HFMA WEBINAR. Building Revenue Integrity Across an Organization. Please log in 10 minutes early and test your computer as this is a new platform.

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1 HFMA WEBINAR Sponsored By: Building Revenue Integrity Across an Organization Date: September 18, 2012 Time: 2:00 3:30 p.m. Central (12:00 1:30 pm Pacific/1:00 2:30 pm Mountain/3:00 4:30 pm Eastern) Please log in 10 minutes early and test your computer as this is a new platform. To view and listen to this web seminar on your computer click on the following link (or paste it into a browser): 1. Type in your full name where it says "Enter as a Guest 2. Please Enter in Your First & Last Name ONLY! Do not type in GUEST 3. Click Enter Room Your computer will launch the webinar Note: You will not have access to this Web Seminar until 15 minutes prior to start time. If you log in prior to that time, you will get a message: This meeting has not started. Online live seminars are broadcast over the web via Adobe Connect. You'll need a computer with a browser, Adobe Flash Player 10.1, and Internet connection. Test Your Computer If you have never attended an Adobe Connect meeting before: Test your connection:

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3 Sponsored By: Building Revenue Integrity Across an Organization September 18, :00 3:30 pm Central Time/3:00 4:30 pm Eastern Jill Cuckler Revenue Management Manager, BayCare Health System Kelley Blair Senior VP of Professional Services, Craneware

4 Agenda 1. Industry Drivers 2. BayCare Story 3. Background 4. Evolution of Revenue Integrity 5. Results 6. Charge Capture Evolution 7. Questions 2

5 A Changing Industry Electronic health record Bundled payments Accountable Care Organizations ICD-10 Expanded coverage 3

6 Impact to Revenue Cycle Electronic Health Record Integration of chart and chargemaster Increased importance of clinical department education on documentation Elimination of paper reconciliation processes 4

7 Impact to Revenue Cycle Bundled Payments Decreased reimbursement Increased importance on charging accuracy both historically and moving forward 5

8 Impact to Revenue Cycle Accountable Care Organization Decreased overall reimbursement Better collaboration between physician, pharmacy, and hospital revenue cycle Focus on charging as a measure of cost of care 6

9 Impact to Revenue Cycle ICD-10 Increased importance in detailed documentation Transition management accuracy of payments Education across the organization 7

10 Impact to Revenue Cycle Expanded Coverage Increase in number of people accessing health system Increase in patient liability and coverage issues Increased need to provide outpatient utilization management 8

11 Need for Revenue Integrity Departments Bringing clinical and financial together 9

12 Approach to Revenue Integrity Our Philosophy: You can t fix revenue integrity because it is a dynamic process that is always changing You can create a sustainable monitoring and process improvement culture using the right people, process, and technology 10

13 BayCare Health System Background Team structure evolution Charge capture evolution Results 11

14 About BayCare Leading community-based healthcare system in Tampa Bay Network of 10 not-for-profit hospitals, outpatient facilities & services including imaging, lab, behavioral health and home health care More than 200 locations throughout Tampa Bay Founded in 1997 as integration of 3 Community Health Alliances (CHA) St. Joseph s Baptist Morton Plant Mease St. Anthony s 12

15 Where We Have Been Chargemaster Standardization Electronic Health Record Implementation Charge Capture Process Automated Charge Capture with Standardized Charges Phase 1 standards developed Phase 1 charge capture implementation Phase 2 standards developed Team Regionalized Phase 2 charge capture design Phase 2 education & implementation starts Team re-aligned Standardized prices Phase 2 implementation completed New Chargemaster technology 13 implemented 13

16 Charge Capture Evolution Three areas of change Chargemaster Structure Standardization Migrated from hospital based to standard product lines Charge Capture System Upgrade Invision Clinical manual process replaced with integrated charge capture processes using Cerner (BEACON), IDX, and ParEx Statistical Modeling of Charges SCORE project 14

17 Team Structure Decentralized Traditional Chargemaster function at each CHA Hospital role included CDM requests, education, process evaluation Charge requests processed by 2 centralized team members and entered into Invision 2008 Regional Team Team centralized to Regional operations and duties split between 2-person areas Example: Surgery, IR, Cath Lab, Supplies, and Non- Invasive Cardiology covered by 2 people Charge maintenance continued to be processed by 2-person team but they also had other clinical area duties Team Members = 5 Team Members = 8 15

18 Team Structure in Nursing Team Nursing Behav Hlth Amb Care IV Therapy ED Rad Therapy Surgery Endo Recovery Anesthesia Hemodialysis L&D Technical Team Chargemaster Mainten. GL Keys Processing Errors Supplies Reporting Chargemaster tool Edits Coordination Denials Coordination Team Members = 10 Ancillary Team Rehab Wound & Ostomy Pharmacy Radiology Cath Lab IR Lab Respiratory Non-Inv Card Neurology F&N/Diab Mgmt R&B 16

19 Current Team Structure Revenue Performance Auditors Service line based Also assigned Rev for specific hospital(s) Regional TM s Lead for root-cause work On the ground Integral part of RITs Dashboard drill-down BI lead for areas assigned Revenue Data Analysts Task based Regional TM s KPI & dashboard publication Data coordinators Root-cause work as needed Issue/Project Coordinators Task based Regional TM s Tracking & savings Facilitator as needed Root-cause work as needed Lead for RITs as needed CDM Coordinator Task based Regional TM All Craneware maintenance Chargemaster & Rev 3 Pub 17

20 You want me to do what? 18

21 Why Did We Change? Leverage resources and migration to standards Initial alignment of integrated team began focus shift to clinical charge capture processes Realignment to Clinical vs. Technical Allowed greater integration with Clinical teams Ensured specific roles and responsibilities per Product Line owner but still allowed cross-training back-ups by area Positioned team for EHR support & new Chargemaster technology implementation 19

22 Team Structure Evolution Where do we go from here? Keeping same base structure but rebalancing Significant shifting over last 2 months New team members Positioning to better Revenue Integrity work Responsibilities expanding as we prepare for Reform and the future Revenue Integrity focus Charge Capture (SCORE), root-cause analysis, and efficient process development and implementation 20

23 Chargemaster Standards Phase 0 Phase I Phase II+ Lab Pharmacy Amb Care Anesth Cath Lab Critical Care CVP Rehab Surgery Dialysis ED F&N/Diab Mgmt IR IV Tx Endo Lung Center Neuro NICU Trans Non-Inv Cardio Nursing Recovery OB Ostomy Psych R&B Radiology (CT, Dexa, Diag Rad, Mammo, MRI, Nuc Med, Pet, US) Supplies Part 1 Rad Tx Uro Rehab (PT, OT, ST, & AUD) Wound Rentals RT Supplies Part 2 21

24 Charge Capture Standardization is key Charge capture processes defined by hospital service area Charges captured via: Automated charge entry driven by clinical documentation Manual charge entry selected by team members Automated charge entry driven by Supply wanding Cerner Document & Charge Invision Register IDX Document & Charge ParEx Supplies & Charge Invision Billing 22

25 No More Seek & Find Statistical modeling to find missed charges Workflow embedded in tool Focus on two areas Immediate rebill for net impact and ROI Trend identification, root-cause analysis, and process corrections at fundamental level Found $1M+ GROSS after just 1 month 23

26 Chargemaster Technology Top 5 benefits Maintaining the standard Prospective regulatory analysis Best practice chargemaster Request process: paperless & quality steps Efficiency gains 24

27 Maintaining the Standard Corporate standard links Every item in the chargemaster is housed at a parent level in the standard As maintenance is completed on a corporate level charge, changes are pushed-down to each child charge in the hospitals Child charges are all the same price, description, revenue code, and CPT Exceptions are documented and easily identified 25

28 Prospective Regulatory Analysis Chargemaster audit tabs Goal is to only have items on Valid & Deactivated tabs Items placed items on the following tabs: Valid Deleted Replaced Invalid Missing CPT/HCPCS Revenue Mismatch New charges added are auto-analyzed and placed on appropriate tab New code updates cause auto-analysis 2012 Wound replacement code Modifier Mismatch Compliance Linked Deactivated 26

29 Best Practice Chargemaster Industry usage Compares each chargemaster area to appropriate grouping in Best Practice Shows items we don t have anywhere in the chargemaster as well as items just not in that particular area Prompts conversation with clinical teams Hospitalbased BayCare Standard And beyond 27

30 Request Process: Paperless & Quality Steps Workflow Product line owners initiate additions, modifications or inactivations within tool Add from Best Practice or Code Book Items enter workflow and go to Approver groups All prices reviewed by CDM Manager at corporate level Additions/changes scripted to Invision Ticket must be logged to IS for charge capture build All changes and approvals show in each item s audit trail 28

31 Efficiency Gains Product Line Team This is so easy! 2012 coding changes Technical (CDM Maintenance) Team Modifications now very quick & easy Additions require more due diligence on the front end but significantly decrease amount of time spent quality checking and root-causing errors on the back end Manager Corporate audit much easier no more manual fields! Pricing variance reviews takes minutes 29

32 Results Charge Automation 1 st hospital implemented: 14% increase in gross charge capture for inpatient population 19% increase for outpatients (tracked up to Month 14) All hospitals saw: Positive change in cross charge capture More consistent and accurate charge capture 30

33 More Results SCORE Validated overall charge capture process Current net return in excess of $1M Root-cause project work $4.5M+ gross charges (annualized) 31

34 Kicking It Up a Notch Revenue Performance Developing Revenue Council structure Designing multi-layer dashboards Sr. Leadership Hospital Mid-level leadership Service Line Implementing Revenue Integrity Teams Dashboard monitoring & drill-down Ability to root-cause & put in long-term solution Integrates entire value stream Focus on value-added activities 32

35 Kicking It Up a Notch Brainstorming ways technology can make entire revenue cycle workflow even easier Cerner M-pages: Suspends, Incomplete tasks, Medical Necessity Work-drivers: Edits, incorrect charges, other billing issues 33

36 Summary Restructure the Revenue Team Horizontal integration aligned to clinical focus Expand revenue professional skill sets beyond finance Identify and alleviate points of revenue leakage and root causes Shift focus from revenue cycle to revenue integrity Automate workflow and standardize EHR-integrated enterprise-wide charge capture 34

37 Bottom Line Three most important items to know: We need to help each other do the right thing From this We need a consistent process to follow We need to work together to rootcause issues and implement sustainable process corrections To this 35

38 Questions. 36