CAH Revenue Cycle Assessment Project 2012

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1 CAH Revenue Cycle Assessment Project 2012 Our Mission: To protect and improve the health and environment of all Kansans. The first step in improving a process is measuring current performance. How did KS financial performance compare to benchmark? 1

2 2

3 In short 50% of our CAHs fall short in achieving 4 of the 5 Flex Monitoring Team national performance benchmarks. 44% of Kansas CAHs are at high risk of financial distress. What are we to do?!? 3

4 Whatever we decided to do had to meet several criteria: Provide baseline information on individual and aggregate hospital revenue cycle management processes, Provide information to help KS FLEX determine meaningful future programming, Be useful to participating CAHS, Be available to all 83 CAHS at no additional cost to them, Be available to roll out in the next couple of months. NRHP s RevCat met all those criteria, plus they were able to take us on immediately, meet our timeline and be flexible to our evolving needs. 11 A means to improve hospital revenue and reimbursement by streamlining workflow, processes, and education in the following areas: Front Middle End Scheduling Pre Registration Insurance Verification Insurance Authorization Registration POS Cash Collections Financial Counseling Charge Capture Utilization Review/Interqual Clinical Documentation Coding Charge Master Late Charge Reduction Billing Reimbursement Contract Management Accounts Receivable Bad Debt Refunds Denials Management What is Revenue Cycle? 12 4

5 Provide financial stability and sustainability Increase cash flow Improve operating margin Cement the success of business services Accelerate the pace of change Significantly enhance the capability of tools Build a stronger leadership team Revenue Cycle Objectives 13 Unique opportunity to increase first year cash flow Reduce controllable write-offs and denials Improve contract compliance to reduce underpayments Improve coding quality and documentation Reduce medical necessity denials Revise charge master and perform charge capture and rate structure assessments Insulate facilities from the potential negative impact of government regulatory programs, such as RAC Revenue Cycle Opportunities 14 An on line survey, designed to help hospital CEOs assess the current condition of their revenue cycle & determine areas of potential need. It measures revenue cycle practices in your hospital against revenue cycle best practices. It provides a gap analysis for each hospital, indicating where your hospital diverges from best practices. And it provides an aggregate gap analysis for the Kansas Flex program to use for creating meaningful programming addressing primary gaps. What is the Revenue Cycle Assessment Tool? 15 5

6 Areas of Strength Billing and Coding, including Utilization Review Chargemaster (CDM) and Charge Capture Charity Care and Self-Pay Account Management Areas for Improvement Denials and Third Party Payer Management Front-End Patient Processes, including Financial Counseling and Point of Service Collections Charge Audit Quality Assurance/Improvement Activities Summary of Preliminary Findings Immediate financial impact/ low hanging fruit Compliance related issues with financial return Enhancement of revenue cycle processes with potential financial impact Compliance related issues with potential penalty and fine avoidance Quality assurance monitoring and improvement with potential financial impact Classification of Opportunity Kansas Preliminary RevCat Results Point of Service Collections Benefits and Eligibility Verification Scheduling and Pre-Registration Financial Counseling Charity Care Self Pay Management Billing Staffing Levels Revenue Cycle Process Enhancement with Potential Financial Return 6

7 What software system do you use for registration? Question Enter comments in the text box if appropriate option is not available in the drop down response option box: Drop Down Response Option What software system do you use for financial? Enter comments in the text box if appropriate option is not available in the drop down response option box: What system do you use for billing? (Clearinghouse and scrubber software) Enter comments in the text box if appropriate option is not available in the drop down response option box: How many registrations are performed daily? Please provide an average by area: OPT, IP, ER, LT Care, Clinics. Enter comments in the text box if appropriate option is not available in the drop down response option box: Do you utilize a quick registration process for emergency room patients? Enter comments in the text box if appropriate option is not available in the drop down response option box: Do you have a benefits/eligibility process? Enter comments in the text box if appropriate option is not available in the drop down response option box: Assessment Questionnaire 20 Questionnaire Guidance 7

8 Questionnaire responses were evaluated and scored under the following criteria: Evaluations were performed by NRHP contractors who have experience in healthcare revenue cycle and NRHP s approach to revenue cycle Scoring criteria included the following: current process identified, level of process functionality, level of deficiency, and level of required enhancement. The above evaluation and scoring became the basis for specific recommendations that were provided to the individual facilities Gap analysis Snapshot SUMMARY ASSESSMENT REPORT 8

9 SUMMARY ASSESSMENT, CONTINUED SUMMARY ASSESSMENT, CONTINUED Upcoming Programming for Revenue Cycle Management Improvement 9

10 A. Year long Revenue Cycle Improvement Curriculum Three 3 month long courses, each on a revenue cycle process identified in aggregate gap analysis. 2 webinars + one face to face workshop (at SNC?) Pre test, post test and re test to see what you re learning and what re you re implementing at home. Audience: CEOs, CFOs, Business Office, QI Manager B. Intensive Improvement Collaboratives Objective = concretely improving hospitals financial performance. Aimed at hospitals interested in and ready to improve financial performance, that have completed the Revenue Cycle Assessment Tool. Characteristics of Collaboratives Designed to help organizations close that gap by creating a structure in which interested organizations can easily learn from each other and from recognized experts in topic areas where they want to make improvements. Intensive short term (6 to 15 month) Brings together teams from different hospitals to work on improvement in a focused topic area. In hospitals teams are multidisciplinary. Performance is REPORTED regularly to track and measure results. Team sends members to attend Learning Sessions (face to face meetings over the course of the Collaborative), to share with other hospitals. 10

11 Characteristics of a Collaborative The Breakthrough Series is designed to help organizations close that gap by creating a structure in which interested organizations can easily learn from each other and from recognized experts in topic areas where they want to make improvements. Collaborative is a Intensive short term (6 to 15 month) learning system that brings together teams from different hospitals to work on improvement in a focused topic area. Teams are multidisciplinary. Collaboratives range in size from 12 to 160 organizational teams. Each team typically sends three of its members to attend Learning Sessions (three face to face meetings over the course of the Collaborative), with additional members working on improvements in the local organization. Select Topic (develop mission) Expert Meeting Develop Framework & Changes Planning Group LS Learning Session AP Action Period IHI Breakthrough Series (6 to 18 months time frame) Participants ( teams) Prework A P S D A P S LS 1 LS 2 LS 3 AP1 AP2 AP3* (listserv) Visits Supports Assessments D Phone Conferences Monthly Team Reports A P S D Dissemination Publications, Congress. etc. Holding the Gains *AP3 continue reporting data as needed to document success 11

12 Questions Our Mission: To protect and improve the health and environment of all Kansans. Our Mission: To protect and improve the health and environment of all Kansans. 12

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