MAP Award Journey - Departmental Collaboration to Improve Revenue Cycle Performance

1. MAP Award Journey - Departmental Collaboration to Improve Revenue Cycle Performance Joseph Koons, MSA, FHFMA, CPAM Managing Director, Revenue Cycle August 1, 2012

2. Agenda • About Centra • Financial Impact • DNFB Green Belt Project Review • POS Collections • Continuous Process Improvement • Technology & Other Components

3. 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

4. Payer Mix and Hospital Demographics • Service Lines: • Home Health • Hospice • Substance Abuse • Mental Health • Child & Adolescent Residential Treatment • Skilled Nursing • Reference Lab • Rivermont Schools • Cancer Center • Mammography Centers Medicare - 50.9% HMO / PPO- 25.3% Medicaid - 14.2% Self Pay - 5.8% Commercial - 1.9% Other - 1.8% Admission: 26,824 ED Visits: 92,212 Employees: 5,000+

5. 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%

6. Charity and Bad Debt Trending • Charity Policy • Payment options • Statements • Presumptive Charity • Discounts • SP Outsource

7. Revenue Cycle Structure 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

8. “Courage is rightly esteemed the first of human qualities…because it is the quality which guarantees all other.” Winston Churchill

9. DNFB PROJECT

10. DNFB GREEN BELT PROJECT Scope of the project focused on inpatient (IAL & IAV) stays

17. POINT OF SERVICE COLLECTIONS

18. Bringing It All TogetherPoint of Service Collections = Financial Counseling

19. 2007 – Before State Inconsistent upfront collections No automated payment posting Limited pre-registration No measurement for accuracy Limited insurance verification Chargemaster was the only estimation tool Estimates contract pricing non existent Implemented medical necessity checking and ABN issuance

20. Continuous Review and Change continuous process improvement Process Optimization Implement best practice for all work processes across patient access points. Hold staff accountable. Elevate Staff Centra continually trains staff, implemented staff promotion path, and paid testing for certification Communicate with Service Lines Director and VP level communication with leaders, educating front line clinical staff Analyze Work Processes Identify Barriers and System Shortfalls Emphasis should be on any process that continues to be manual – can it be migrated. or does it have system optimization potential.

21. 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

22. Staff Training and Communication 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

24. 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

25. 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

26. It all starts with registration accuracy – REALTIME!

27. Sample Daily Error Report

28. Sample Scorecards Manager Registrar

29. 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

30. 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

31. 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

33. 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

35. 2011 - Continuous Process Improvement 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

37. End of Year 2011 – $5,471,296

38. Instant notification of approval for credit cards Daily reconcilement report from vendor Run estimates from workstation Directly access other tools 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

39. What’s Next? 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