Building an automated financial clearance process
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Building an Automated Financial Clearance Process. Niobis Queiro, MBA Corporate Vice President, Revenue Cycle Hartford HealthCare Corporation Hartford, CT. Hartford HealthCare. 4 hospital system serving 63 towns in Connecticut 75,711 inpatient visits per year

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Building an Automated Financial Clearance Process

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Building an automated financial clearance process

Building an Automated Financial Clearance Process

Niobis Queiro, MBA

Corporate Vice President, Revenue Cycle

Hartford HealthCare Corporation

Hartford, CT

Hartford healthcare

Hartford HealthCare

  • 4 hospital system serving 63 towns in Connecticut

  • 75,711 inpatient visits per year

  • 2 Million outpatient and homecare visits a year

  • 280,000 ED patients per year

  • 60% of all behavioral health visits in the state of CT

  • $52 million in charity care FY 2011

  • $14 million invested in research

  • 15,000 Employees

  • 2,100 Physicians

  • $2.0B Total Revenue

Current issues facing healthcare industry

Current Issues Facing Healthcare Industry

  • Hospitals will Never Be Paid as Well as They are Today

  • Losing 7.2% on Medicare Cases, losing 14% on Medicaid*

  • Medicare Reimbursement rates declining**

  • Increasing Medicare & Medicaid population

  • Increasing high deductable plans and bad debt

  • Fee for Serviceversus Fee for Value

  • Rewards chasing revenue, not margin/quality

  • Capitation payment encourages less volume

  • Evidence Based Care Plans are needed

  • Care Delivered in Silos

  • Physicians, hospitals, providers and plans not aligned (incentives)

  • Coordination lacking inside/outside walls of hospital

  • EMR Adoption/MU requires new processes**

  • Data is housed in silos

  • Chronic Disease Patient Volume Increasing

  • Rapid increase in patients with multiple chronic diseases (CHF, COPD, Diabetes); 133M Americans have a chronic disease***

  • 5% patients = 55% of admissions, care at Medicare rates

  • Health Plans shift risk to provider. Bundled care, ACO

*Source:Modern HC 6-29-09, pg 16 MEDPAC . FierceHealthFinance, 12-15-09 **ObamaCare Impact this for Primary care Physicians. 1 – Appropriate Tort Reform when practice pattern reflects standard. ***CDC 2005 Chronic Disease Prevention and Health Promotion Report.

Traditional operating models will fail under the complexities of healthcare reform

Traditional Operating Models Will Fail UnderThe Complexities of Healthcare Reform

  • Short term:

  • Increased access to care

  • New shared reimbursed at government rates

  • Outcome risk

  • Reduced operating margins

  • On the horizon:

  • ICD-10

  • Outcomes Performance

  • Clinical integration

  • IT interoperability

  • ACO investments

  • Next generation gain sharing

  • Bundled payments

Greater Access – Reduced Reimbursement – Growing Operational Complexity

Patient access the root of much evil

Patient Access: The Root of Much Evil

  • Percent of data needed for billing originates at registration: 70%

  • National average registration error rate: 46%

  • Percent of denials that could be prevented at registration: >50%

Sources: Patient Access Resource Center: HCPro Quarterly Benchmarking Report 12/10,

Healthcare Informatics Research Series Data, NAHAM, Modern Healthcare

Cash collection curve

Cash Collection Curve

Hartford healthcare project goals

Hartford HealthCare Project Goals

  • Create an Optimal Patient Experience that Makes HHC the Provider of Choice

  • Create and Automate a Data Rich Financial Clearance Process

  • Produce Patient Liability Estimates for Transparency

  • Improve POS Cash Collections

  • Centralize Scheduling

  • Real-time Quality Assurance to empower the end-user

  • Enable Field Level Registration Edits

  • Link patient Access Errors to Denials and A/R Liquidation

  • Provide structure around E&B and Authorizations

  • Establish a Partnership with all HHC providers and assets

Hartford healthcare flashback 18 months

Hartford HealthCare: Flashback 18 months

  • No patient access standardization

  • Variable financial clearance process

  • No centralized scheduling

  • No patient liability estimates

  • < $1M/Yr in POS cash collections

  • No registration quality edits

  • No link between access & denials

  • IT patchwork across 4 hospitals

Current state hartford healthcare patient access

  • Address

  • Validation


Current state:Hartford HealthCare Patient Access

  • ATB Data

  • Centralized Scheduling

  • ADT Feed

  • Eligibility & Benefit Verification

  • Automated Financial Clearance Workflow Platform

  • Reg

  • Integrity

  • Prior Auth

  • (pilot)

  • Medical Necessity

  • Patient Funding w/ Via Note

  • (pilot)

  • Patient Estimates

HCIT Integration

Reporting & Metrics

Post Go-Live

Point of service patient liability estimates

Point of Service Patient Liability Estimates

Linking patient access errors to denials

Linking Patient Access Errors to Denials



Hartford healthcare kpis

Hartford HealthCare KPIs

Joys of the open road

Joys of the Open Road

Joys of the open road1

Joys of the Open Road

  • Employee Engagement

    • HHC offers employees access to Local Community College

    • HHC covers tuition and salary for Wednesday afternoon coursework

    • Clear career path and education boost employee morale

    • HHC maintains a 99% employee retention rate

  • Team Building Exercises

  • Rewards For Outstanding Performance

Lessons from the road

Lessons From The Road

Lessons from the road1

Lessons from the Road

  • Appraise organizational readiness

    • Finance will likely want to run faster than departments

    • Provide training to physicians and nursing staff

    • Communicate early and often with hospital leadership (CEO/CFO)

  • Appraise Financial Clearance Staff

    • Some personality types are not suited to ask for payments

  • Be aware of HR challenges

    • 9 Benefits Packages

    • 4 Compensation Models

    • Union job descriptions

    • Employee transfer requires new employee paperwork

    • HHC full homogenization by 2013

Leadership behaviors

Leadership Behaviors

  • Be In The Moment

  • Be Authentic & Humanistic

  • Volunteer Discretionary Effort Constantly

  • Model High Performance-Desired Behaviors that Drive Desired Results

  • Respect & Leverage Separate Realities

  • Be Curious vs. Judgmental

  • Look in the Mirror First – Be Accountable

  • Have Courageous Conversations

  • Provide Timely, Clear & Specific Performance Expectations & Feedback

  • Teach, Coach & Mentor - Spend at Least Half of Your Time Developing Others

Questions to ask yourself everyday

Questions to Ask Yourself Everyday

  • What more can I do right now to be a role model for those around me?

  • What more can I do right now to achieve the outcome we desire?

  • What more can I do right now to prevent something undesired from occurring?

  • What expectations or feedback can I deliver right now to make a positive difference?

  • What more can I do right now to seek or provide the clarity that I think does not exist?

  • What more can I do right now to make this meeting more productive?

  • When some outcome has not met my expectations, ask, “How did I contribute to that?” and “What more will I do next time to make it successful?”

Building an automated financial clearance process

  • A journey of a thousand miles begins with a single step.

  • Lau-Tuz, Chinese philosopher (604 BC - 531 BC)

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