Best Practice Revenue Management Strategies. | 2 | 2 Presented By Christy L. Pehanich, CPC, FHFMA,...
-
Upload
calvin-hines -
Category
Documents
-
view
222 -
download
1
Transcript of Best Practice Revenue Management Strategies. | 2 | 2 Presented By Christy L. Pehanich, CPC, FHFMA,...
Best Practice Revenue Management Strategies
| 2| 2
Presented By
Christy L. Pehanich, CPC, FHFMA, MHSA, Associate Vice President, Professional Operations Revenue Management, Geisinger Health System
Lori J. Masters, CPC, Director Accounts Receivable Management, Professional Operations, Revenue Management, Geisinger Health System
| 2
The content of this presentation represents the views of the author and presenters. GE, the GE Monogram, Centricity and Imagination at work are trademarks of General Electric Company
| 3
Agenda
• About Geisinger• Geisinger Revenue Management • Environmental Backdrop• People Process Technology• ETM Case Study• Results
| 4
Geisinger Health SystemAn Integrated Health Service Organization
Physician Practice Group
$948M
Managed Care
Companies
$2,167M
Provider Facilities
$1,924M
| 5
Provider Facilities
$1,924M
Geisinger Medical Center and its Shamokin Hospital Campus
Geisinger Wyoming Valley Medical and its South Wilkes-Barre Campus
Geisinger Community Medical Center Geisinger Bloomsburg Hospital Geisinger Lewistown Hospital Marworth Alcohol and Chemical Dependency
Treatment Center 4 Outpatient Surgery Centers 2 Nursing Homes Home Health and Hospice, services covering 18
counties 86,000 Admissions, Observations and SORUs 1,745 Licensed Inpatient Beds
Geisinger Health SystemAn Integrated Health Service Organization
| 6
Physician Practice Group
$948M
Multispecialty Group 1,110 Physicians 675 Advanced Practitioners 83 Primary and specialty clinic sites 1 Outpatient Surgery Center 2.5 Million outpatient visits 430 Resident and Fellows 335 Medical Students
Geisinger Health SystemAn Integrated Health Service Organization
| 7
Managed Care
Companies
$2,167M
477,000 Members, including 100,000 Medicare Advantage members and 132,000 Medicaid Members
Diversified Products 50,000 Contracted Providers and Facilities 43 Pennsylvania Counties Offered on Public and Private Exchanges Members in 5 states
Geisinger Health SystemAn Integrated Health Service Organization
| 8
Geisinger Revenue Management
Access
Coding and Revenue Capture
Hospital Operations
Professional Operations
Administrative Services
Integrity
Scheduling Call Center
Pre-Visit Clearance
Patient Registration
Financial Counseling
Point of Service Collections
Uninsured Conversion
Coding
RevenueCapture
Concurrent Coding - CDIP
Professional Reimbursement
Physician Education
Third-Party Billing
Clinical Trials
Collections
Cash Management
Revenue Enhancement
Vendor Management
Third-Party Billing
Collections
In-House Patient Collections
Revenue Enhancement
Patient Service Call Center
Physician Credentialing
Systems Support
Quality Assurance
Business Analysis
Training
Charge Master
Budget and Planning
Credit Balances
Charge Capture Audit
Regulatory Compliance and Internal Controls
| 9
Environmental Backdrop
Shrinking Payer Reimbursement
Increased Patient Obligations
Reduce Cost-To-CollectACA, Insurance
Exchange, Medicaid Expansion
| 10
Environmental Backdrop – Shrinking Payer Reimbursement
Provider-Payer Relationships
Underpayment Recovery
Allowance Adjustments
Denial Management
| 11
Environmental Backdrop – Patient Obligations
Propensity to Pay
Pre-Service Collections
HDHP
BAI
TSP
POS Collections
| 12
Environmental Backdrop – Cost to Collect
Demographic & Financial Data
Collection
Coding
AR Management
Claims Processing
| 13
Environmental Backdrop – ACA
CAC Medicaid Expansion
Presumptive Eligibility
Uncompensated Care
| 14
Operational Accountability
Charge Capture
Coding
Reconciliation
Claim Submission
| 15
Planning
• Defined desired outcomes
• Identified each operational step and its components
• Assigned accountability & escalation procedures
• Measured performance daily
• Resolved exceptions
| 16
Desired Outcomes
• Error-Free Processing
• Reduced & Sustained Cycle Time
• Cash Acceleration
• Accurate and Compliant Processing
• Improvement in Cost to Collect & Employee Productivity
| 17
Action Planning
• Created template to measure charges posted vs. budget• Developed acceptable charge capture thresholds
(charge lag)• Electronic charge files vs. manual data entry
• Automated charge transfer – next day
• Manual data entry – 3 days
• Created automated alerts for exceptions & validation • Transactions > $ threshold
• Transactions > # units threshold
• Monthly reconciliation of services to charges entered
| 18
Billing
Daily report on reasons for ‘not yet submitted to payer” • Assigned accountability for resolution
Modified claims generation logic within legacy patient accounting system toward “clean-claim generation”
Measure and trend “Days to Payment” on primary-payer claims
Address unwanted variations
| 19
Third-Party Payment Patterns
• Understand managed care contractual terms and reimbursemento Review Unbilled (TES) reports dailyo Establish outlier threshold (total charge) for
management review and action
• With payer payment schedule, determine last day of the month claims should be submitted to achieve payment within the same period; review and adjust weekly
| 20
Billing – Managing Claim Submission
• Manage exceptions on transmissions with clearing house
• Invest in technology that allows custom edits for error free processing, minimizing the total number of human “touches” to a claim• Use this technology to edit all claims, including claims
submitted hard copy to payers
• Technology should retain audit trail of claim changes to:• Identify opportunities for pre-billing edits• And employee training
| 21
Achieving Results
• Convergence of:
o Peopleo Processo Technology
• Managing key performance metrics to achieve desired results
| 22
People
• Investment in Education
• Career Development
• Providing Career Paths – with longitudinal opportunities
• Employee Engagement
| 23
People
• Financial incentives aligned with desired outcomes• Performance driven reporting delivered
daily – actual vs minimum incentive threshold
• Visibility into operational effectiveness• Motivational tool to achieve highest
level of performance
| 24
People
• Established career paths• Revised job descriptions – aligned with market
competitive compensation• Established incentive compensation plan
• Educated work force on their respective role in achieving desired outcomes
• Communicate forecast of monthly performance daily
• Promoted employee certification (CRCR, CHFP, CPC, ICD-10) in desired field of study
| 25
People
• Defined roles• Delivered tasks• Assigned accountability for performance
outcomes• Line employees – performance/productivity
standards• Management – scope of authority
“Accountability breeds response-ability” – Stephen Covey
| 26
Process
Leverage TechnologyMitigate Opportunities for Human Error
Design a Streamlined Process
| 27
Technology
Must be scalable
Intelligent/Intuitive workflows
Drive processing decisions
Must contribute to cost-efficiency
Return on investment
| 28
Technology Case Study
ETM
| 29
ETM
Enterprise Task Manager (ETM) is a web application that integrates with the Centricity Business Billing & Accounts Receivable (BAR)
ETM supports Geisinger Clinic Revenue Management activities
1st workflow went live on August 25, 2014
Subsequent workflows started to be deployed on
February 9, 2015
| 30
ETM
• Immediate benefits include:• Real time productivity reporting for employee and
supervisor• System generated exception based assignments• Increased accountability and effective identification of
training needs (return feature if work performed failed to resolve the receivable)
| 31
Projected ROI
Annualized Return on Investment: 414.11%
ROI to be achieved through:
0.5 reduction to Days in AR• 12 month ramp up required for a 0.5 reduction to Days in AR,
additional $55,000 per month in increased collections
Increased cash collections• Year 1 = $4,290,000.00
| 32
Results to Date
• Actual FTE’s Professional Insurance Collections
= 47 pre ETM (Oct 2013)
• Actual FTE’s Professional Insurance Collections
= 38 post ETM (Feb 2015)
• 9 FTE reduction valued at $364,680 annually (salary + benefits)
| 33
Results to Date
• 113% increase in staff productivity
• % Cash in first 30 days
• % Cash in first 60 days
• DRO trending
| 34
Summary
• Create an infrastructure that is transparent with employees and other customers
• Educate stakeholders
• Manage exceptions for error free- processing
• Understand external forces (payer mix, payer behavior and payment patterns)
• Measure and course-correct promptly
• Hold people accountable for results and
• Get out of their way!
| 35
Cost to Collect
| 36
Bending the Curve Impact
2011 2012 2013 2014 2015 YTD Total Projection $-
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$5,757
$8,041 $6,536 $7,190
$3,335
$30,860
Cost Savings (in thousands)
| 37
GE Metrics
TES
GSS Geisinger System Services Comparative Data
Region: Eastern
Client Year Qtr Total ChargesMedian
Post Lag Days
Median Extract Lag
Days
Extract Same Day %
Median Post Lag
Days
90th Percentile Post Lag
Days
Median Extract Days
90th Percentile
Extract Days
Median Extract
Same Day %
GSS FY2014 1 $530,502,390 1.0 1.0 30.7 4.0 1.0 0.0 0.0 64.5
GSS FY2014 2 $544,629,922 1.0 1.0 27.0 4.0 1.0 0.0 0.0 70.3
GSS FY2014 3 $536,529,806 1.0 1.0 28.7 4.0 1.0 0.0 0.0 72.8
GSS FY2014 4 $573,141,495 1.0 1.0 29.1 3.0 1.0 0.0 0.0 73.5
Transactional Editing System (TES) Metrics compared to GE peer groups
| 38
BAR
GSS Geisinger System Services Comparative Data
Region: Eastern
Client Year Qtr Total Charges Total A/RClaim Lag
Days
Days in A/R
Percent A/R > 90
Days
Median Claim Lag
Days
90th Percentile Claim Lag
Median Days in
A/R
90th Percentile Days in
A/R
Median % A/R > 90 Days
GSS FY2014 1 $524,394,945 $169,324,872 3.0 29.7 25.6 7.0 5.2 42.1 32.1 23.4
GSS FY2014 2 $543,208,341 $155,615,973 3.0 26.4 29.4 7.0 5.0 39.7 29.9 24.6
GSS FY2014 3 $538,311,227 $164,953,778 3.0 27.6 27.2 7.0 4.9 42.2 32.7 24.7
GSS FY2014 4 $572,419,043 $159,910,355 3.0 25.4 26.1 6.0 5.0 40.8 30.5 24.7
Billing & Accounts Receivable (BAR) Metrics compared to GE peer groups
GE Metrics
| 39
Questions?