Engaging Touch Free Practices Carolinas HealthCare System - A Case Study on Automation in the Revenue Cycle

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1 Engaging Touch Free Practices Carolinas HealthCare System - A Case Study on Automation in the Revenue Cycle Elizabeth P. Staas, Recondo Technology Katie Davis, Carolinas HealthCare System

2 Who we are Elizabeth Staas Elizabeth Staas serves as an Advisory Revenue Cycle Consultant for Recondo Technology. She brings a deep understanding and working knowledge of the revenue cycle and all its associated components to include workflow, human factors, and technology. Elizabeth has worked with for 20 years with numerous hospitals and other healthcare providers in her career concentrating on increasing prompt and proper payment for the services they provide. She currently serves on the Board of Directors and as President Elect for the Virginia-DC Chapter of HFMA. She has organized a wide variety of HFMA and AAHAM Educational Events centered on Revenue Cycle and Payment Reform. She serves as Legislative Chair for The Virginia Chapter of AAHAM with concentrated efforts in lobbying at both state and federal levels to reduce wasted efforts affecting the healthcare revenue cycle.

3 Who we are Katie Davis Katie Davis, AVP Corporate Patient Access for Carolinas Healthcare System. Katie holds a Bachelor s Degree in Healthcare Management and has 25 plus years of experience in Patient Access plus 8 years of physician practice management experience. Katie has been with Carolinas HealthCare System for 25 years and serves as the Assistant Vice President for the Western Division of Corporate Patient Access which includes the Pre- Service Department for 9 facilities, the Patient Financial Specialists, PRN Pool, the Patient Identity Management team, and the Access Team for CMC-Cleveland and CMC-Kings Mountain. Katie has been a member of the National Association of Healthcare Access Management since 1992 and has been a speaker at the national meeting on three occasions and has been a member of the North Carolina Association of Access Managers since 1989, serving as President from Katie has also been a member of HFMA s North Carolina chapter since 2004.

4 Overview Transforming today s manual revenue cycle activities into an automated no touch process dramatically improves staff productivity and financials. Attendees will learn/confirm: Current challenges across Patient Access and Business Office areas The importance of getting it right upfront to avoid delays / rework / unnecessary reimbursements Technology, data, and automation capabilities to improve operations Best practice considerations to increase patient satisfaction and improve financials This transformation enables staff to spend less time on payer websites (and phone calls) and more time with patients which leads to increased patient satisfaction.

5 US Health Spending continues to increase at a higher rate than other Industrialized Nations

6 Healthcare Revenue Cycle is becoming more challenging Increasing volume and complexity of healthcare transactions Verifying Eligibility is a challenge today and is expected to be more challenging with the Affordable Care Act Health Exchanges Confirming Authorizations are highly manual and often require staff to call the payer or verify on payer websites Industry administrative costs will grow by about 10 percent annually over the coming years higher than the rate of growth of medical inflation. - Source: McKinsey

7 Manual vs. Electronic Per Transaction Cost $20.00 Authorization Potential Opportunity Savings $13.33 $18.00 $16.00 $14.00 $12.00 $10.00 $8.00 $6.00 Manual Electronic $4.00 $2.00 $0.00 Claim Submission Eligibility Prior Claim Status Authorization Claim Payment Remittance

8 Transforming Patient Access allows refocusing on patient care

9 Case Study: Carolinas HealthCare System Continuum of Care Breadth of CHS Nursing Homes Rehabilitation Hospitals Hospitals Emergency Care Centers Ambulatory Surgery Centers Hospice & Palliative Care Behavioral Health Urgent Care Centers Health Clinics Primary Care Practices Home Health LiveWELL Carolinas Specialty Care Practices 60,000 employees 2,535 physicians Summary of System Close to 800 care locations Nearly 7,500 licensed beds 11 long-term care facilities 12 home health agencies 9 hospice providers 8 freestanding EDs One of 5 academic medical centers in the state of North Carolina

10 CHS Experience Carolinas HealthCare System affiliates and physician networks in NC, SC and GA.

11 Corporate Patient Access CMC Anson

12 Pre-Service Department In 2000 as a result of an Ernest and Young Revenue Cycle Review, a dedicated Pre-Service Department was established to focus on the following goals: Decrease Denials Improve Patient Satisfaction Increase POS Cash Collection

13 Areas of Responsibility Scheduled Services Inpatients & Observation Patients (unscheduled/ed admits) Pre-Registration Insurance Verification Non-Clinical Authorization (NCA) POS Cash call Insurance Verification Non-Clinical Authorization (NCA) If needed, communication with Clinical Care Management

14 Pre-Automation Process Prior to April 2007 Individual Approach Registrar works account to completion including: After April 2007 After April 2007 Team Approach Pre-Registration Insurance Verification Non-Clinical Authorization POS Cash Call Pre-Registration Team Insurance Verification and Non- Clinical Authorization Team Cash Team

15 Pre-Automation Process for Estimation and Cash PCON Estimator Cash Collection

16 Our Automation Story Replace our Price Estimator Better Customer Service when Providing Estimates Better Verification Data

17 Key Components SurePayHealth (automated patient estimator) AuthDP (automated authorization) Working by Exception

18 Roll Out Plan Radiology Surgery OP Areas Inpatient

19 18

20 Front Line Communication

21 Support

22 KPI s for Scheduled Services ,014 Scheduled 264,061 Scheduled 241,941 Pre-Registered 263,982 Pre-Registered 99.9% 99.9%

23 Completed Days Out Surgery 10 in Advance of Scheduled DOS Radiology 5 in Advance of Scheduled Procedure

24 KPI s for Radiology Denials Accounts $3,282, Denied Dollars Accounts $1,747, Denied Dollars 24.7% decrease in accounts 46.7% decrease in denied dollars

25 Adjustments 3.00% Denial Adj as % of Net Mgd Care Revenue Jan 2015 YTD Performance 2.50% 2.00% 1.50% 1.00% 0.50% 0.00% H R C F U L K M S 2014 Actual 2.15% 2.66% 0.74% 0.53% 0.65% 0.49% 0.96% 0.40% 0.66% 2015 Goal 2.04% 2.52% 0.70% 0.51% 0.62% 0.47% 0.91% 0.38% 0.62% 2015 YTD 0.74% 0.63% 0.57% 0.35% 0.17% 0.13% 0.07% 0.05% 0.04%

26 Priceline Calls 2014 Price Estimation Report 25,000 1,000 22,500 20,000 22,345 21, ,500 17,919 16,998 15,000 15,071 15,712 15,682 14,881 15, ,500 13,618 10,000 12,115 11, ,500 5, , Recondo Estimates Priceline Calls

27 FTE Staffing Beds vs. FTEs # of Beds # of Pre-Service FTEs

28 $2,371, $3,033, $3,017, $2,476, $2,409, $2,533, $2,681, $3,202, $3,048, $4,190, $11,493, $10,007, $12,927, $13,545, $11,871, $12,849, $11,272, $11,525, $10,959, Pre-Service vs. Corporate Facility YTD Cash Collections $14,000, $12,000, $10,000, $8,000, $6,000, $4,000, $2,000, $ (Jan- Feb) Pre-Service YTD Total Corporate Facility YTD Total

29 Collections Percent of Net Revenue Overall % %

30 Questions/Comments Thank you for your time and interest Katie Davis Elizabeth Staas

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