Engaging Touch Free Practices; Carolinas HealthCare System

Transcription

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

2 Hello, I am Elizabeth Staas Elizabeth Staas serves as an Advisory understanding and working knowledge of the revenue cycle and all its associated components to include workflow, human factors, and technology. Elizabeth has worked with Revenue Cycle Consultant for Recondo Technology. She brings a deep 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 Hello, I am Jonathan Johnson Jonathan Johnson, Director Corporate Patient Access for Carolinas HealthCare System Western Division. Jonathan holds a degree in Political Science from Transylvania University and has been working in Patient Access for 7 years. Jonathan has been with Carolinas HealthCare System for 4 years and has responsibility for the patient access functions at CHS-Cleveland and CHS-Kings Mtn. In addition, Jonathan is responsible for the Corporate Patient Access Trainers, the PRN, and Patient Financial Service Specialist Float Pools.

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

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

8 Transforming Patient Access allows us to refocus on Patient Care

9 CHS at Glance. Case Study: Carolinas HealthCare System The Continuum of Care 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 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 Specialty Care Practices

10 The 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 Pre-Registration Insurance Verification Clinical Authorization (NCA) POS Cash call Inpatients & Observation Patients (Unscheduled/ED Admits) 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: Pre-Registration Insurance Verification Non-Clinical Authorization POS Cash Call After April 2007: Team Approach 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 Automated Patient Estimator Automated Authorization Working by Exception

18 Roll Out Plan Radiology Surgery Out Patient Areas In Patient

19 Patient Estimation Estimate Calculation 18

20 Front Line Communication Front Line Communication

21 Support is always there

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 Radiology 10 in Advance of Scheduled DOS 5 in Advance of Scheduled Procedure

24 KPI s for Radiology Accounts 723 Accounts $3,282, Denied Dollars $1,747, Denied Dollars 24.7% decrease in accounts 46.7% decrease in denied dollars

25 Denial Adjustments as % of Net Managed Care Revenue 7.00% 6.00% Adjustments 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% H R C F U L K M S 2015 YTD 0.74% 0.63% 0.57% 0.35% 0.17% 0.13% 0.07% 0.05% 0.04% 2015 Goal 2.04% 2.52% 0.70% 0.51% 0.62% 0.47% 0.91% 0.38% 0.62% 2014 Actual 2.15% 2.66% 0.74% 0.53% 0.65% 0.49% 0.96% 0.40% 0.66%

26 2014 Price Estimation Report 25,000 1,000 22,500 20,000 22,345 21, ,500 15,000 12,500 10,000 7,500 5,000 12, , ,712 15,682 15, ,881 15, ,618 17, , Priceline Calls 2, Recondo Estimates Priceline Calls

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

29 Questions or Comments? Thank you for your time. Jon Johnson Elizabeth Staas