MAP Award Journey Departmental Collaboration to
Improve Revenue Cycle Performance
Joseph Koons, MSA, FHFMA, CPAM
Managing Director, Revenue Cycle
August 1, 2012
Agenda
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About Centra
Financial Impact
DNFB Green Belt Project Review
POS Collections
Continuous Process Improvement
Technology & Other Components
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About Centra Health
Available Beds:
– Acute
463
– Acute Rehab
20
– Acute Psych
41
– Post Acute
447
Acute Care Hospitals:
– Lynchburg General
– Virginia Baptist
– Southside Community
Payer Mix and Hospital Demographics
Medicare HMO / PPOMedicaid Self Pay Commercial Other -
50.9%
25.3%
14.2%
5.8%
1.9%
1.8%
Admission: 26,824
ED Visits: 92,212
Employees: 5,000+
• Service Lines:
> Home Health
> Hospice
> Substance Abuse
> Mental Health
> Child & Adolescent Residential
Treatment
> Skilled Nursing
> Reference Lab
> Rivermont Schools
> Cancer Center
> Mammography Centers
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Revenue Cycle Metrics for Centra
Gross Revenue:
$1,194,866,318
Net Revenue:
$ 591,616,570
Gross AR Days:
39
Bad Debt % GR:
1.7%
Charity % GR:
3.7%
DNFB Coding:
4.6 Gross Revenue Days
Inhouse/Unbilled:
2.9 Gross Revenue Days
Cost to collect: 3.0% (HIM, CCD, Pt Access, Pt Accting)
Cash % of NR:
99.7%
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Charity and Bad Debt Trending
8.0%
7.0%
6.0%
5.0%
4.0%
•Charity Policy
•Payment options
•Statements
•Presumptive Charity
•Discounts
•SP Outsource
7.0%
7.0%
6.6%
6.4%
6.3%
5.8%
5.8%
5.5%
5.4%
5.4%
3.3%
4.1%
3.8%
2.8% 3.1% 3.1%
3.0%
2.0%
1.0%
3.1%
3.6%
4.2%
3.7%
4.1%
2.8%
2.8% 2.5%
2.7% 2.9%
2.3%
2.1% 2.2%
1.7%
0.0%
YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Charity % GR
Bad Debt % GR
Total %
Revenue Cycle Structure
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Managing Director of Revenue Cycle with Direct Reports of:
– Director, Patient Access - centralized and decentralized in16 locations
• 5 Managers, 2 Financial Counselors
• 80.42 FTE’s
– Director, Clinical Coding - centralized and decentralized in 5 locations
• 1 Manager
• 28.35 FTE’s
– Director, Health Information - centralized in 2 locations
• 2 Managers
• 56.1 FTE’s
– Director, Patient Accounting - centralized business office
• 2 Managers
• 45.68 FTE’s
– Director, Revenue Cycle Physician Practices
– IT Specialist, RAC Coordinator, and Manager Revenue Integrity
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“Courage is rightly esteemed the first of human
qualities
…because it is the quality which guarantees all other.”
Winston Churchill
DNFB PROJECT
DNFB GREEN BELT PROJECT
Scope of the project focused on inpatient (IAL & IAV) stays
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POINT OF SERVICE
COLLECTIONS
Bringing It All Together
Point of Service Collections = Financial Counseling
Local
Economy
Incentives
Training
Payment
Policy
Technology
POS
Collections
Charity
Program
Uninsured
Discount
Payer Mix
Support
Prompt Pay
Discount
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2007 – Before State
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Inconsistent upfront collections
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No automated payment posting
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Limited pre-registration
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No measurement for accuracy
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Limited insurance verification
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Chargemaster was the only estimation tool
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Estimates contract pricing non existent
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Implemented medical necessity checking and ABN issuance
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Continuous Review and Change
continuous process improvement
Process
Optimization
Elevate Staff
Communicate with Service Lines
Analyze Work Processes
Identify Barriers and System Shortfalls
Implement best practice for all work
processes across patient access points.
Hold staff accountable.
Centra continually trains staff,
implemented staff promotion path, and
paid testing for certification
Director and VP level communication with
leaders, educating front line clinical staff
Emphasis should be on any process that
continues to be manual – can it be
migrated. or does it have system
optimization potential.
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2008 – The Journey Begins…
• Collections policies and procedures created
• Senior Executive and Board approval
• Trained staff on collections policies – introduced scripting
• Completed implementation of pre-registration unit (call center)
• Introduced incentives and tied them to accuracy of registration
• Implementation of staff scorecards to include productivity,
accuracy and collections. Posted on departmental webpage
• Upgraded existing systems to include integrated payment
posting, separate estimation tool to include contract pricing
• Daily progress emails from department Director
• Rolled out process in May 2008 – Total collected $753,638
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Staff Training and Communication
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Online policies and procedures
Workflows
Role playing
Scripting
HFMA CBTs
Videos
Daily updates on departmental webpage
Training documents available on departmental webpage
Utilization of tools to enhance workflow, not encumber
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Incentives for Collections
• Annual reset of departmental
goal
• Annual reset of unit goals
• Annual resets of individual goal
• Departmental goal adjusted
monthly based on historical data
• Individual accuracy goal must be
met for payout for staff
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Incentives for Productivity and Accuracy
Example:
• Jane worked 13 shifts during month
• Her average per shift was 58 accounts
• Jane’s registration accuracy is 98%
• Jane productivity exceed standard by 23 accounts
• Productivity bonus = (23 accounts * 13 shifts) * $0.20 = $59.80
• Accuracy bonus = (23 accounts * 13 shifts) * $0.10 = $29.90
Productivity is pulled from account transactions, divided by common denominator, and
averaged against hours worked to determine accounts managed
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It all starts with registration accuracy –
REALTIME!
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Sample Daily Error Report
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Sample Scorecards
Manager
Registrar
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Staff in Access work as members of
multidisciplinary groups to improve
service scores
Departmental KPI’s are published on
webpage, open the entire
organization
Scores are shared at departmental
meetings, service areas and with
senior executives
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Tool runs estimates based
on insurance plan and
contract pricing
Estimates returned
include negotiated rates
so as to help explain to
the patient their final
responsibility
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2009 Gaining Traction
• Redefined goals, set thresholds based on historical data
• Refined scripting – provided retraining
• Focused on 1st of year deductible & out of pocket
• Added staff to pre-registration unit to increase percentages
• Estimation tool integrated in registration screens
• Refined estimation tool parameters to increase accuracy
• Continued recognition of high performers
• Total collected $1,896,240
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2009 Gaining Traction
• Redefined thresholds based on % of net revenue and potential cash
collections
• Reviewed collections in service lines and communicated with those
leaders to enhance POS collections activity
• Staff training on new financial aid programs
• Implementation of prompt pay discounts and payment plans
• Implementation of Financial Counseling for inpatient and high dollar
outpatient
• Implementation of Financial Counseling software (RevRunner)
• Refocus on inpatient accounts and balance after insurance
• Centralized staff & implemented collections in mammography
centers
• Continued to refine pre-registration practices
• Continued daily/weekly recognition of high performers
• Total collected $3,418,058
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2011 - Continuous Process Improvement
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Refined reporting tools for management
HFMA’s Map App
Advisory Board – Patient Compass
Horizon Business Insight (HBI) customized drilldowns
Further empowerment of Financial Counselors and Pre-reg
team
Referral workflows reviewed
Continued build for common procedure file in estimation tool
and continued refinement of “lookback” criteria
Revised repayment plans to include >12 months
Revised scripting to emphasize deposits toward service
Continued rule builds in FCW to enhance accuracy
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End of Year 2011 – $5,471,296
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Integration is Key
• Automated receipts
• Ability to post cash, credit
card, e-checks, and other
transaction codes as defined
• Ability to post directly from
registration screens
• Instant notification of approval
for credit cards
• Daily reconcilement report from
vendor
• Run estimates from workstation
• Directly access other tools
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What’s Next?
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eSignature for ABN’s
Patient friendly signature pads
Kiosks and Biometric security
Revisit service lines with inconsistent collections
Continued communication to the organization providing
education as to collections program and purpose
• Continue comparison to % of net revenue and cash
collections using determination of projected potential in
threshold calculation
• Use management tools to further enhance departmental
processes, focusing on patient experience
• Consistency, consistency, consistency
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