Webinar Recording: Confidence in Compliance and Efficiency

WEBINAR TRANSCRIPT

Welcome, everyone. We're excited to have you here today, for our webinar with SimiTree and WorldView talking about confidence and compliance and efficiency.
 
Just so everyone is aware, the the chat feature is open. So if you have any questions as we're going through the webinar, feel free to leave them there, and we can, address them at the end. This is also being recorded, so you will get a link to the webinar once, it's completed.
 
So we're excited to have you join us for today's discussion on how health care agencies can improve efficiency and financial stability through better document management and workflow automation.
 
So I'm Chelsey Heil, head of marketing at WorldView, and I'm joined today by Nick Corbi, Senior Manager of Financial Consulting at SimiTree. Nick, thanks for being here today.
 
Thank you so much, Chelsey, and hello to everyone. Thank you for joining. Really excited to join this group and excited to embark on this presentation together.
 
So let's start by setting the stage. What's holding health care agencies back from being more financially stable and efficient?
 
So before we jump into solutions, I just wanted to take a quick look at what's happening across the industry today. So ninety percent of healthcare leaders say that revenue cycle inefficiencies impact their bottom line.
 
Seventy percent of providers report that documentation delays contribute to that revenue loss. And fifty percent of health care organizations say they lack staffing resources to manage compliance and billing effectively.
 
So that means that agencies are struggling to keep up and leading to lost revenue and potential compliance risks.
 
You're you're exactly right, Chelsey. And, again, agencies, they're not just dealing with growing regulations, but also a combination of staffing source shortages and process optimization or really a lack of understanding of how certain processes and documentation management should be found. The result is delays in billing, increase in denials as of improper documentation and leaving a lot of dollars left on the table that need that need to be achieved and maximized.
 
Absolutely. So how much revenue do you think agencies have sitting in limbo due to the delays in documentation?
 
Right. So the biggest piece is when we take a look at the real impact of documentation delays, we take a look at unbilled AR issues, unsigned unsigned orders problems and how it relates manual processes that are straining the staff and then the compliance risks as a result of that. We go back up to the unbilled AR, on average fifteen percent to twenty five percent of healthcare organizations' monthly revenue sits in an unbilled AR due to documentation gaps, not to mention all the other normal unbilled holds that could occur within a system. So if our documentation delays are higher than average, that greater impacts our overall unbilled AR in the negative.
 
The unsigned orders problem on average, potentially up to thirty percent of physician orders remain unsigned beyond thirty days. Thirty days from that initial date of that order. Right? So that's not thirty days from the period for all of the orders from the initial date.
 
So if we're not having real tangible steps in place to make sure that we are achieving those signed orders right on in the early stages of that order creation, that leads to that piece there. These manual processes due to a potential lack of automated process leads to a prolonged administrative burden and which leads to be a top cause of burnout for around sixty percent of healthcare professionals.
 
And then compliance risks, CMS has increased audits on improper documentation with around forty percent rise and take back through the missing or incomplete physician orders. A lot of insurances are doing a lot of reviews as a result of some of these some of these strains and gas and process, which results in take backs as we were mentioning. So all these pieces are the true impact of documentation delays that these processes are not presented and have a strong foundation.
 
Exactly. And we're not just talking about minor delays. These are real financial risks.
 
Unbilled AR and unsigned orders don't just slow down the reimbursement period. They impact your ability to invest in patient care and grow your agency.
 
Right.
 
So why is this a bigger issue today than ever before? So claim denials have risen twenty percent in the past year and a half due to missing or incomplete documentation.
 
Inefficient billing leads to the three a three to six percent revenue loss per provider, which is a major hit in an industry already operating on slim margins.
 
And so what we want to get to is the answer here. Right? So agencies that automate those document management and billing workflows see a seventy seven percent improvement in efficiency and a ninety percent reduction in time spent processing documentation.
 
Exactly. So what what do these numbers tell us? Right? The bottom line is if agencies want to either achieve financial strength, stay at financial strength, or work toward financial strength, they have to tighten up documentation processes now and not later.
 
So we're gonna talk a little bit about what if there was a better way to manage documentation and reduce, reduce unbilled AR.
 
So this is where WorldView and SimiTree come in. Together, we're kind of providing a seamless approach to document management, workflow automation, and financial optimization.
 
So WorldView, we specialize in referrals and orders management. So in ensuring that that documentation is processed not only accurately, but in a timely and efficient manner.
 
Documentation and compliance. So tracking and managing essential paperwork to keep agencies ready for audits at any moment. And then reports and analytics. So giving teams the visibility they need to improve workflows and cash flow.
 
And then on the next slide is you'll see where does SimiTree come into play here in partnership with WorldView, and then just in general is what we really bread and butter from a consultative standpoint where we sit.
 
Offering of a personalized assessment of your documentation management process for actionable insights. Again, we like to take a collaborative approach of these four areas that you see listed on this on this slide here, and ultimately that combined with subject matter experts in partnership of understanding what an effective and optimized process should look like, assisting with the agency to maximize the cash flow, conducting analysis of operations and really diving into the data and the staffing levels to see if volumes are adequate for success even if a successful process is put in place.
 
Of that process, what is the optimization for prioritization including submission and follow-up protocols? What are the set timelines that we identify for certain milestones along that orders documentation process? And then from there, improving billing workflows tied to WorldView's document tracking in partnership of what can be provided here. Through the analysis of the data and interacting real time with pivotal members of the agency, we uncover impactful findings that lead to implementation and process optimization efforts for overall financial success related to document management.
 
Thanks, Nick.
 
So what this means for agencies in real time. Right? So driving financial and clinical success.
 
With with what word am I trying to say?
 
With timely and accurate billing. So organizations leveraging WorldView have seen a ninety percent reduction in time spent processing documentation, which leads right back to, trying to minimize that staff burnout that we talked about earlier. And then intake processing has improved by seventy seven percent, allowing quicker patient onboarding.
 
Orders can now be turned around in as little as two days, shortening that time to care. And, additionally, referral processing time gets cut down to an average of just thirty seconds, making sure that we're accelerating care coordination and patient access to services.
 
Right. And we're that's absolutely right, Chelsey. And then what SimiTree has been able to showcase through work and effort of these partnered assessments together and implementation optimization is a reduction in overall unbilled AR to the industry benchmark of ten percent of your average monthly revenue. And then from there, reduction of unsigned orders to orders volume to ten percent over thirty days compared to that higher average of thirty percent across the industry that we're seeing. We're able to have over a twenty percent reduction in both of these areas leading to overall financial sustainability and improvements as well as billing efficiency as well.
 
And then on our next slide what we'd really like to talk about is documentation management and some of the common issues that are really kind of seen across this. Delays in plan of care and the four eighty five is being completed. So delays in obtaining authorization for required payers, delays in getting orders sent and back timely. So that delays in billing, which delays in cash flow and potentially bad debt if not billed out timely or when we bill out not getting the sufficient data.
 
Misidentification of the MD following the patient. So this is really critical at intake and identification to determine if there's a delay in the PCP, if it agrees to that agrees to follow. If that is not kept up to the bargain, it delays in billing. So that identification of the MD that is filing a patient at the very initial point of referral review is very pivotal to success in the documentation management chain of command.
 
And then also unknown billing requirements, holding claims that do not require unsigned orders. Is there something in the system that is showing it's an order hold when when it actually isn't an order hold, but it's not showcasing internally within the system? And that follows in turn to lacking lack of updating or reviewing physician directory in the EMR. It causes orders to be sent to incorrect fax numbers in MD offices.
 
Overall, I wanted to add in that there are agencies that if there is a failure to establish a sound process with set sets of current of certain milestones in that life cycle of orders management, these common issues are what really come to light in terms of billing and billing efficiency and financial success or lack thereof.
 
So what are the solutions that we can find here is through follow-up, really working to establish a sound process with the data that we are gathering from the EMR and in partnership with WorldView and also really tracking and how we're organizing the orders follow-up, assessing how large your orders follow-up team is. Is there someone with a set designation for orders follow-up? Or is it another member of the team that this is part of their job? And if they're not able to balance that workflow based off physician volumes, that is something that needs to be assessed as well.
 
So we like to group orders by we always recommend to group orders by physician when completing tracking to reduce the follow-up efforts needed rather than grouping by patient. If you group by physician and they have multiple patients with unsigned orders, you can follow-up with that physician real time and knock out all of those outstanding patient documents at once when communicating with that physician or their office.
 
Following up on unsigned orders every seven days via phone and or refax, Would always like to recommend both if possible, and then recommend calling within seven days to ensure the correct physician and contact information. We talked about that misidentification on the prior slide. If that is not identified early on in the process, it prolongs the issue where there is a smaller window of success in obtaining that real time signature in a timely manner. And then also utilizing sales and marketing staff with positions for unsigned orders aged over thirty days. And then lastly, leveraging third party documentation management vendors to aid in sending, re faxing and checking orders back into the EMRs.
 
And then some further solutions is we want to identify, determine, implement, and conduct. So with identify identify which payers require signed orders and set billing rules accordingly.
 
Determine which orders require signature determine which orders are requiring signature, and then implement a verification step to ensure the MD will follow and sign orders to prevent delays and refusals in fighting.
 
Conduct an audit and an annual biannual an annual slash biannual or needed basis to ensure MD information is correct. Cannot stress how the importance of tracking and gathering that appropriate ensure MD information is to the success in documentation management.
 
And then overall best practices, you know, as we stated prior in this presentation, as you see on this slide, the industry benchmarks and the goals that we have for unbilled AR, average days through signature for orders and percentage of orders aged over thirty days for the order date, Through this set improvement and capabilities of SimiTree subject matter experts and the subject matter experts at WorldView, these proven methods are attainable with agencies that really work to identify where gaps and areas for opportunity in existing documentation processes fall and what that gap and disparity is to reaching industry best practice and optimization of the process workflow related to documentation management.
 
Awesome. Thank you, Nick.
 
So how can you start making some of these improvements that Nick, went through with you today?
 
So we have created the Stronger Together bundle. So when you sign up for WorldView, you're going to get six months of these different services to try out and see how they work within your system and how having Worldview to kind of plug them all into your EMR, is going to end up with smoother workflows, faster reimbursements, and more efficient patient care.
 
Specifically with SimiTree, they're giving a free assessment of your current workflows and processes for document management, which is great so that you can get all of those best practices into play, and make sure that you're really experiencing the benefits of, of this fully connected ecosystem that we're kind of suggesting for you.
 
Now is really the time to make your agency more efficient, more connected, and more prepared for the future.
 
So that kind of wraps up our discussion. Oh, go ahead, Nick. Sorry.
 
I was just gonna say absolutely and just can't reiterate that enough. I think it's all the points that Chelsey had stated there, it's very integral and important to embrace where change may need to be made in certain areas where assessing can we be better in certain areas and understanding where that gap is and understanding the partners that can be utilized for that overall success and long term financial financial sustainment.
 
Awesome. So we have some time for questions. If you have your any that you'd like to ask, you can drop them in the chat, and we'd be happy to, answer them for you.
 
Let me look here if any have come through. Okay.
 
So what metrics should agencies take to track and manage and build AR more efficiently effectively?
 
Yes. Of course. So for overall unbilled AR, we really wanna track first of all, we we wanna assess how we're aging our AR. Right?
 
So always going to recommend that you age your AR in the system by the last claim date of service on the billing period. Right? The reason why we do that is because that's where majority of that timely filing for these payers is based off of is that last is that last through date on that claim starting claim through date period. And from there, unbilled AR over thirty days is where we wanna have our barometer or our benchmark.
 
Right? You'll notice prior in this prior in the slideshow, what we had talked about was on bill AR over thirty days and how what is that percentage. We want that to be no greater than ten percent of your average monthly revenue. Now that might seem like a lofty number to start.
 
Understanding what is leading to your AR percentages at a higher rate if they're not already being tracked in that regard is what is crucial to determining what level of improvement can be found in that percentage from a pacing standpoint. So for example, we wanna track the factors that are leading to unbilled. Is it is it outstanding orders? Is it unverified visits?
 
Is it lack of signatures in the plan of care and the forty five that we talked about before? What are those particular reasons in tracking your unbilled AR in thirty in in a zero to thirty bucket, sixty one in a thirty one to sixty, sixty one to ninety, ninety one to one eighty, and then a one eighty one to three sixty five and three sixty five plus. You wanna have all of those aging buckets for all of your AR, but overall that AR unbilled AR over greater than thirty days, that is our true benchmark that we always recommend for tracking your unbilled AR in comparison to earned and unearned revenue at that point in time.
 
Thanks, Nick.
 
So how does WorldView help reduce unsigned orders and order delays? So I will start this off.
 
So within WorldView, you can configure your work flows to what works best. And this is where Symmetry comes into play. So Symmetry can give you guidance on what we should be looking for, and then Worldview can go in and set up triggers to refax, send emails, send messages to your internal team to make sure you're doing those calls.
 
So, really, it's that combined effort of symmetry looking at best practices and us setting up the workflows that then put those best practices into into action.
 
Did I leave anything out there, Nate?
 
No. I think you covered it. I think system system set up from the very beginning is so crucial to this, not just with and it's it starts internally with it starts internally within the the EMR, but also that external assistance that WorldView can provide really is what continues to set agencies ahead of the curve in terms of their partnership and their technological advancement and how that's just so important in today's in in to in today's industry that that we find ourselves in.
 
So another one just popped up. What's the impact on compliance risk if we if our documentation billing isn't as efficient as it could be?
 
Of course. I mean, if if we go if we go just back to the one slide where it talks about the real impact and documentation delays, so there is as a whole, EMRs and other payers and things of that nature, they're they're conducting internal audits on a more frequent level.
 
So if we do not have a sound in the off chance that that would happen, the risk of a potential take back as a result of improper documentation management is at a higher percentage than what it would be if our processes are sound in terms of what we're gathering. I think it really kind of stems back to misidentification of physicians from the very beginning.
 
And when we're sending out documentation to the incorrect physicians and then having that back and forth discussion of we're conducting services there, that is what leads to a potential compliance risk as a result of that, which is why we need to make sure that we are gathering the appropriate information real time at the very beginning of point of referral.
 
And then valid having a set process in place to validate that information that is gathered from the initial point of referral.
 
Having your clinicians follow-up, making sure that they're confirming making sure that they're confirming the actual PCP on file that is following the patient so that we can validate and we can validate our documentation efforts that we sent out. And this way, we know if something is not being signed. It's not as a result of an incorrect position. It's a result of another potential reason that could be out there where they prefer they prefer efaxes. They as opposed to as opposed to someone driving and bringing the documents to them. There's a lot of different ways. But overall, sound processes in general lead to a a lesser risk of compliance issues down the road.
 
Perfect. I think we have time for one more. So the last one that I see popping up here. Okay.
 
What kind of internal audits or checks should agencies perform to prevent backlogs?
 
Yep. Absolutely.
 
Regularly every a minimum every week, revenue cycle or front end revenue cycle leadership should be running a report to determine your total outstanding orders and then aging out from the order date from there. Because that breakdown in that report, at a minimum weekly, we'll be able to identify where the orders sit from an aging breakdown. What is your percentage of orders greater than thirty days? And then by how many physicians is that percentage contributing to?
 
Another way to do that is also making sure that you have your physician list and directory up to date. Right? So on average, from a staffing perspective, we've we've we've found that a successful document orders management position can handle orders for roughly around two fifty independent positions. Right?
 
So if there's orders coming from independent roughly two fifty independent physicians, that is the adequate number for one full time person in orders management. If you are constantly evaluating what that list is of the current order that you are receiving, that will be able to provide to you, are we are we dedicating enough resources to this process. Also, regular that regular orders reporting coupled with a work queue that provides to your direct orders management staff or your document management staff so that they can follow and help set priority. We should always be prioritizing greatest number of oldest claims or or not claims, orders at that point in time.
 
Because if we are tracking the oldest first, we're gonna knock those off the list, which will make our overall documentation percentage aged over thirty days lesser and more close toward industry benchmark.
 
Perfect. And that's where something like WorldView comes into play as well because we have great dashboards and analytics setup where you can filter by those exact settings that Nick was just speaking about. So really the best of both worlds there.
 
Alright. I think those are all the question. Oh, no. One more popped up.
 
What would you say is the best first step an agency should take to improve billing and document management?
 
Yeah. It's a phenomenal question. And I think the first step I would say and what I've seen with it because I I've I've held I've held positions in my past where I've been a revenue cycle manager. I've been a revenue cycle director, and I'm also currently working in a room at certain agencies.
 
The first step that I always recommend to do is get a sense. And what I mean by get a sense is understand what current state of affairs is. Right? Understanding what current state of affairs is through your reporting to see where the area and point of focus is.
 
Depending on your EMR system, what level of unbilled reporting that you do you have? Not necessarily it's and and that is not solely related to dollars and cents, from an unbilled AR percentage standpoint from agent bucket, but do you have a level of reporting that can identify why certain claims are on hold and they're not able to be billed out at a point in time? Understanding what that needs to be and understanding what steps need to be taken from there based off of what current state of affairs that you're finding is. And then establishing a set routine level of reporting in unbilled AR, AR aging as a whole to compare build AR versus unbilled AR in your total in your total portfolio.
 
And then from there, maintaining that same consistent reporting practice with the varying different pieces that result in billing success, documentation and outstanding orders reporting in the system, visit closures so that revenue cycle leadership and operational leadership can partner with clinical leadership, making sure that visits are being closed timely and documents that need to be signed by the clinicians need to be signed in a timely manner internally within the agency as well. Does that make sense?
 
Absolutely. Yep. Thank you so much, Nick.
 
You're welcome. Okay. I think those are all the questions.
 
Again, this is being recorded, so we'll send it out later.
 
And if you have any additional questions or wanna hear more about Worldview, SimiTree, the Stronger Together bundle, we'd be happy to chat with you and hear more about your agency, what they're going through right now, and how we can better assist.
 
Thank you again, Nick, for being here. I appreciate you. Have a great day.
 
Appreciate you as well, Chelsey. Thank you for organizing. Have a great day, everyone.
 
Bye, guys.