Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance
|
|
- Sophie Daniels
- 8 years ago
- Views:
Transcription
1 Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Matt Seefeld CEO & Co-Founder (404) HFMA Fall Institute 2011
2 Agenda Purpose of Leveraging Predictive models and Artificial Intelligence Root Cause Analysis Defining Predictive Analytics Case Studies Revenue Modeling and Resulting Net Revenue Impact Financial Reserve Process Example Analytic Models Revenue Cycle Reserve & Hindsight Health Reform Marketing and Strategy Payor Mix Clinical Analytics Defining Artificial Intelligence Technology and Example Models Example Data Systems to Integrate with and Data Points to Extract from 2 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
3 Why Use Predictive Models and Artificial Intelligence Analysis? Today s rapidly changing healthcare landscape is forcing providers to look at IT solutions that drive advanced planning and understanding to make informed decisions. High demand for understanding how today s decision can impact future financial outcomes Rapid growth in digital data capture systems and the ability to link these systems to a centralize data warehouse creates unparalleled analysis flexibility Protecting every dollar in good revenue is imperative for long term financial viability Positive clinical outcomes will require the ability to look at decisions and outcomes in new and dynamic ways (especially to change Physician behavior) Lack of time to data mine and try to figure out why things are happening Go beyond Dashboards and Scorecards that tell you things are good vs. bad but don t tell you the why Bottom line is advanced technology models and root cause analysis engines can help your organization make informed business decisions. 3 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
4 Advanced Technology with Predictive Analytics / Forecasting Predicative Analytic models when built on a scalable and dynamic technology platform can pull data from an existing data warehouse or consolidate data from multiple stand alone systems. What are some key components to consider in the design of a Predictive Analytic technology: Allows the user to interact with the data points to generate what if scenarios Shows a trend line of historical data points compared to the future based on informed decision making Ability to drill down into the data (e.g. Inpatients, Medicare, Admit from ER) Ability to data cube to look at different dimensions (e.g. by payor, service, department) Identify the rate of change over time (e.g. at what rate is Medicare denials improving) Provide flexibility with setting time periods (e.g. Q3 compared to last Q3) Allows the user to apply various mathematical algorithms to assist in understanding the past, since the end user is likely to be more familiar with the current data These models will allow your team to Forecast future financial, operational and clinical impacts based on your knowledge today and using the appropriate historical data set. 4 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
5 The Old Way of Predicting Using Excel to run models time consuming and not flexible and have to be manually updated to change views (e.g. what if we wanted to look at Anthem Blue Cross for Neurology Inpatients admitted from the Emergency Department?) 5 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
6 A New Way of Predicting Using a dynamic and scalable technology to develop predictive models allows the user to run scenarios instantly saving time and improving insight into data that will help the decision making process. 6 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
7 The Old Way of Predicting the Reserve Process Using Excel to run reserve and liquidation models time consuming and not flexible and have to be manually updated each month or quarter depending on how often your organization updates the reserve process. Ability to change views would take too much time in Excel or Access (e.g. what if we wanted to look at Aetna insurance plans bad debt write-offs for Inpatient, Cardiology patients?). Reserve Modeling Payor Hindsight A/R Balance % Contractural % Bad Debt % Charity % Denied Current A/R Balance Est Contr. Allowance Est Bad Debt Est Charity Est Denials Blue Cross (4) $25,110, % 1.2% 0.6% 0.6% $25,379,117 $13,276,134 $301,331 $150,665 $143,132 Champus (7) $5,120, % 0.1% 0.1% 1.4% $4,987,949 $3,830,989 $7,168 $6,144 $71,172 Commercial/Managed Care (3) $32,115, % 2.3% 1.2% 3.5% $32,100,192 $11,969,538 $738,662 $378,966 $1,124,051 Medicaid (2) $27,682, % 0.8% 2.5% 0.1% $13,528,779 $18,724,603 $210,389 $692,068 $19,378 Medicare (1) $51,204, % 0.1% 0.3% 1.4% $55,591,557 $34,521,872 $46,084 $143,372 $721,979 Self Pay (5) $37,715, % 14.0% 15.2% 0.4% $46,140,949 $0 $5,280,140 $5,744,037 $147,090 Workers Comp (8) $2,029, % 0.1% 0.0% 0.0% $1,567,858 $1,028,342 $1,624 $0 $406 Total $180,979,029 $179,296,401 $83,351,478 $6,585,397 $7,115,253 $2,227,208 The old way of reserving usually results in a time consuming process where you can only look at one view limiting flexibility and often times accuracy. 7 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
8 Defining the Variables Impacting the Reserve Process The changing healthcare landscape, specifically patient mix and payor behavior is putting tremendous pressure on Finance departments to have more dynamic ability to reserve appropriately: Rising uninsured and utilization of Emergency Services as their primary care medium Increase insurance premium cost being shifted to the patients (e.g. rising bad debt on commercially insured patients) Retrospective reviews (RACs) and other means of payors to delay payment, partially or completely deny services after they have occurred Appropriate classification of transaction codes so you have a complete and accurate liquidation of Gross Revenue Improving process at your hospitals are showing financial dividends much quicker than prior years (e.g. ABN processing, Medical Necessity screening, POS collections) Maintaining an accurate Contract Management system The bottom line is all these changes have a dramatic impact on predicting how much of each gross revenue dollar needs to be reserved for non cash write-offs. 8 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
9 A New Way of Managing the Reserve Process Dynamic reserve models (A) provide the insight to make more informed decisions on what you should reserve for each deduction to revenue. The ability to interact with your schedule (B) allows you to forecast beyond historical performance. Bullet 1 A B 9 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
10 A New Way of Managing the Reserve Process Using a dynamic and scalable technology to develop predictive reserve models allows the user to run scenarios instantly saving time and improving insight into data that will help the decision making process on how to reserve A/R appropriately. Be able to look back at Revenue liquidation for any period of time (e.g. 6, 9, 12 months) and segment the deductions to revenue for cash and adjustments Go beyond Financial Class views and be able to drill into specific insurance plans along with being able to set filters on other dimensions (e.g. patient types, services) Understand how well you are tracking to your expected reserve schedule from your prior analysis (e.g. Self Pay A/R is reserved for bad debt at150 days at 100% but your trend shows you will be at 100% bad debt write-off at day 120) Be able to save, share and collaborate within your technology medium with other key finance personnel for planning and executing the reserve process Be able to interact with the reserve model so you can change the projected reserve percents and see what the new reserve amount on current A/R should be These dynamic models allows your team to interact and forecast future financial reserve requirements and quickly adapt when required based on your knowledge today and using the appropriate historical data set. 10 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
11 Revenue Cycle Analytics What is the impact of changes in Payor Mix? What if we see a 5% increase in Medicaid volume? What if we see a10% increase in Medicare volume? What is the impact of changes in Cash Factor/Reimbursement? What if BCBS lowers it s fee schedule by 10% What if BCBS lowers it s fees on Procedure X? What if all payors lower fees on Procedure X? What is the impact of reducing denials by 10%? What is the impact of reducing bad debt by 15%? What is the impact of reducing A/R over 90 by 10%? What is the impact of reducing DNFB over 4 days by 20%? Other? 11 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
12 Reserve and Liquidation Analytics What is the impact of changes in Patient Type? What if we see a 10% in Emergency Room Self Pay Volume? What if we see a 15% increase in patient liability collections for elective same day surgeries at the point of service? What is the impact of claims for UHC being paid on average 10 days quicker? What if a group of Physicians are doing procedures that are being denied by Medicare? What is the impact if financial counselors are securing more charity care patients? What is the trending of my contractual allowance percents for iplan B01 zero balance accounts for the last 3 months? How about 6 months? What should I reserve for denials for medical necessity if I improve my level of care screening in the Emergency department? Other? 12 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
13 Health Reform Analytics What will be the impact of pending health reform proposals? What is the impact of an increase in government sponsored plans? Assume % of uninsured s move to government plan Assume % of commercially insured s move government plan Assume combination of both What will be the impact if Medicare moves to Value-Based Purchasing? What will be the potential impact of bundled payments? What will be the impact of reductions in certain DRGs? Other? 13 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
14 Marketing & Strategy Analytics Where are our patients coming from? Which communities have the preferred patient mix? What if we increase our volume from preferred communities by 10%? What service lines generate the highest revenue? Which communities should we target our marketing? Which services should be marketed in those communities? Should we build more Medical/Surgical Beds? What is the P&L impact of closing the Neurosurgery service line? Other? 14 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
15 Payor Mix Analytics Changes in the local market place What is the financial impact of a local employer closing? What service lines will see less volume because of the closing? What if Company X reduces their workforce by 10%? What if Company Y increases workforce by 10% What if self-pay increases by 10% due to rise in unemployment? Changes in the State Budget What is the impact of proposed changes to certain insurance plans? What if there is an increase in Medicaid numbers? What if Medicaid reduces reimbursement? What will be impact of an increase in Medicare beneficiaries due to Baby Boomers? What if more retirement communities are developed? Other? 15 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
16 Clinical Analytics What is the impact of Bystolic vs. Lisinopril in treating blood pressure reduction in males over 40 with benign hypertension? What is my RAC audit risk if my chest pain inpatients admitted from the Emergency room that stay less than 24 hours increases from 20% to 30%? If my medical necessity denial overturn rate increases 10% over the next quarter what is the net revenue impact? If I reduce my length of stay by.25 for top 3 DRGs when compared to the GMLOS for Cardiology patients how much bed capacity will be opened? Will it impact my off service placement rate? Other? 16 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
17 Advanced Technology with Artificial Intelligence Artificial Intelligence technology models will bring the answers root cause to the pressing questions you are faced with the constantly changing face of healthcare. These models are designed to run on their own and alert you to the key reasons on why your financial, operational, and clinical landscape is changing. What are some key components to consider in the design of a Artificial Intelligence Technology: Design models that have a direct impact to financial performance or clinical quality (e.g. changes in outstanding receivable; changes in length of stay; changes in payor mix) Implement automated alerts sent to PDAs and when your landscape is changing in a negative or positive manner Stratify the variables that are driving the highest change for the areas you build Artificial Intelligence models around (e.g. AR is increasing Medicare IP over 90 days increasing) Build templates that help with the design of action plans based on what the models are telling your organization (e.g. reduction strategy for denials; improvement of cash factor) 17 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
18 Artificial Intelligence Root Cause Models Artificial Intelligence models should be aimed at identifying the variables that impact financial, operational or clinical efficiency and performance. Why are my A/R days and A/R over 90 levels increasing for commercial payors? Has my denial rate increased? Is my billing lag (discharge to claim submit date) increasing? Is my average days to pay increasing? Why is my length of stay going up? What are the top 3 DRGs, Physicians and Medical Services that are increasing the length of stay over CMS benchmark? Why is my cash flow over the last quarter down 6% compared to goal? Is my self pay revenue increasing? What are the top 3 services? Am I writing off more commercially insurance patient liability to bad debt? If so what payors? Why are my denial overturns declining? What are the top 3 denial codes driving the reduction in overturns? Is the volume of denials increasing causing workflow issue? 18 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
19 What Types of Data Sources to Extract from? Some critical data systems that will help improve financial performance, clinical quality, operations and overall strategic decision making for both predictive analytic and artificial intelligence technology models. Patient Accounting Cost Accounting Labor Management Non Labor Supply Chain Clinical Documentation Electronic Health Record Bed Management Standard Data Sets (835/837, 270/271) CPOE Decision Support Physician Practice Management 19 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
20 What Types of Data Dimensions should be Extracted Whether you are pulling from a centralized data warehouse or pulling from multiple disparate data sources it is imperative to think through what data fields will drive the most value. It is not recommended to pull every data point as that adds unneeded complexity and could cause confusion and impact user adoption. Some examples: Medical Service Patient Type Financial Class Department / Location Attending Physician DRG Diagnosis Codes Procedure Codes Insurance Plans Admit Source Patient Zip Code / City Admit & Discharge Nurse Stations Discharge Disposition Present on Admission Facility Code Supply Item Supply Cost Units Transaction Codes GL Code Charge Code Revenue Code Chief Complaint / Admit Diagnosis Total Charges Total Insurance Payments Total Patient Payments Total Adjustments Admit & Discharge Date & Time 20 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
21 Value Proposition of Leveraging Advanced Technology Building these interactive and automated technology models will help drive performance, awareness and accountability across your organization. Some key areas of immediate value: Improve Cash Flow Reduce accounts receivable Improve net revenue Increase gross revenue Improved Reserve Prediction Reduce bad debt expense Maximize outsourcing vendor commissions Protect every dollar of good revenue Decrease in FTE expense by automation Improve quality of care Reduce variation in Physician practice patterns Target marketing 21 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
22 Business Areas that Utilize these Models to Drive Performance Many business segments within your organization will utilize these interactive tools: Patient Access Patient Accounting HIMS Marketing Case Management Nursing Strategy and Operations Decision Support Procurement Labor Management 22 Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
23 Questions? Matt Seefeld (404) Leveraging Predictive Analytic and Artificial intelligence Technology for Financial and Clinical Performance Nov 10, 2011 Confidential
Top Ten Questions. Time and Energy. Robin Bradbury 800-355-0410 robin@ereso.com
Robin Bradbury 800-355-0410 robin@ereso.com Top Ten Questions 1. What are the key measures for the Revenue Cycle? 2. How do you document and share this information with the Revenue Cycle staff? 3. What
More informationRetrospective Denials Management
Retrospective Denials Management Weaving together the Clinical, Technical, and Legal Components Glen Reiner, RN, BSN, VP of Clinical Operations Nicole Guido, VP Business Development Our goals for our time
More informationHFMA MAP Keys Patient Access Measure:
HFMA MAP Keys Patient Access Pre-Registration Rate Trending indicator that patient access processes are timely, accurate, and efficient Indicates revenue cycle efficiency and effectiveness N: number of
More informationRevenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps
Common Findings Revealed: Revenue Cycle Review John Bartell, RN, BSN, Partner Tina Nazier, MBA, Director Wipfli LLP Topics for Discussion Revenue Cycle Objectives Challenges Management Goals and Expected
More information6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series
6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the
More informationRevenue Cycle Management
Revenue Cycle Management ~Becoming a patient focused but metrics driven Revenue Cycle team~ Presented by: Kimberly Moore Director, Health Care Revenue Cycle Consulting 701.239.8673 kmoore@eidebailly.com
More information6 Critical Impact Factors of Health Reform on Revenue Cycle Management
6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the
More informationTransformational Data-Driven Solutions for Healthcare
Transformational Data-Driven Solutions for Healthcare Transformational Data-Driven Solutions for Healthcare Today s healthcare providers face increasing pressure to improve operational performance while
More informationTen Overlooked Opportunities For Significant Performance Improvement and Cost Savings
Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Huron Healthcare s Performance
More information6 Critical Impact Factors of Health Reform on Revenue Cycle Management
6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the
More informationBetter Analysis of Revenue Cycle and Value-Based Purchasing Data Improves Bottom Line
Better Analysis of Revenue Cycle and Value-Based Purchasing Data Improves Bottom Line Written by Katy Smith Senior Business Analyst Health Care DataWorks Better Analysis of Revenue Cycle and Value-Based
More informationConifer Health Solutions Tenet Investor Webinar
Conifer Health Solutions Tenet Investor Webinar May 16, 2012 Stephen Mooney President, Conifer Health Solutions 1 2012 Conifer Health Solutions, LLC. All Rights Reserved. Forward Looking Statements Certain
More informationOur Journey to the MAP Award. Thursday, March 19, 2015
Our Journey to the MAP Award Thursday, March 19, 2015 Mission As a Catholic Healthcare Ministry, we provide comprehensive and compassionate care that improves the health of the people we serve. Snapshot
More informationNEVADA RURAL HOSPITAL BENCHMARKING INITIATIVE AND NEVADA RURAL HOSPITAL REVENUE CYCLE INITIATIVE
NEVADA RURAL HOSPITAL BENCHMARKING INITIATIVE AND NEVADA RURAL HOSPITAL REVENUE CYCLE INITIATIVE Nevada Rural Hospital Benchmarking Two core, cross cutting initiatives undertaken by Nevada Flex Program
More informationUniversity Healthcare Administrative Policy
Page 1 of 6 APPROVED BY: Signatures on File FINANCIAL POLICY (UH) is a not-for profit teaching hospital committed to providing quality health care services. In order to provide necessary medical services
More informationUsing Six Sigma Concepts to Improve Revenue Cycle
Using Six Sigma Concepts to Improve Revenue Cycle Presented by Joseph Koons, MHSA, FHFMA, CRCE-I Managing Director, Revenue Cycle Centra Health Lynchburg Virginia March 4, 2014 Agenda Introduction to
More informationThe Power of Business Intelligence in the Revenue Cycle
The Power of Business Intelligence in the Revenue Cycle Increasing Cash Flow with Actionable Information John Garcia August 4, 2011 Table of Contents Revenue Cycle Challenges... 3 The Goal of Business
More informationhealthcare services, provided that a member, in good standing, of SJMH s medical staff determines the need for such medical care treatment.
St. James Mercy Hospital Policy Section: General Information Policy Name: Charity Care/Financial Assistance Developed by: Dave Capone Date: 2/1/07 Page 1 of 13 PURPOSE St. James Mercy Health (SJMH) is
More informationRejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle
Rejection Prevention How Actionable Data Can Drive Results in Your Revenue Cycle Objectives Build a data collection strategy in denials and rejections that drives action and ultimately improved results
More informationDecember 2011 PRACTICE CHECK-UP. XYZ Anesthesia Group. AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.
December 2011 PRACTICE CHECK-UP XYZ Anesthesia Group AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.com (908)-279-8120 AdvantEdge Healthcare Solutions Anesthesia Practice Check-Up I. Introduction:
More informationGranville Health System
Approved by: Granville Health System FINANCIAL POLICY Effective Date: Revised Date(s): FINANCIAL POLICY - DRAFT 09-16-2014 Granville Health System is a not-for profit hospital committed to providing quality
More informationWestchester Medical Center. 2014 Operating Budget
Westchester Medical Center 2014 Operating Budget December 4, 2013 WESTCHESTER COUNTY HEALTH CARE CORPORATION Operating Budget 2014 Table of Contents Page Executive Summary 1 Detailed Discussion of Revenue
More informationBack 2 Basics: Revenue Cycle: KPI, Risk Factors, and Compliance
Back 2 Basics: Revenue Cycle: KPI, Risk Factors, and Compliance March 25, 2010 Claudia Birkenshaw Garabelli, MSA President Modern Management Muse, Inc -- the ART of HealthCare Finance 1 Our Time Together
More informationCycle Dashboard. G2N, Inc. Honest & Healthy Bottom Lines
Managing Operations By A Revenue Cycle Dashboard Mission of G2N We work to ensure America s healthcare providers have honest & healthy bottom lines in order to continue to fulfill their mission of improving
More informationUniversity of Mississippi Medical Center. Access Management. Patient Access Specialists II
Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue
More informationProvider Revenue Cycle Management (RCM) and Proposed Solutions
Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive
More information5 KPIs That Require Revenue Cycle Managers' Attention. Devendra Saharia FEATURE STORY. healthcare financial management association www.hfma.
SEPTEMBER 2014 healthcare financial management association www.hfma.org FEATURE STORY 5 KPIs That Require Revenue Cycle Managers' Attention Devendra Saharia Devendra Saharia REPRINT September 2014 healthcare
More informationA Primer on Ratio Analysis and the CAH Financial Indicators Report
A Primer on Ratio Analysis and the CAH Financial Indicators Report CAH Financial Indicators Report Team North Carolina Rural Health Research and Policy Analysis Center Cecil G. Sheps Center for Health
More informationProtect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit
Protect and Improve Profitability in Your Practice Positioning Your Organization for a RAC Audit 2011 Annual Educational Seminar March 9, 2011 Presented By: Cindy Tipton-Cain, Exec. Director Physician
More informationThe New Gold Standard in PASC s and Regional Service Centers RSC s: Best Practices for Centralizing Operations that Improves Revenue Cycle
The New Gold Standard in PASC s and Regional Service Centers RSC s: Best Practices for Centralizing Operations that Improves Revenue Cycle Today s Learning Lab Panel Mary Anne Pace Vice President, Consulting
More informationHealthcare Revenue Cycle and Collection Considerations
Healthcare Revenue Cycle and Collection Considerations Vince Marzula, BNY Mellon Paul Ishizuka, University of Washington January 30, 2012 UW Medicine School of Medicine, 4 hospitals, 30 primary care clinics,
More informationREVENUE CYCLE MANAGEMENT : A DEEPER DIVE
REVENUE CYCLE MANAGEMENT : A DEEPER DIVE 2016 TABLE OF CONTENTS Introduction The Participants Revenue Cycle Steering Committee Personnel Accounting Platform Service Outsourcing Performance Metrics Accounts
More informationPatient Finance Services Policy
Patient Finance Services Policy CONEMAUGH HEALTH SYSTEM FINANCIAL ASSISTANCE POLICY I. PURPOSE Conemaugh Health System is a community of persons committed to being a transforming, healing presence in the
More informationExploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012
Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 4 th Quarter 2012 March 8, 2013 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors
More informationThe Road to Performance. Evaluating Metrics and Benchmark Trends in the Revenue Cycle June 2012
The Road to Performance Evaluating Metrics and Benchmark Trends in the Revenue Cycle June 2012 1. philosophy 2. resources 3. framework 2 Confidential Services 3 Confidential Services 4 Confidential Services
More informationPatient Account Services. Patient Reference & Frequently Asked Questions. Admissions
Patient Account Services Patient Reference & Frequently Asked Questions Admissions Each time you present for a new medical service, a new account number will be assigned. You will be asked to pay any patient
More informationRevenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013
Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process
More informationRevenue Cycle Management
Revenue Cycle Management Manage and Improve Your Results with Origin RCM Financial pressures are escalating for both healthcare providers and patients. In this challenging climate, a wellmanaged revenue
More informationThe Big Data Dividend
The Big Data Dividend Enhancing Revenue in an Era of Change May 7, 2015 Agenda Big Data Sample Healthcare Big Data Sets Healthcare Applications of Big Data Revenue Enhancement Opportunities Rate Benchmarking/Rate
More informationtreating technology as a luxury?
FEBRUARY 2007 healthcare financial management Steven H. Berger treating technology as a luxury? 10 necessary tools If you ve been thinking that technology for improving healthcare financial management
More informationA Measure of Success Using KPIs to Accelerate Revenue Cycle Performance
A Measure of Success Using KPIs to Accelerate Revenue Cycle Performance Sandy Richman, Director of Advisory Services Daniel Bergantz, Director of Advisory Services PNC Healthcare March 23, 2015 Today s
More informationKey Performance Indicators for Physician Practices. Sam Eddy Director, Physician Practice Consulting, QHR
Key Performance Indicators for Physician Practices Sam Eddy Director, Physician Practice Consulting, QHR You can ask a question by clicking the blue? icon or through the orange speech bubble icon. 2 Evaluate
More informationBeyond the Basics: Accelerating the Revenue Cycle Through Advanced KPI s
Optimizing the business of healthcare Beyond the Basics: Table of Contents Overview 1 The Importance of Metrics 1 Taking the Next Step 1 Baseline KPI s 2 Why Advanced KPI s 2 Advanced KPI s In Action 3
More informationCapacity Management: Patient Throughput and Case Management Improvement. February 25, 2015
Capacity Management: Patient Throughput and Case Management Improvement February 25, 2015 Agenda Introduction Impetus for Change Approach to Improving Case and Capacity Management Client Case Study Key
More informationClinical Integration Concepts for Successful Population Health
Annual Conference November 12, 2015 Presented by: Jane Jerzak, RN, CPA, Partner Clinical Integration Concepts for Agenda Population Health and the Movement Toward Clinical Integration Consumerism Patient
More informationExploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 2 nd Quarter 2015
Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 2 nd Quarter 2015 September 10, 2015 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit
More informationMANAGING THE REVENUE CYCLE WITH BUSINESS INTELLIGENCE: June 30, 2006 BUSINESS INTELLIGENCE FOR HEALTHCARE
MANAGING THE REVENUE CYCLE WITH BUSINESS INTELLIGENCE: June 30, 2006 BUSINESS INTELLIGENCE FOR HEALTHCARE Hospital manager and leadership positions face many challenges in today s healthcare environment
More informationOur clients count on us, and we deliver.
Experts in Revenue Cycle Management For Medical Practices and Imaging Centers For over 20 years, we have forged successful partnerships with medical practices and imaging centers to improve their revenue
More informationFinancial Accounting and Management Reports
Financial Accounting and Management Reports To manage a medical practice effectively, whether it be a solo or a group practice, the practitioner and its managers and advisors must have continual access
More informationPOLICY. Title: Financial Assistance (Charity Care/Uncompensated Care) Approver: Kootenai Health Board Date: 09/29/2014
Title: Financial Assistance (Charity Care/Uncompensated Care) Approver: Kootenai Health Board Date: 09/29/2014 Kootenai Health is committed to excellence in providing high quality health care services
More informationEmpowering healthcare organizations with data, analytics and insight
Empowering healthcare organizations with data, analytics and insight Integrated patient access, claims and contract management and collections products and consultative services for redefining your healthcare
More informationENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard
ENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard ICD-10 Lisa Kozakoff Principal Consultant Siemens Healthcare Lisa Kozakoff Principal Consultant Agenda Introduction
More informationCHANGING YOUR CASE MANAGEMENT MODEL OF CARE. Jan Lear, RN, CMC Director of Case Management MedStar Franklin Square Medical Center
CHANGING YOUR CASE MANAGEMENT MODEL OF CARE Jan Lear, RN, CMC Director of Case Management MedStar Franklin Square Medical Center 1 Program Objectives To be able to describe the compliance and regulatory
More informationSolution Overview. Fusion Health Advantage Big Data Accelerator Platform
Solution Overview Fusion Health Advantage Big Data Accelerator Platform Improve Patient Outcomes And Manage Them Cost Effectively Healthcare reform measures have intensified governmental scrutiny, thereby
More informationRevenue Integrity Strategies
Agenda Discuss the key activities performed, risks and typical deficiencies that exist, and various process improvement strategies within the following revenue cycle components: Patient Access Utilization
More informationThe Changing Face of Medical Necessity under ICD-10
The Changing Face of Medical Necessity under ICD-0 Sponsored by 95 N. Fine Ave #04 Fresno CA 93720-565 Phone: (559) 25-5038 Fax: (559) 25-5836 www.californiahia.org Program Handouts Monday, June 8, 205
More informationAMN Healthcare Investor Presentation
AMN Healthcare Investor Presentation Q2 2015 The Innovator in Healthcare Workforce Solutions and Staffing Services Forward-Looking Statements This investor presentation contains forward-looking statements
More informationRevenue Cycle Management
UNITED COLLECTION BUREAU, INC. 5620 Southwyck Blvd. Toledo, OH 43614 866.209.0622 ucbinc.com The Business Case for Outsourcing Revenue Cycle Management Getting reimbursed for services rendered is more
More informationSuccessfully Implementing a Revenue Cycle Self-Pay Solution by Marty Callahan
This article appeared in the September 2008, issue of hfm, published by the Healthcare Financial Management Association. Successfully Implementing a Revenue Cycle Self-Pay Solution by Marty Callahan At
More informationMeasurable Results: Establish service excellence. Reduce errors by 50% The choice for progressive medical centers.
The choice for progressive medical centers Delivering tailored solutions to modern healthcare organization complexities by integrating a unique blend of strategies with wide-ranging industry experience.
More informationCurrent Trends in Revenue Cycle Performance Benchmarks, Outsourcing and Reform
Current Trends in Revenue Cycle Performance Benchmarks, Outsourcing and Reform 1 Discussion Outline Discussion Objectives and Approach Process Definition Leading Practice Comparison Trends in Outsourcing
More information9/28/2015. HFMA s Patient Friendly Billing Focus. Initiatives: Best Practices. Agenda. Iowa Hospital Association Annual Meeting October 6, 2015
HFMA s Patient Friendly Billing Initiatives: Best Practices Iowa Hospital Association Annual Meeting October 6, 2015 Sandra Wolfskill, FHFMA Director Healthcare Finance Policy HFMA Agenda Meet Jack! HFMA
More informationHaving Trouble Explaining and Predicting Net Revenue?
Having Trouble Explaining and Predicting Net Revenue? Crowe Revenue Cycle Analytics Audit Tax Advisory Risk Performance The Crowe Revenue Cycle Analytics Solution As shown below in use by hundreds of hospitals
More informationEFFECTIVE DATE: 6/01/2015 LAST REVISED DATE: 06/01/2015
TITLE: Financial Assistance/Charity Care SEARCH WORD: Charity; Indigent; Assistance DEPARTMENT: Patient Access Services, Business Office, Accounting, Administration, Mission Services VP APPROVAL: Marty
More informationCHAPTER 17 CREDIT AND COLLECTION
CHAPTER 17 CREDIT AND COLLECTION 17101. Credit and Collection Section 17102. Purpose 17103. Policy 17104. Procedures NOTE: Rule making authority cited for the formulation of regulations for the Credit
More informationAged Accounts Receivable
Aged Accounts Receivable Agenda Introduction Objectives About Us Overview Benefits Process Analysis Reporting Investment Next Steps Introduction John Boland John Boland is vice president at MedSynergies
More informationThe ROI of IT: Best Billing Practices
The ROI of IT: Best Billing Practices 1 R O S E M A R I E N E L S O N M G M A H E A L T H C A R E C O N S U L T I N G G R O U P The information and materials provided and referred to herein are not intended
More informationFinancial Assistance Program AKA Charity Care/Uncompensated Care Program
Policy POLICY NO. 100. 85300.600 EFFECTIVE 12/90 REVISED 03/2014 Page 1 of 12 SUBJECT: APPLICATION: PURPOSE: POLICY: Financial Assistance Program AKA Charity Care/Uncompensated Care Program All Departments
More informationCreating a Virtual CBO while guaranteeing AR performance. University of Maryland Medical System Case Study
Creating a Virtual CBO while guaranteeing AR performance University of Maryland Medical System Case Study Today s objectives Do you really need to convert your hospital information system?» Alternatives
More informationThe Joint Commission Page 1 of 6
The Joint Commission Page 1 of 6 PURPOSE The Regional Medical Center recognizes that as part of its mission, there will be instances where care is provided to individuals that do not have healthcare insurance,
More informationOutsourcing Revenue Management Can Pay Big Dividends for Clinical Labs
Outsourcing Revenue Management Can Pay Big Dividends for Clinical Labs A report by Donna Beasley, DLM (ASCP) McKesson Revenue Management Solutions, Laboratory Effective management of a clinical laboratory
More informationRecovery Auditors and Fee-for-Service Medicare DIVISION OF RECOVERY AUDIT OPERATIONS CENTERS FOR MEDICARE & MEDICAID SERVICES
Recovery Auditors and Fee-for-Service Medicare 1 DIVISION OF RECOVERY AUDIT OPERATIONS CENTERS FOR MEDICARE & MEDICAID SERVICES What is a Recovery Auditor? The Recovery Auditors are CMS contractors who
More informationRevenue Cycle Executive Roundtable Preparing for ICD-10: Staying the Course
Revenue Cycle Executive Roundtable Preparing for ICD-10: Staying the Course Presented by Industry Leaders Moderated by 3M HIS and HFMA A 3M Health Information Systems (HIS) Sponsored Webinar April 17,
More informationRural Hospital Performance Improvement (RHPI) Project
Rural Hospital Performance Improvement (RHPI) Project Best Practice Concepts in Revenue Cycle Management August 8, 2014 600 East Superior Street, Suite 404 Duluth, Minnesota 55802 Phone: 218-727-9390 info@ruralcenter.org
More informationThe University of Texas Southwestern Medical Center Denials Management Audit University Hospitals. Internal Audit Report 14:10B
Office of Internal Audit The University of Texas Southwestern Medical Center Denials Management Audit University Hospitals Internal Audit Report 14:10B November 19, 2014 Table of Contents I. Executive
More informationPurpose Statement Outlines purpose of and guidelines for receiving charity care or financial assistance at Valley Children s Hospital.
Policy/Procedure Number AD-3004 Policy/Procedure Name Charity Care Financial Assistance Type of Policy/Procedure Administration Date Approved 12/14 Date Due for Review 12/17 Policy/Procedure Description
More informationHITAM. Business Intelligence for Hospitals: Empowering Healthcare Providers to Make Informed Decisions through Centralized Data Analysis
Business Intelligence for Hospitals: Empowering Healthcare Providers to Make Informed Decisions through Centralized Data Analysis Healthcare providers today are impacted by an acute combination of rising
More informationOverview of Hospital Utilization Review
Overview of Hospital Utilization Review Legal Authority The Inspector General (IG) hospital utilization review function operates under guidelines and regulations contained in: Texas Administrative Code
More informationTransfer DRGs: Approaches to Revenue Recovery. A BESLER White Paper
Transfer DRGs: Approaches to Revenue Recovery A BESLER White Paper June 2014 Copyright 2014 BESLER Consulting. All rights reserved. *HFMA staff and volunteers determined that Transfer DRG Revenue Recovery
More informationThe Changing Landscape of Healthcare and What it means to you!
The Changing Landscape of Healthcare and What it means to you! Marc Leighton Imagination at work. How do hospitals/providers get paid? Introduction to Payment Mechanisms DRG- or APDRG-based mechanisms
More informationCOLLABORATIVE CARE MANAGEMENT. throughout the continuum
COLLABORATIVE CARE MANAGEMENT throughout the continuum OPTIONAL modules Morrisey helps hospitals and other healthcare providers achieve measurable clinical, process and financial outcomes. Our products
More informationEHR Client Bulletin: Answers to Your Most Frequently Asked Condition Code 44 Questions
EHR Client Bulletin: Answers to Your Most Frequently Asked Condition Code 44 Questions Originally Issued On: February 25, 2010 Last Update: February 20, 2013 UPDATE: The following EHR Client Bulletin was
More informationManagement Reporting Part I: Standard Reports and Measurements. by Patricia A. Kroken, FACMPE
Management Reporting Part I: Standard Reports and Measurements by Patricia A. Kroken, FACMPE Monitoring practice performance indicators at regular intervals enables physician and administrative leadership
More informationCertified Healthcare Financial Professional
Certified Healthcare Financial Professional Certification Basics Friday, February 25, 2016 Courtney Stevenson, MSA WA/AK HFMA Certification Committee Co-Chair Agenda Module I The Business of Healthcare
More informationHealthcare Reform: An Analysis of the Impact on Healthcare Providers
Healthcare Reform: An Analysis of the Impact on Healthcare Providers Background The financial impact from the Affordable Care Act on providers from changes in Medicare reimbursement have been well documented
More informationWHITE PAPER. Payment Integrity Trends: What s A Code Worth. A White Paper by Equian
WHITE PAPER Payment Integrity Trends: What s A Code Worth A White Paper by Equian June 2014 To install or not install a pre-payment code edit, that is the question. Not all standard coding rules and edits
More informationThe Patient Contact Center: Finding My Way!
The Patient Contact Center: Finding My Way! Presented by James Hawkins SVP, Patient Contact Center Convergent 1 For Today s Discussion Market Conditions ANI Survey Results Patient Contact Center Overview
More informationA Roadmap for Modernizing the Health Care Revenue Cycle
A Roadmap for Modernizing the Health Care Revenue Cycle 1 March 2016 Timothy Panks Senior VP, Finance and Revenue Management Douglas Hires Senior VP, Strategic Client Relationships Conflict of Interest
More informationWhat the New Health Economy Means for your Revenue Cycle
www.pwc.com/healthcare What the New Health Economy Means for your Revenue Cycle South Carolina HFMA Annual Institute Our Agenda for Today I. Today s Revenue Cycle The Case for Change II. Healthcare Reform
More informationPre-Employment Test for Business Office Staff Answer Key
P a g e 1 Pre-Employment Test for Business Office Staff Answer Key 1. Mr. Walker owes $83.25. His health plan requires a 20% coinsurance. How much does he owe? Answer: $16.65 2. Scenario: Your practice
More information12 16 Memorial Physician Network Billing Cycle Audit Report
O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12 16 Memorial Physician Network Billing Cycle Audit Report September 2012 O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12
More informationEISENHOWER MEDICAL CENTER Financial Assistance Program Full Charity Care and Discount Partial Charity Care Policies
EISENHOWER MEDICAL CENTER Financial Assistance Program Full Charity Care and Discount Partial Charity Care Policies PURPOSE Eisenhower Medical Center (EMC) serves all persons within Rancho Mirage and the
More informationEmpowering Value-Based Healthcare
Empowering Value-Based Healthcare Episode Connect, Remedy s proprietary suite of software applications, is a powerful platform for managing value-based payment programs. Delivered via the web or mobile
More informationHow to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice
How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice Janice Crocker, MSA, RHIA, CCS, CHP Introduction Reimbursement for medical practices has been impacted by various trends and
More informationWestchester Medical Center. 2012 Operating Budget
Westchester Medical Center 2012 Operating Budget December 7, 2011 WESTCHESTER COUNTY HEALTH CARE CORPORATION Overview Westchester Medical Center s (WMC) 2012 Operating Budget reflects significant reductions
More informationHackensack University Medical Center Administrative Policy Manual. Effective Date: January 2016 Page 1 of 11
Policy #: 1845 Hackensack University Medical Center Administrative Policy Manual Effective Date: January 2016 Page 1 of 11 Purpose: To identify the governing rules for the collection of all fees associated
More informationHow To Use Business Intelligence (Bi)
Business Intelligence: How better analytics can lead your business to higher profits. Introduction The economic downturn is forcing business leaders to rethink strategic plans. To remain competitive, businesses
More informationRevenue Cycle Management Excellence Easily improving bottom line!!!!!
Revenue Cycle Management Excellence Easily improving bottom line!!!!! SN Academy Seminar 9 th May 2014 PRR 5/5/14 Revenue Cycle Management ; Are you doing it right? Are you earning what you deserve? Do
More informationWestchester Medical Center. 2015 Operating Budget
Westchester Medical Center 2015 Operating Budget December 3, 2014 WESTCHESTER COUNTY HEALTH CARE CORPORATION Operating Budget 2015 Table of Contents Page Executive Summary 1 Detailed Discussion of Revenue
More informationNot all NLP is Created Equal:
Not all NLP is Created Equal: CAC Technology Underpinnings that Drive Accuracy, Experience and Overall Revenue Performance Page 1 Performance Perspectives Health care financial leaders and health information
More information