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UCSF Medical Group Revenue Cycle Advisory Committee

UCSF Medical Group Revenue Cycle Advisory Committee. System Improvement Ideas March 6 th , 2007. Agenda:. Committee Overview Specific Projects Next Steps. Committee Scope:.

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UCSF Medical Group Revenue Cycle Advisory Committee

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  1. UCSF Medical GroupRevenue Cycle Advisory Committee System Improvement Ideas March 6th, 2007

  2. Agenda: • Committee Overview • Specific Projects • Next Steps

  3. Committee Scope: The primary scope is system changes, enhancements, new applications or products that will improve the pro-fee revenue cycle, either through improved efficiency or improved collections.

  4. GUIDING PRINCIPLES • COMMITTEE COMPOSITION • PROCESS • Ideas • Vendor Presentation • Priority List

  5. Ingenix Claims Manager

  6. Ingenix Claims Manager • Software Product. Works with TES. • Reduce denials • Increase billing accuracy • Shorten claim turnaround

  7. Ingenix Claims Manager • Encounter editor • Comes packaged with: • LCD (Medicare Local Coverage Determination) part B edits-update as they change • Annual CPT and ICD-9 revisions • Medicare CCI (Correct Coding Initiative) edits-updated quarterly • Commercial and government edit templates for user defined edits

  8. What we feel Ingenix will bring us • Cleaner claims • Efficiency tool • Revenue cycle shorter • Reduce denials • Reduce re-work=efficiency on the backend • Less paper-DRQ • Reduce opportunity for accounts “falling off radar” • Reduce billing lag

  9. What we feel Ingenix will bring us • More Compliant Billing • New vs. established edits using claim history • Unbundling edits • Increased Patient Satisfaction • Resolution of potential denials prior to billing will reduce patient inquires • Increase Revenue • Missing charge edits • Supply billed without service • Primary service not billed-add on service billed

  10. ROI • COST: • One Time: $90K • Ongoing: $145K to $167K / Year • RETURN: • Est. $700K Year One

  11. E-Commerce Enhancement • Existing IDX Feature • Eligibility Inquiry with Payor • Improve Functionality: • Payors? • Data? • Work Files for Exceptions • Expand User Base

  12. ROI • COST: • One Time: $75K • RETURN: • $29K per Year (conservative)

  13. Visit Management Enhancement • Existing IDX Application • Pre-Arrival and Arrival Alerts • Copy of Insurance Card • NPP/ TACOS • Past Due Balances • Alerts on IDX vs. ONTRAC

  14. ROI • COST: • One Time: $75K • RETURN: • Full Extent not Known • DOM Estimate $150K / Year

  15. Rejection Subsystem • Existing IDX Module • Improve Functionality: • Rejections in Workfiles Sooner • “Action Codes”: FSC Transfer • Better Reporting

  16. ROI • COST: • One Time: $35K • RETURN: • One Time: $348K

  17. EOB Resolve • Payment Accuracy System • Features • Actual vs. Expected • “Appeals” Letters/ Files • Uses EDI Data • EOB Image • Reporting

  18. ROI • COST: • One Time: $10K • Ongoing: $28K / Year • RETURN: • First Year: $592K

  19. Enterprise Task Manager (ETM)

  20. Description • ETM is a tool designed to improve workflow in the GE/IDX Centricity products. • Uses workflow automation and role-based portals to drive revenue management processes through an accelerated and more efficient revenue cycle. • Provides an interface allowing users to go to the correct place to work

  21. Why ETM? • Decentralized revenue cycle structure with “partially” centralized business office • Access unit, ONTRAC • Focus on front-end • Navigation ease in GE/IDX modules • Eliminate Paper based processes

  22. Benefits • Assign tasks to specific users • Increase task completion efficiency • Improve staff production, quality and accuracy • Potential to reduce staff expenses • Minimizes training time • Optimize revenue cycle throughput • Create best practice workflows • Potential to replace ONTRAC

  23. Project Plan Multi Year Split Financial Responsibility • COST: • Year One: $40K • RETURN: • TBD

  24. Next Steps • Board Approval • Coordination with Purchasing • Implementation Planning • General Time Lines

  25. SUMMARYProjectFunding Request ONE TIMEONGOING • Ingenix Claims Manager $90K $145 to $167K • Visit Management $75K 0 • E-Commerce $75K 0 • Rejection Subsystem $35K 0 • EOB Resolve $10K $28K • ETM $40KTBD TOTAL $325K $195K

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