Creating a Virtual CBO while guaranteeing AR performance. University of Maryland Medical System Case Study

Transcription

1 Creating a Virtual CBO while guaranteeing AR performance University of Maryland Medical System Case Study

2 Today s objectives Do you really need to convert your hospital information system?» Alternatives to HIS conversion» How the efr customizable, intelligent workflow transformed revenue cycle processes within the University of Maryland Medical System» How robust dashboard reporting allowed UMMS to respond quickly to trends impacting cash from operations» How UMMS gained greater accountability, transparency, productivity and efficiency in its revenue cycle operations Jupiter Images photos

3 Conversion Aversion Hospital information conversions are major events that put significant pressure on all departments and processes within the revenue cycle The result of HIS conversions typically include:» Increased DNFB and unbilled» Increased AR days» Decreased cash collections How can you avoid conversion and extend the life and functionality of your existing hospital information system?

4 The efr Bridge Single HIS Multiple HIS Single HIS (same) Extend life and expand revenue cycle tools through efr workflow and functionality Enterprise reporting adds business intelligence Multiple HIS (different) All HIS feed efr Standardization in look and process Enterprise reporting combines all facilities/his under common KPIs

5 The efr Bridge Single HIS Single HIS (different) Both HIS feed efr, historical (original HIS) data and new HIS data in one place Standardization in look and process Minimize user training and learning curve

6 UMMS Background 8 Hospitals 1,709 Beds 1 Academic Medical Center 1 Teaching Hospital 4 Community Hospitals 2 Rehab Hospitals 5 CBOs McKesson Star Meditech Magic and C/S Quadramed Affinity $2.4 billion in revenues Grown from $1.2 billion since system was created

7 How we got here Need Identified CFOs asked Revenue Leads to: - Automate & Standardize Practices - Measure Performance Consistently Entity- Specific Structure No Corporate Structure Solid Revenue Performance Cautious, Deliberate CFO Group Pockets of Innovation / Automation Multiple Systems Doing Same Thing Similar Stay- Awake Issues Significant Variance in Process & Systems Reporting Not Applesto-Apples

8 UMMS Results $155 million dollar increase in collections Reduction in AR by 11 days Decrease in Bad Debt of $700,000 Increase in Revenue of $82 million Enhanced Staff Productivity Re-Allocation of FTE s to proactive processes Increased Patient Satisfaction

9 Go from this Medical Necessity Check Claim Submission Contract System Registration System Eligibility Verification Black Hole Claim Denials Compliance System Claims Mgmt Patient Registration Black Hole Patient Accounting Remittance Payment Healthcare providers maintain a number of disparate systems to help manage the revenue cycle. Unfortunately, they are not integrated. The risk of problems falling through the cracks is high.

10 To this Medical Necessity Check Claim Submission Eligibility Verification Compliance System Contract System Registration System Claims Mgmt Claim Denials Patient Registration Patient Accounting Remittance Payment The efr simplifies the revenue cycle. The efr platform provides workflow, document management, business intelligence and disparate system integration to manage the revenue cycle at the patient level.

11 The challenges: Multiple systems to manage the revenue cycle Islands of information No aggregate account view Communication and accountability challenges Reactive and not Proactive Denied claims Inefficiencies resulting in lengthier payment cycle Cost of manual processes Need for high level intuitive measurements Standard reporting doesn t meet needs Inability to view the headlines Ineffective decision support Workflow challenges Denied claims Insufficient accountability Increased administrative overhead

12 The solution: efr One Revenue Cycle Data Store Centralized repository for all relevant information Longitudinal data indexed at the patient level providing aggregate view Allows interdepartmental collaboration Workflow Collect/Process/Organize/Review/Do From putting out fires to fire prevention Institutionalize revenue cycle best practices Enable and Facilitate-aligning organizational goals with departmental activities Enterprise Reporting Collect/Process/Organize/Review/Measure Outcomes based measurement-moving away from how many to cash Provides analytics on all revenue cycle measurements High level result monitoring with KPIs Decision-support tools built in to measure re-design progress Intelligent workflow Denial prevention Performance measurement Reduced administrative overhead

13 Production-Like Efficiency in PFS The Greatest Amount of Dollars in the Shortest Amount of Time by Utilizing the Least Resources Ensure timely and accurate billing Efficient use of staff time by directing accounts to them only when required vs previous ATB method of working Optimizing billing processes in order to improve cash flow and minimize the amount of dollars that go uncollected Implementing projects to increase the first pass yield rate and minimizing errors to avoid re-work Simplifying Automating Integrating Motivating Intelligent Workflow vs Worklisting

14 Beyond Payer and Aging to Process and Issues AR stratification must be done differently» Event driven, exception based processing Event driven, exception based processing What/Who is holding up the cash?» Prevent billing delays through interdisciplinary efforts» Using assists vs to route accounts to other areas to work and better manage responses and timeliness Immediately seeing issues that impact your ability to collect and address those root causes» Minimize variations in billing of claims; pinpoint and eliminate sources of variation» Leverage lean production methods to maximize revenue» Improving each and every revenue cycle process

15 Benefits of an Executive Dashboard Reduced time to consolidate multiple reports Aggregate data across all hospitals/providers Process improvement through elimination of duplicate processing Improved productivity Cost savings Ease of monitoring change and trends Ability to align operations with goals and objectives Drill down capability to get to root cause analysis Improved decision making ability Benchmarking against industry and your own historical data

16 AR By Entity

17 AR Measurements By Entity DRO

18 AR Measurement By Milestone Balance

19 AR Financials Denials

20 Denial Recovery Rate Code Type and Plan Type

21 The efr Bridge Questions?