO NOT just need
• diagnosis or procedure codes applied to drop
  the bill, even though
• that is what it appears.
• There are multiple paths a patient record can
  take, and
• some are unknown by the medical record
  department.

STACKS of loose sheet dictation, emergency room
records, and complete patient charts have been
known to be found In the trunks of residents
cars In lockers of employees In wastebaskets,
paper bags and in backpacks Intermixed in other
patients charts on the nursing units Hidden by
nurses to finish their nursing notes the next
time they work
At the facility where the patient was
transferred to (including the
morgue/mortuary!)
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Frustrations of the DNFB Report

• Each case has a different story to tell
• All the cases on the report DO NOT just need
• diagnosis or procedure codes applied to drop
  the bill, even though
• that is what it appears.
• There are multiple paths a patient record can
  take, and
• some are unknown by the medical record
  department.
• System issues and interface problems are not
  apparent by
• viewing the report. Intermittent problems are
  not identified
• or monitored by most IT departments.

It is very common for intermittent interface
problems, or better known as burps in the
systems. These types of burps can stop a
handful of records from generating a bill. If
the record was re-sent, the claim would
generate. Standard mainframe or system upgrades
do not take into an account of all interfaced
products to that system and the impact of the
upgrade to the unsupported software. Upgrade
testing only takes into account those systems or
software products interfaced to the mainframe
that are supported by the mainframe vendor.
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Frustrations of the DNFB Report

• Each case has a different story to tell
• All the cases on the report DO NOT just need
• diagnosis or procedure codes applied to drop
  the bill, even though
• that is what it appears.
• There are multiple paths a patient record can
  take, and
• some are unknown by the medical record
  department.
• System issues and interface problems are not
  apparent by
• viewing the report. Intermittent problems are
  not identified
• or monitored by most IT departments.
• No single department is to blame for the number
  of cases
• that have not been billed.

Even though this is a patient accounting
financial report, due to its misrepresentation,
the HIM (Medical Record) department is typically
assigned to recover the outstanding or aged
cases. HOWEVER, this report is actually the
responsibility of the registration department,
clinics, ancillary departments, nursing units,
emergency room, physicians, technicians, nursing,
and patient accounting responsibility as well.
Each departments processes play a part in EVERY
claim that is generated. If a claim does not
generate, a mistake was made or someone dropped
the ball.
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Frustrations of the DNFB Report

• Each case has a different story to tell
• All the cases on the report DO NOT just need
• diagnosis or procedure codes applied to drop
  the bill, even though
• that is what it appears.
• There are multiple paths a patient record can
  take, and
• some are unknown by the medical record
  department.
• System issues and interface problems are not
  apparent by
• viewing the report. Intermittent problems are
  not identified
• or monitored by most IT departments.
• No single department is to blame for the number
  of cases
• that have not been billed.
• Even when the DNFB report is cleaned up and the
  balance is being
• maintained, changes or updates in systems,
  departments, and
• processes, can potentially have a negative
  and dramatic effect on
• your DNFB report . without warning.

Clean up of the DNFB report is challenging but
possible. Maintaining and continually monitoring
the DNFB report is a necessity to the consistency
of your Days in AR.
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Frustrations of the DNFB Report

• Each case has a different story to tell
• All the cases on the report DO NOT just need
• diagnosis or procedure codes applied to drop
  the bill, even though
• that is what it appears.
• There are multiple paths a patient record can
  take, and
• some are unknown by the medical record
  department.
• System issues and interface problems are not
  apparent by
• viewing the report. Intermittent problems are
  not identified
• or monitored by most IT departments.
• No single department is to blame for the number
  of cases
• that have not been billed.
• Even when the DNFB report is cleaned up and the
  balance is being
• maintained, changes or updates in systems,
  departments, and
• processes, can potentially have a negative
  and dramatic effect on
• your DNFB report . without warning.
• It could require up to ten different departments
  and the combined
• knowledge of their areas, to investigate and
  analyze one or more
• cases on the DNFB report.

Do you have those resources and the time of those
resources?
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Frustrations of the DNFB Report

• Each case has a different story to tell
• All the cases on the report DO NOT just need
• diagnosis or procedure codes applied to drop
  the bill, even though
• that is what it appears.
• There are multiple paths a patient record can
  take, and
• some are unknown by the medical record
  department.
• System issues and interface problems are not
  apparent by
• viewing the report. Intermittent problems are
  not identified
• or monitored by most IT departments.
• No single department is to blame for the number
  of cases
• that have not been billed.
• Even when the DNFB report is cleaned up and the
  balance is being
• maintained, changes or updates in systems,
  departments, and
• processes, can potentially have a negative
  and dramatic effect on
• your DNFB report . without warning.
• It could require up to ten different departments
  and the combined
• knowledge of their areas, to investigate and
  analyze one or more
• cases on the DNFB report.
• Many, many others

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Why use Pro-Active Revenue Solutions?
We can see the global picture.
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Why use Pro-Active Revenue Solutions?
from the time the patient arrives at the
hospital.
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Why use Pro-Active Revenue Solutions?
to the different types of documentation
obtained from the medical staff.
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Why use Pro-Active Revenue Solutions?
to the different charges the patient acquires
during their stay.
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Why use Pro-Active Revenue Solutions?
to the time the patient is discharged from the
hospital.
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Why use Pro-Active Revenue Solutions?
to the completion of the record, the coding of
the record.
CPT
DRG
ICD
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Why use Pro-Active Revenue Solutions?
to the billing of the record.
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Why use Pro-Active Revenue Solutions?
to the point when payment is received from the
insurance company.
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We can offer you our global knowledge in areas
of registration, patient care, auditing, coding,
medical records, and patient accounting. Through
our experience, we have learned that seeing the
global picture from admission to reimbursement,
gives us the complete knowledge to identify and
analyze unbilled cases easier than independently
working departments on their own. We also have
the experience of evaluating various other
institutions and have seen similarities, as well
as common resolutions to help them lower their
write-offs and collect on possible untimely
cases. We can do it for you..let us show you
how
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High End DNFB Breakdown
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Plus Quantified Analysis Detail by Service Area
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Weekly compare reports to show progress..
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Pro-Active Revenue Solutions, Inc
27100 Oakmead Dr. Suite 313
Perrysburg, Ohio 43551
(800) 691 - 0450
www.PARS-Inc.com
Chief Officers
Barbara Allgire
James Takas