Revenue Cycle Management Industry Trends and Tips to Improve Efficiency

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1 Revenue Cycle Management Industry Trends and Tips to Improve Efficiency Bob Svendsen, Chief Executive Officer February 7, 2013

2 CHMB Who We Are Founded in 1995 o Privately Held o Inc Award Winner ( ) o Profitable and Well Funded for Growth Partners w/ Allscripts since 2007 o Star Reference Site o Deeply Connected Across Multiple Disciplines o Enterprise EHR//PM and Professional EHR/PM o Hosting, Implementation and Support o RCM Services o HCLS Partner w/ Dell since ,500 + physicians (13,000 + end-users) o staff in 24/7 work-cycle o Locations San Diego, Irvine, Oakdale and Chicago o Customers Located Across U.S. o Remote Workforce 15 Different States Largest Install of Allscripts PM o Allscripts PM Databases Built, Deployed and Supported o 30,000 + Implementation Hours Annually o 1,000 + physicians supported on EHR Service Technology Results Physician Centric Physician/Hospital Alignment ACO Leading Technology Leverages Staff Efforts and Allows Repurposing of Staff End-to-End Revenue Cycle Solution Optimizes Results

3 Key Industry Trends Consolidation New Business Models Connectivity and Interoperability Reliance on Data Unfunded Mandates

4 Risk Factors Rate of Change Exceeds Capabilities Scalability of Infrastructure Human/Tech Stuck in a Silo Business Intelligence Resource Constraints

5 Revenue Cycle Management Success Dedicated Revenue Cycle Team o Team Model - Dedicated Team with Support Infrastructure to Enable Optimum Performance o Workflows Complement Technology o Auditing + Accountability = Performance Claims Executive Leadership Advocacy IT Reporting/ Analytics Reconciliation, Tracking & Auditing Rev Cycle Team Account Manager Data Entry Payment Posting Patient Calls Appeals Follow-Up Information Services Conversions Interfaces Compliance Document Imaging Application Support

6 Blocking and Tackling RCM Basics 1) Policies, Procedures and Processes Documented 2) Accuracy and Timeliness of Information Clean Claims 3) Time of Service Collections and Self-Pay Collection Policy and Technology 4) Productivity Measures Clinical, Administrative and Financial Staff 5) Claims Submission Process, Process, Process 6) Work Aging Buckets Proactively and Consistently Know your AR 7) Review and Audit Coding EHR Charge Capture Spotlights Physician Challenges 8) Review and Enforce Contracts 5% or More 9) Application Expertise New Products with Increasingly Enhanced Capabilities 10) Manage to Goals - That which gets measured gets done! Noun blocking and tackling (idiomatic, US) Basic tasks or skills in an undertaking or occupation.

7 Key Revenue Cycle Metrics Days in AR 39.5 Net Collection % 99.1 AR Over 90 Days % 17.0 First Pass Clean Claims % 97.1 Other Benchmarks: Service Date to Receive Date Receive Date to Post Date Denial Rate Contract Performance Results will vary by practice as many factors contribute to overall revenue cycle success

8 Allscripts/CHMB RCM Services Shifting the Responsibility Allscripts/CHMB Responsibilities PM SYSTEM HOSTING Provide for PM System Access for Authorized Users Provide for System Failsafe, Backup, & Redundancy PM SYSTEM IMPLEMENTATION & TRAINING Best Practice Based PM System Implementation & Training Client Staff Responsibilities PATIENT REGISTRATION Patient Demographic Capture Insurance Card Scanning & Documentation Capture PATIENT SCHEDULING & PRE-VISIT MANAGEMENT Patient Appointment Scheduling Batch & Real-Time Eligibility Processing Eligibility & Appointment Confirmation Exception Follow-up MISSING INORMATION FOLLOW-UP Attend to Work Queue with Data Requests for Missing Information DATA ENTRY & POSTING Posting Charges Posting Payments (Patient & Insurance) INSURANCE FOLLOW-UP Claims Submissions / Patient Statements Insurance Follow-Up/Correspondences Filing appeals & follow-up and tracking status Reporting denials & underpayments Liaison with payers PATIENT COLLECTIONS Patient account inquiries Requests for correct/updated information Letters to delinquent/no-pay accounts Phone calls to delinquent/no-pay accounts Prepare accounts to send to collections

9 Resource Re-Allocation A change to the status quo fosters opportunities to evaluate operational resources and priorities particularly at the staff level. New technology, new business models and a changing marketplace all create new opportunities for deploying staff resources in a new more effective model. Charge Entry Clerks = Charge Review Specialists Biller/Coders = Physician Educators Patient Registration Clerks = Patient Financial Services Reps IT Specialists = Business Intelligence Analysts

10 Summary 1) Understand the Impact of Industry Trends Financial, Technical and Human 2) Assess Risk Factors to Your Organization How Much Risk Can You Absorb? 3) Find Alignment Balance Are You Aligned with All Stakeholders? 4) Evaluate Core Competencies Policy, Procedure and Process 5) Take Care of the Basics Blocking and Tackling 6) Measure and Manage to Goals