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Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting

Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting. R. Henry Capps Jr., MD, FAAFP, S enior VP of Physician S ervices & Medical G roup CMIO Novant Health

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Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting

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  1. Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician Services & Medical Group CMIO Novant Health Geoffrey Gardner, CPA, VP of Finance Novant Health Making Healthcare Remarkable

  2. FPO Novant Health • Bringing together world-class technology and clinicians to provide care that works with patients’ schedules, preferences and needs. Creating a healthcare experience that is simpler, more convenient and more affordable, so that our patients can focus on what really matters: • getting better and staying healthy.

  3. 100

  4. Billing offices consolidated into one

  5. Practice management system implementation timeline 301 clinics live Jan. 2012 July 2011 Jan. 2011 July 2012 Feb. 2013 July 2013 289 clinics live ROLLOUT COMPLETE 343 clinics live

  6. Single system and operational transformation FOOTER AREA

  7. Led to increased efficiency, higher collection rates and lower contractuals FOOTER AREA

  8. RCS performance 66% 10%

  9. RCS performance 98 35 2010 2014

  10. RCS performance

  11. RCS performance

  12. FPO What does RCS look like today?

  13. RCS staffing 320 employees in core RCS • Cash posting • Cash reconciliation • Credit resolution • Insurance follow-up • Customer service • Patient follow-up • Support & analysis 20 employees in technical billing (for split bill clinics) 71 employees in advocates 57 employees in coding 76 employees in preverification

  14. Enhanced RCS services

  15. Revenue Cycle Advocates • Serve as clinics’ primary point of contact for any billing issues • Resolves complex patient billing issues escalated by Customer Service • Navigates the patient through the financial assistance application process • Partners with the clinics to collect any patient outstanding self-pay and bad debt balances owed prior to the patient’s next appointment

  16. Coding • Executes comprehensive coding program including backend review functions and on-site clinic support for providers and clinic staff • Partners with compliance and coding education • Delivers feedback to providers for improved documentation and payer requirements

  17. Preverification • Ensures that patient’s registration is accurate with insurance information verified and loaded correctly prior to the patient’s visit • Navigates automated eligibility tools to locate coverage(s) and add appropriate coverage to the patient’s account • Optimizing and streamlining current workflow to target higher risk encounters

  18. Integrated approach to Revenue Cycle Services Core RCS Revenue Cycle Advocates Patients Customer Service Clinic Operations Optimization Team

  19. 38 FOOTER AREA

  20. Percent decrease in RCS core cost FOOTER AREA

  21. RCS costs 40 35 30 25 20 15 10 5 0 In millions Year

  22. RCS costs

  23. RCS costs Core RCS Cost as a % of Collections RCS Case Collected Typical outsource cost as % of collections

  24. 48

  25. Percentage reduction in total cost as related to total dollars billed

  26. Patient engagement tools FPO

  27. MyNovant

  28. The road ofcontinuous improvement

  29. What’s next? • Enhanced analytics • Coding optimization • ICD-10 • Improvement of self-pay outstanding balances through integration of “propensity to pay” technology • Additional front-end process and staffing redesign • Denial management

  30. Let’s chat

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