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Engaging Touch Free Practices – Carolinas HealthCare
System - A Case Study on Automation in the Revenue
Cycle
Elizabeth P. Staas, Recondo Technology
Katie Davis, Carolinas HealthCare System
Who we are…Elizabeth Staas
Elizabeth Staas serves as an Advisory Revenue Cycle Consultant for Recondo Technology. She brings a deep
understanding and working knowledge of the revenue cycle and all its associated components to include
workflow, human factors, and technology. Elizabeth has worked with for 20 years with numerous hospitals
and other healthcare providers in her career concentrating on increasing prompt and proper payment for the
services they provide.
She currently serves on the Board of Directors and as President Elect for the Virginia-DC Chapter of
HFMA. She has organized a wide variety of HFMA and AAHAM Educational Events centered on Revenue Cycle
and Payment Reform.
She serves as Legislative Chair for The Virginia Chapter of AAHAM with concentrated efforts in lobbying at
both state and federal levels to reduce wasted efforts affecting the healthcare revenue cycle.
Who we are…Katie Davis
Katie Davis, AVP Corporate Patient Access for Carolinas Healthcare System. Katie holds a Bachelor’s Degree
in Healthcare Management and has 25 plus years of experience in Patient Access plus 8 years of physician
practice management experience. Katie has been with Carolinas HealthCare System for 25 years and serves
as the Assistant Vice President for the Western Division of Corporate Patient Access which includes the Pre-
Service Department for 9 facilities, the Patient Financial Specialists, PRN Pool, the Patient Identity
Management team, and the Access Team for CMC-Cleveland and CMC-Kings Mountain.
Katie has been a member of the National Association of Healthcare Access Management since 1992 and has
been a speaker at the national meeting on three occasions and has been a member of the North Carolina
Association of Access Managers since 1989, serving as President from 2004 – 2005. Katie has also been a
member of HFMA’s North Carolina chapter since 2004.
Overview
Transforming today’s manual revenue cycle activities into an automated “no touch”
process dramatically improves staff productivity and financials.
This transformation enables staff to spend less time on payer websites (and phone calls) and more time with patients which leads to increased patient satisfaction.
Attendees will learn/confirm:
• Current challenges across Patient Access and Business
Office areas
• The importance of “getting it right upfront” to avoid delays
/ rework / unnecessary reimbursements
• Technology, data, and automation capabilities to
improve operations
• Best practice considerations to increase patient
satisfaction and improve financials
US Health Spending continues to increase at a higher rate than
other Industrialized Nations
Healthcare Revenue Cycle is becoming more challenging
• Increasing volume and complexity of healthcare transactions
• Verifying Eligibility is a challenge today and is expected to be more challenging with the
Affordable Care Act Health Exchanges
• Confirming Authorizations are highly manual and often require staff to call the payer or verify
on payer websites
• Industry administrative costs will grow by about 10 percent annually over the coming years—
higher than the rate of growth of medical inflation.
- Source: McKinsey
Manual vs. Electronic Per Transaction Cost
Authorization Potential
Opportunity Savings $13.33
$0.00
$2.00
$4.00
$6.00
$8.00
$10.00
$12.00
$14.00
$16.00
$18.00
$20.00
Claim
Submission
Eligibility Prior
Authorization
Claim Status Claim
Payment
Remittance
Manual
Electronic
Transforming Patient Access allows refocusing on patient care
Case Study: Carolinas HealthCare System
Breadth of CHS
Rehabilitation Hospitals
LiveWELL Carolinas
Primary Care Practices
Health Clinics
Urgent Care Centers
Hospitals
Behavioral Health
Nursing Homes
Home Health
Continuum of Care
Emergency Care Centers
Ambulatory Surgery Centers
Hospice & Palliative Care
Specialty Care Practices
Summary of System
• 60,000 employees
• 2,535 physicians
• Close to 800 care locations
• Nearly 7,500 licensed beds
• 11 long-term care facilities
• 12 home health agencies
• 9 hospice providers
• 8 freestanding EDs
• One of 5 academic medical centers in
the state of North Carolina
CHS ExperienceCarolinas HealthCare System
affiliates and physician networks in NC,
SC and GA.
Corporate Patient Access
CMC Anson
Pre-Service Department
In 2000 as a result of an Ernest and Young Revenue Cycle Review,
a dedicated Pre-Service Department was established to focus on
the following goals:
• Decrease Denials
• Improve Patient Satisfaction
• Increase POS Cash Collection
Areas of Responsibility
Scheduled Services
• Pre-Registration
• Insurance Verification
• Non-Clinical Authorization
(NCA)
• POS Cash call
Inpatients & Observation Patients
(unscheduled/ED admits)
• Insurance Verification
• Non-Clinical Authorization (NCA)
• If needed, communication with Clinical
Care Management
Pre-Automation Process
Prior to April 2007
Individual ApproachRegistrar works account to completion
including:
• Pre-Registration
• Insurance Verification
• Non-Clinical Authorization
• POS Cash Call
After April 2007
After April 2007
Team Approach
• Pre-Registration Team
• Insurance Verification and Non-
Clinical Authorization Team
• Cash Team
Pre-Automation Process for Estimation and Cash
• PCON Estimator
• Cash Collection
Our Automation Story
• Replace our Price Estimator
• Better Customer Service when Providing Estimates
• Better Verification Data
Key Components
• SurePayHealth (automated patient estimator)
• AuthDP (automated authorization)
• Working by Exception
Roll Out Plan
• Radiology
• Surgery
• OP Areas
• Inpatient
18
Front Line Communication
Support
KPI’s for Scheduled Services
2013
• 242,014 Scheduled
• 241,941 Pre-Registered
• 99.9%
2014
• 264,061 Scheduled
• 263,982 Pre-Registered
• 99.9%
Completed Days Out
• Surgery 10 in Advance of Scheduled DOS
• Radiology 5 in Advance of Scheduled Procedure
KPI’s for Radiology Denials
2013
• 961 Accounts
• $3,282,947.00 Denied
Dollars
2014
• 723 Accounts
• $1,747,259.00 Denied
Dollars
24.7% decrease in accounts
46.7% decrease in denied dollars
Adjustments
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
H R C F U L K M S
2014 Actual 2.15% 2.66% 0.74% 0.53% 0.65% 0.49% 0.96% 0.40% 0.66%
2015 Goal 2.04% 2.52% 0.70% 0.51% 0.62% 0.47% 0.91% 0.38% 0.62%
2015 YTD 0.74% 0.63% 0.57% 0.35% 0.17% 0.13% 0.07% 0.05% 0.04%
Denial Adj as % of Net Mgd Care Revenue
Jan 2015 YTD Performance
2014 Price Estimation Report
12,11511,428
15,07115,712 15,682
14,881 15,174
13,618
17,919
22,345
16,998
21,429
227
140
193 201
233258 267
245258
324
276
151
0
200
400
600
800
1,000
0
2,500
5,000
7,500
10,000
12,500
15,000
17,500
20,000
22,500
25,000
Pri
celin
e C
alls
Recondo Estimates Priceline Calls
FTE Staffing
1290
1366
1888
76
67
62
60
62
64
66
68
70
72
74
76
78
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2001 2013 2014
Beds vs. FTEs
# of Beds # of Pre-Service FTEs
Pre-Service vs. Corporate Facility YTD Cash Collections
$2,3
71,8
71.0
0
$3,0
33,1
36.6
8
$3,0
17,4
22.4
7
$2,4
76,0
31.4
9
$2,4
09,8
69.9
2
$2,5
33,2
92.1
5
$2,6
81,1
22.3
7
$3,2
02,0
27.9
2
$3,0
48,8
81.1
8
$4,1
90,9
75.5
2
$11,4
93,0
33.0
0
$1
2,9
27
,34
4.0
0
$13,5
45,0
93.0
0
$11,8
71,5
47.0
0
$12,8
49,0
91.0
0
$10,0
07,5
40.0
0
$11,2
72,4
39.0
0
$11,5
25,4
76.0
0
$10,9
59,6
40.0
0
$0.00
$2,000,000.00
$4,000,000.00
$6,000,000.00
$8,000,000.00
$10,000,000.00
$12,000,000.00
$14,000,000.00
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 (Jan-
Feb)
Pre-Service YTD Total Corporate Facility YTD Total
Collections Percent of Net Revenue Overall
• 2012 0.70%
• 2014 0.80%
Questions/Comments
Thank you for your time and interest……
Katie Davis [email protected]
Elizabeth Staas [email protected]
