Our Journey to the MAP Award. Thursday, March 19, 2015

Transcription

1 Our Journey to the MAP Award Thursday, March 19, 2015

2 Mission As a Catholic Healthcare Ministry, we provide comprehensive and compassionate care that improves the health of the people we serve.

3 Snapshot Located in Northern Kentucky Part of the Greater Cincinnati Market 5 Inpatient Hospitals and 1 ED/Ambulatory Care Center 1,000 Licensed Beds $1,000,000,000 in Net Revenue Group of 400 Physicians and Mid-Level Providers

4 Background Merger of the St. Luke Hospitals and St. Elizabeth in 2008 Implemented EPIC in 2010 EPIC HB was not fully built out at the time of go-live Continued to use bolt-ons to manage AR Heavy use of third party vendors as solutions Partially centralized Revenue Cycle Operation Cost to Collect was 6%

5 What is MAP? Winners show innovative and effective Revenue Cycle practices that deliver sustainable financial performance based on HFMA s MAP s comprehensive strategy that allows organizations to: Measure Revenue Cycle Performance using the industry-standard MAP Keys. Apply evidence-based strategies for improvement. Perform to the highest standards to improve financial results and patient satisfaction. St. Elizabeth Healthcare has been awarded the Healthcare Financial Management Association (HFMA) 2014 MAP Award for High Performance in Revenue Cycle. We were recognized for meeting or exceeding evaluation criteria addressing critical performance factors such as revenue cycle processes, financial performance, innovation, adoption of patient friendly billing principles, and patient satisfaction.

6 The 3 Year Journey At the time, the AR wasn t really broken. We were just working really hard to make things work. Plus, it was costing too much to collect No formal Customer Service training Denials were not mapped correctly inside of EPIC Denials were outsourced AR was being worked out of a bolt-on Access and Business Office goals were not aligned Director and Managers were not empowered to make change

7 First Things First Created: Sense of Urgency Culture of Accountability Identified the talent The Keepers Put the talent where they could be most successful Recruited a strong leadership team

8 Talking Points Today Customer Service Improvements Organization Re-Design Staffing Analysis Point of Service Collections Vendor Management Cost-to-Collect ACA Impact RAC Department Denials Self Pay Cash posting DNFB Payment Variance Late Charge Bad debt Corporate KPI

9 Organizational Re-Design/Staffing Analysis By Department Essentially right sizing the departments In the end, we actually ending up adding staff due to insourcing

10 Before Re-Design - Org Chart

11 Current State Org Chart

12 ACA Impact Self Pay to Medicaid Conversion We focused on interviewing all emergency room and inpatient self pay patients to determine eligibility for the new expanded Medicaid programs at the time of service. Scheduled outpatients were also interviewed. If the patient was deemed to be eligible, the application was completed online with the patient at the time of service. This approach resulted in immediate approval if no further documentation was required. If further follow up was needed, we aggressively worked with the patient to expedite the Medicaid approval.

13 Self Pay to Medicaid Conversion

14 Customer Service Performed an RCA regarding call volume Redesigned statements Monitored success by tracking Statement-to-Call Ratio Introduced a formal training program Created a dedicated Financial Assistance Unit Results: Complaints essentially disappeared Improved staff morale

15 STC RATIO SLIDE

16 Customer Service

17 POS Collections We revamped our point of service collection procedure in March of Collections went from $150,000 to over $700,000 (average) per month by the end of The Patient Access team developed monthly individual scorecards to evaluate staff on their performance. These tied directly to the KPI s for the department. They were evaluated on their POS collections, customer service, quality, and productivity. Managers have monthly discussions with their staff to review the metrics and develop plans for improvement if necessary.

18 POS (cont.) The key to success was: Provide education Provide scripting and daily feedback Accountability Ensure every patient is asked every time Provide an estimate for all scheduled procedures and offer a discount if the patient pays at that point Our Pre-Access Team improved their collections from $4.9 in 2013 million to $8.3 million in 2014.

19 POS

20 Self Pay / Financial Assistance Know what is in your self pay Creating a dedicated Financial Assistance Unit Is your patient statement friendly

21 What s in Self Pay? What is True Self pay AR versus residual? What is going to Bad Debt? What is on a payment plan? What AR is greater than 90, 180, 365 days?

22

23 Self Pay AR Categories FAP Not Returned With Dialer Unit Delinquent PMT Plan LTR FAP Denied FAP Incomplete Charity AP Requested Hardship Committee Review Review for Bad Debt Acct on a Payment Plan Risk Mgmt. Hold

24 Bad Debt Bad Debt Vendor reduction Primary Agency 4 to 2 Secondary Agency 2 to 1 Legal Several to 1 Allowed us to negotiate better rates by leveraging higher volumes Managing fewer relationships created more consistencies, less confusion for our staff -Insurance adds, bankruptcies, financial assistance Managed fewer interfaces for BD file transfers, BD payment files, Close Backs -Less employee training -Less potential for error

25 Bad Debt Write-offs

26 Financial Assistance Re-Design: Self Pay - Revised the Financial Assistance Policy to ensure we remain compliant with the responsibilities articulated within the proposed Regulations pertaining to Section 501(r) under the Affordable Care Act - Created dedicated Financial Assistance Program (FAP) Unit within the Self-Pay Department - Dedicated FAP phone line - Streamline the FAP process FAP applications & approval process and added to the back of the statement - Created new Financial Hardship Assistance Program for those who did not qualify under the standard FAP program

27 New Statement

28 Denial Re-Design Denials Management was insourced in a phased approach Utilized Epic to automate workflow 835 denial codes mapped to employee WQ s Clinical and technical teams created Performance metrics were created Weekly and monthly data sharing established awareness and accountability Collaborative teams were formed between Revenue Cycle and Clinical Departments Clinical Departments were able to reduce denials by as much as 53%. Front end scheduling and prior authorization improvements Medical necessity improvements Improved documentation Quality checklists

29 Initial Denials %

30 Denial Write-off %

31 Initial Denials by Category

32 Denial Write-Offs by Category

33 RAC Created RAC Team Cleaned the data base Interfaced a RAC software to EPIC Mapped out the Workflow Identified our liability

34 Medicare RAC Workflow

35 RAC (cont.)

36 Cash Posting Cash Posting leveraged existing technology 95% electronic posting percentage Utilizing bank technology to convert paper remits to 835 s. Route no pays and correspondence through Banks document management technology Work in 4 days Funds Verification to match EOB s/era s to EFT s Added a one day delay for cash posting Credit Balance Monitoring from Dashboard

37 Cash Posting (cont.)

38 Candidate for Bill Accountability Utilized Epic Dashboard to separate Edits by owning area Each department had goals based on days of revenue held up from billing Goal is under 3 days of average daily revenue in the Candidate for Bill Build edits in coding days so bill can drop after coding is completed Created alerts Coding not started from 3 days of discharge Physician queries, HAC s

39 CFB (cont.)

40 CFB (cont.)

41 Payment Variance Utilize the expertise you have in-house Utilize the expertise of a qualified Vendor/Partner Utilize your Practice Management System to it s capacity Have a good balance

42 Underpayments Flow Chart

43 Vendor Management Reviewed ALL Vendor Contracts Vendor Realization Approach - Business Case Analysis Recommendation & Timeline Objective approach during RFP process Constantly monitoring vendor s performance and cost. Re-evaluate contracts on a regular basis.

44 CTC Dashboard

45 CTC Dashboard By Department

46 Late Charges Issue Identified Late Charges were consistently over 4% of the total daily charges which potentially affected the net revenue collections. The definition of a Late Charge for this reporting is Transaction Posting Date greater than 4 days from the Service Date Plan to Address The Director of the CDM/Charge Capture formed a committee with the representatives from those departments who consistently had high levels of Late Charges Initially a monthly report was generated and distributed to all revenue producing departments Goals Established -1.75% Action Plan Developed Every revenue producing department s Manager and Director were personally visited by the Director of the CDM/Charge Capture Previous and current Late Charges/Trends were reviewed Individual corrective action plans were developed Daily Clarity reporting ability through EPIC was then requested by the Director of the CDM/Charge Capture On-Going Communication Monthly reports continue to be distributed Daily reports are now completed and reviewed by the Director of the CDM/Charge Capture Departments with unusual increases receive the report requesting an explanation of the variance Positive reinforcement is routinely communicated as we now have met and exceeded our goal Conclusion Total reductions from was $62 Million

47 Late Charges

48 KPI Dashboard

49 Questions?