MAP Award Journey - Departmental Collaboration to Improve Revenue Cycle Performance

Joseph Koons, MSA, FHFMA, CPAM Managing Director, Revenue Cycle

August 1, 2012

• About Centra• Financial Impact• DNFB Green Belt Project Review• POS Collections• Continuous Process Improvement• Technology & Other Components

Agenda

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About Centra Health

Available Beds:– Acute 463– Acute Rehab 20– Acute Psych 41– Post Acute 447

Acute Care Hospitals: – Lynchburg General – Virginia Baptist– Southside Community

Payer Mix and Hospital Demographics

Medicare - 50.9%HMO / PPO- 25.3%Medicaid - 14.2%Self Pay -5.8%Commercial -1.9%Other -1.8%

Admission: 26,824ED Visits: 92,212Employees: 5,000+

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• Service Lines:>Home Health>Hospice>Substance Abuse>Mental Health>Child & Adolescent Residential

Treatment>Skilled Nursing>Reference Lab>Rivermont Schools>Cancer Center>Mammography Centers

Revenue Cycle Metrics for CentraGross Revenue: $1,194,866,318

Net Revenue: $ 591,616,570

Gross AR Days: 39

Bad Debt % GR: 1.7%

Charity % GR: 3.7%

DNFB Coding: 4.6 Gross Revenue Days

Inhouse/Unbilled: 2.9 Gross Revenue Days

Cost to collect: 3.0% (HIM, CCD, Pt Access, Pt Accting)

Cash % of NR: 99.7%5

Charity and Bad Debt Trending

3.1% 2.8% 2.5% 2.3% 2.7% 2.9%

4.1%3.3%

3.8%2.8% 3.1%

4.1%

6.4% 6.6%

5.4% 5.5% 5.8%7.0%

6.3%5.8%

7.0%

5.4%

3.6% 3.7%4.2%

2.2%2.1% 1.7%2.8%

3.1%

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%

YTD2002

YTD2003

YTD2004

YTD2005

YTD2006

YTD2007

YTD2008

YTD2009

YTD2010

YTD2011

Charity % GR Bad Debt % GR Total %

• Charity Policy• Payment options• Statements

• Presumptive Charity• Discounts• SP Outsource

Revenue Cycle Structure

• Managing Director of Revenue Cycle with Direct Reports of:– Director, Patient Access - centralized and decentralized in16 locations

• 5 Managers, 2 Financial Counselors• 80.42 FTE’s

– Director, Clinical Coding - centralized and decentralized in 5 locations• 1 Manager• 28.35 FTE’s

– Director, Health Information - centralized in 2 locations• 2 Managers• 56.1 FTE’s

– Director, Patient Accounting - centralized business office• 2 Managers• 45.68 FTE’s

– Director, Revenue Cycle Physician Practices– IT Specialist, RAC Coordinator, and Manager Revenue Integrity

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“Courage is rightly esteemed the first of human qualities

…because it is the quality which guarantees all other.”

Winston Churchill

DNFB PROJECT

DNFB GREEN BELT PROJECT

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Scope of the project focused on inpatient (IAL & IAV) stays

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POINT OF SERVICE COLLECTIONS

Bringing It All TogetherPoint of Service Collections = Financial Counseling

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POSCollections

Local Economy

Training

PaymentPolicy

UninsuredDiscount

SupportPrompt PayDiscount

Payer Mix

CharityProgram

Technology

Incentives

2007 – Before State

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•Inconsistent upfront collections

•No automated payment posting

•Limited pre-registration

•No measurement for accuracy

•Limited insurance verification

•Chargemaster was the only estimation tool

•Estimates contract pricing non existent

•Implemented medical necessity checking and ABN issuance

Continuous Review and Change

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Implement best practice for all work processes across patient access points.Hold staff accountable.

Centra continually trains staff, implemented staff promotion path, and paid testing for certification

Analyze Work ProcessesIdentify Barriers and System Shortfalls

Process Optimization

Communicate with Service Lines

Elevate Staff

continuous process improvement

Director and VP level communication with leaders, educating front line clinical staff

Emphasis should be on any process that continues to be manual – can it be migrated. or does it have system optimization potential.

2008 – The Journey Begins…

• Collections policies and procedures created• Senior Executive and Board approval• Trained staff on collections policies – introduced scripting• Completed implementation of pre-registration unit (call center)• Introduced incentives and tied them to accuracy of registration• Implementation of staff scorecards to include productivity,

accuracy and collections. Posted on departmental webpage• Upgraded existing systems to include integrated payment

posting, separate estimation tool to include contract pricing• Daily progress emails from department Director• Rolled out process in May 2008 – Total collected $753,638

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Staff Training and Communication

• Online policies and procedures• Workflows • Role playing• Scripting• HFMA CBTs• Videos• Daily updates on departmental webpage• Training documents available on departmental webpage• Utilization of tools to enhance workflow, not encumber

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Incentives for Collections

• Annual reset of departmental

goal

• Annual reset of unit goals

• Annual resets of individual goal• Departmental goal adjusted

monthly based on historical data• Individual accuracy goal must be

met for payout for staff

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Incentives for Productivity and Accuracy

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Example:• Jane worked 13 shifts during month• Her average per shift was 58 accounts• Jane’s registration accuracy is 98%• Jane productivity exceed standard by 23 accounts• Productivity bonus = (23 accounts * 13 shifts) * $0.20 = $59.80• Accuracy bonus = (23 accounts * 13 shifts) * $0.10 = $29.90

Productivity is pulled from account transactions, divided by common denominator, and averaged against hours worked to determine accounts managed

It all starts with registration accuracy – REALTIME!

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Sample Daily Error Report

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Sample Scorecards

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Manager Registrar

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Staff in Access work as members of multidisciplinary groups to improve service scores

Departmental KPI’s are published on webpage, open the entire organization

Scores are shared at departmental meetings, service areas and with senior executives

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Tool runs estimates based on insurance plan and contract pricing

Estimates returned include negotiated rates so as to help explain to the patient their final responsibility

2009 Gaining Traction

• Redefined goals, set thresholds based on historical data

• Refined scripting – provided retraining

• Focused on 1st of year deductible & out of pocket

• Added staff to pre-registration unit to increase percentages

• Estimation tool integrated in registration screens

• Refined estimation tool parameters to increase accuracy

• Continued recognition of high performers

• Total collected $1,896,240

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2009 Gaining Traction• Redefined thresholds based on % of net revenue and potential cash

collections• Reviewed collections in service lines and communicated with those

leaders to enhance POS collections activity• Staff training on new financial aid programs• Implementation of prompt pay discounts and payment plans• Implementation of Financial Counseling for inpatient and high dollar

outpatient• Implementation of Financial Counseling software (RevRunner)• Refocus on inpatient accounts and balance after insurance• Centralized staff & implemented collections in mammography

centers • Continued to refine pre-registration practices• Continued daily/weekly recognition of high performers• Total collected $3,418,058

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2011 - Continuous Process Improvement

• Refined reporting tools for management• HFMA’s Map App• Advisory Board – Patient Compass• Horizon Business Insight (HBI) customized drilldowns • Further empowerment of Financial Counselors and Pre-reg

team• Referral workflows reviewed• Continued build for common procedure file in estimation tool

and continued refinement of “lookback” criteria• Revised repayment plans to include >12 months • Revised scripting to emphasize deposits toward service• Continued rule builds in FCW to enhance accuracy

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End of Year 2011 – $5,471,296

Integration is Key

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• Instant notification of approval for credit cards

• Daily reconcilement report from vendor

• Run estimates from workstation• Directly access other tools

• Automated receipts• Ability to post cash, credit

card, e-checks, and other transaction codes as defined

• Ability to post directly from registration screens

What’s Next?

• eSignature for ABN’s• Patient friendly signature pads • Kiosks and Biometric security• Revisit service lines with inconsistent collections• Continued communication to the organization providing

education as to collections program and purpose• Continue comparison to % of net revenue and cash

collections using determination of projected potential in threshold calculation

• Use management tools to further enhance departmental processes, focusing on patient experience

• Consistency, consistency, consistency

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