Jim Spause Revenue Cycle Career Presentation 2009
Preview:
Citation preview
- 1. Creating new opportunities Improving existing
operationsHealth Care Revenue Cycle Expert
- 2. Expert in health care revenue cycle operations with over 15
years experience in several sectors Payor, provider, and
consultingDeveloped new services and operational turn-around
strategies Proven record of operational performance improvement
Served as the Director of centralized billing offices Managed
projects and complete A/R liquidation engagements with both
on-shore and off-shore staffNegotiated payor / provider contracts
and settlements Executive MBA Graduate, Temple University Jim
Spause 610-256-0088 jspause@comcast.net2
- 3. Companies and clients that I have served Jim
Spause610-256-0088jspause@comcast.net 3
- 4. Senior Manager of Product Development, McBee Associates:
Developed and launched 3 new revenue cycle service lines with
annual revenue projections of over $2 million Director of Revenue
Operations, DaVita: Improved collections by an average of $1.2 M
per month within a 9-month period Increased payor appeal wins by
more than $12 M Reduced non-contracted DSO by more than 50-days in
one year Settled several disputes with managed care and commercial
payors totaling $3 million in additional collections Lead
Consultant, McKesson: Performed hospital revenue cycle assessments
leading to $3.8 million of additional software and services sales
Co-published an article examining the use of technology in Patient
Access processes for Aspen Publishings Healthcare Registration
newsletter Engagement Manager, Deloitte Consulting: Managed
outsourcing projects with a total accounts receivable of $150 M
resolved over 97% Corporate Director, Patient Financial Services,
Kennedy Health System: Reduced hospital days in accounts receivable
from 72 to 59 in one year Negotiated settlements with managed care
payors totaling $2 M Directed a multi-departmental effort which
increased net revenue and collections by $1.9 M Network Services
Coordinator, Aetna US Healthcare: Received the prestigious Gold
Service Star Award for service excellence twice in one yearJim
Spause610-256-0088jspause@comcast.net4
- 5. Establish stretch goals Develop plan Execute - Repeat
Revenue Cycle DashboardsIndicator Better Practice Hospital Cash
Receipts as % of Net Business Needs100%97.1% Revenue The Hospital
Revenue Cycle Viewed as a System 1. Reduce claim submission
rejections 2. Reduce DNFB A/R Days (Net) 55 Days 50.5 Days 3.
Reduce aged receivables 4. Improve collectionsA/R Over 90 Days 15 -
20% 36.2% 5. Reduce Bad Debt DNFB Gross A/R DaysPatient Admitted5
Days 5.1 Days (includes 4-day bill hold)Point-of-Service
Collections as %Claim coded for initial billing .8% average 2%of
Net Revenue Patient AccessHealth Information Management Patient
Accounting Collect and document all clinical notes Claims scrubbed
for accuracy Billing Backlog Gross A/R Days 1 - 2 Days 1.6
Days(Registration/Admissions) Collect patient demographic / Utilize
patient chart to code diagnoses and compliance Denials as a % of
Gross Revenue1 - 2%6% Claims submitted to insurance insurance
information & procedures Insurance verified & selected /
patient Verify services are medically necessaryBad Debt as a % of
Gross Screen services for medical Paid or Denied3%2.3 % Revenue
Claim follow-up with insurance necessity Collect co-pay /
deductible or patient Status within aged receivables Claim
Demographics GeneratedBetterIndicator Hosp 1Hosp 4 Hosp 2Hosp 3Hosp
5Hosp 6 Practice Clinical Services Provided and Documented DNFB
Gross A/R Days (includes 4-day 5 Days 4.3 Days 5.0 Days5.2 Days 4.8
Days6.8 Days 4.2 Days billhold)IP charts coded per Not Plan to
ImproveDesign & Redesign23-2632 303022.532coder/per dayTracked
Increase pre-registering frequencyProcesses & Services Verify
insurance via EDI OP charts coded per Not 150 23055 30064.322555
coder per/day Tracked POS collections Electronic order entry EMROBS
& AMS charts Not coded per coder/per 36-4050 754564.250
Electronic compliance screening1 Tracked day Clean claims ER charts
coded perOut- Out-Out-Out-Out-180190- 250coder per day
sourcedsourced sourced sourced sourced 1 work Transcription backlog
1 Day1 Day 1 Day1 Day1 Day 1 Day day Not NotNotNot Not % of MPI
duplicates .05%.01 Tracked TrackedTrackedTracked TrackedRecord
Request21-7 days1 day1-7 days 1-7 days1 day14 daysTurnaround
workdays Jim Spause610-256-0088jspause@comcast.net 5
- 6. Be tough on the problem but kind with people Hands-on &
resourceful Brainstorming & Collaboration Mistakes are
forgivable Whats unforgivable is not taking responsibility and
fixing the mistake Do the hard work and analyze - Numbers dont lie
There are always choices and options choose wisely Keep pushing -
You never know how much you can do until you push yourself
Confidence breeds accomplishments (and vice versa) Jim Spause
610-256-0088 jspause@comcast.net6
- 7. Contact me at: Jim Spause, MBA, PMPLafayette Hill, PA (H):
610-567-0295 (M): 610-256-0088 jspause@comcast.netJim Spause
610-256-0088 jspause@comcast.net7