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MAP Award Journey - Departmental Collaboration to Improve Revenue Cycle Performance. Joseph Koons , MSA, FHFMA, CPAM Managing Director, Revenue Cycle. August 1, 2012. Agenda. About Centra Financial Impact DNFB Green Belt Project Review POS Collections Continuous Process Improvement

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map award journey departmental collaboration to improve revenue cycle performance

MAP Award Journey - Departmental Collaboration to Improve Revenue Cycle Performance

Joseph Koons, MSA, FHFMA, CPAM

Managing Director, Revenue Cycle

August 1, 2012

agenda
Agenda
  • About Centra
  • Financial Impact
  • DNFB Green Belt Project Review
  • POS Collections
  • Continuous Process Improvement
  • Technology & Other Components
about centra health
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
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+

revenue cycle metrics for centra
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%

charity and bad debt trending
Charity and Bad Debt Trending
  • Charity Policy
  • Payment options
  • Statements
  • Presumptive Charity
  • Discounts
  • SP Outsource
revenue cycle structure
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
slide8

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

Winston Churchill

dnfb green belt project
DNFB GREEN BELT PROJECT

Scope of the project focused on inpatient (IAL & IAV) stays

2007 before state
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

continuous review and change
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.

2008 the journey begins
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

staff training and communication
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

incentives for collections
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

incentives for productivity and accuracy
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

sample scorecards
Sample Scorecards

Manager

Registrar

staff in access work as members of multidisciplinary groups to improve service scores
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

tool runs estimates based on insurance plan and contract pricing
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

2009 gaining traction
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

2009 gaining traction1
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

2011 continuous process improvement
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

integration is key

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
what s next
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