2016 Experian Information Solutions, Inc. All rights reserved. Experian and the marks used herein are service marks or registered trademarks of

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1 2016 Experian Information Solutions, Inc. All rights reserved. Experian and the marks used herein are service marks or registered trademarks of Experian Information Solutions, Inc. Other product and company names mentioned herein are the trademarks of their respective owners. No part of this copyrighted work may be reproduced, modified, or distributed in any form or manner without the prior written permission of Experian. Experian Public.

2 Introducing: Murry Ford, MBA, MHA Director, Revenue Strategy, Emergency Registration Grady Health System Atlanta, GA Minda McMann Sr. Director, Product Management Experian Health 2

3 Driving Revenue Opportunity Through Coverage Discovery On-Demand

4 About Grady Health System 953 bed, Level I trauma center Verified burn & stroke centers Safety Net for Fulton & DeKalb Co., Ga ($250m uncompensated care) Teaching facility for Emory & Morehouse Schools of Medicine Over 140,000 ED visits 135,000 EMS trips in city of Atlanta Epic version 2014 (Live October 2010) Interstate The Grady Curve 4

5 About Grady Health System 5

6 Agenda What is Coverage Discovery How On-Demand is helpful How it functions Implementation Results Lessons learned 6

7 What is Coverage Discovery On-Demand? User-driven utility that finds potentially unknown coverages 270/271 transactions to deliver data electronically Accessible in Health Information System or through Passport ecare NEXT Limits exposure to phishing as data is queried in internal Experian networks 7

8 What is Coverage Discovery On-Demand? Batch process Automated Checks all self-pay accounts Next day results On-Demand Triggered Check any account Results within seconds or minutes 8

9 When patients do not communicate insurance status MVA patients who don t think it s their responsibility ACA & other high deductible policy holders not wanting to use coverage Patients who are medically unable to communicate Dependents who may not know insurance status 9

10 How is On-Demand Helpful? Denial avoidance Late inpatient admission notification denials Authorization denials Timely filing denials Billing the appropriate party Incorrectly billing the patient Coordination of Benefits 10

11 How On-Demand works 1) On-Demand coverage queried by Access Rep. 2) Record queried against Experian database with scoring algorithm -SSN, Name, DOB, Address 3) Identified coverage appears as new response in response history 4) Access Rep. attaches coverage 11

12 How On-Demand works 12

13 How On-Demand works Original workflow involved Financial Counseling use of Epic patient WQ to find and attach coverages not attached at TOS Counselor completes Inpatient admit notification if applicable System action adds Found by Coverage Discovery billing indicator for reporting purposes Currently using in ED, Inpatient & Ambulatory Surgery New workflow leverages Epic ADT confirmation records 13

14 How On-Demand works 14

15 Implementation 6-8 weeks implementation timeline (4 weeks if already using batch) Interface setup (270/271) On-Demand plan code build Bad plan code detection plan mapping Patient workqueue build Unattached coverage workflow Registrar training & tip sheets for On-Demand 15

16 Implementation Bad plan code detection plan mapping Facilitates identification and attachment of On-Demand coverages Started with largest commercial payors Difficult out-of-network exchange plans Medicare/Advantage plans 16

17 Implementation Training Training minimal due to use of current Epic workflows Registration/Financial Counseling all-hands discussion Tip sheets on how to query using the On-Demand coverage record 17

18 Implementation Workqueues & process monitoring Registrars attempt real-time attachment Routed to dedicated patient WQ Financial Counseling ownership Coverage attachment Inpatient admit notifications Billing prevention setup to avoid billing patient with On-Demand found coverage 18

19 Results $7.3m in On-Demand assisted payments over 7 month period Medicaid Managed Care 3% Commercial Non- Contract 2% Medicaid 2% Medicare 7% Average age of Medicare patient found through On-Demand Coverage Discovery =45 years Medicare Managed Care 21% Blue Cross 21% Commercial 44% Source: Passport Analytics/ Epic Clarity 19

20 Lessons Learned Use automation where possible Leverage Epic confirmation records to trigger On-Demand vs. patient WQ approach Admit to Inpatient ADT confirmation message currently in use New RTE status of Eligible-CD to track On-Demand attachments Discharged ED/Observation under development Trigger based on Address Verification under review for all accounts 20

21 Lessons Learned Bad plan code detection plan map testing should be conducted by insurance SME Testers may understand technology but may not familiar enough with insurance to spot mapping issues May lead to incorrectly mapped coverage records Can lengthen project timeline 21

22 Coverage Discovery Product Updates and Strategic Direction Minda McMann Sr Director, Product Management Experian Health 22

23 Coverage Discovery Year in Review Highlights 16.5% Average Found Coverage Hit Rate 34.74% Commercial Coverage 65.26% Government Coverage *NEW*: Power Reporting for Coverage Discovery! Launched January 2016 Fall 2016: Duplicate Inquiry Re-Use Rules 1.3+ million 370+ Found Payers Coverages Coverage Discovery Core Improvements Benefitting 284 Clients 23

24 Coverage Discovery 2.0 Initiative Enterprise Coverage Discovery: Advanced Analytics End-to-end Workflow Safety Net Feature Risk-Free Option Claims Reconciliation Increased Intelligence Increased Data Assets Coverage Discovery will be the market leading discovery solution for all integration points in the Revenue Cycle. 24

25 Coverage Discovery 2.0 Primary Focus Executive insight Data consolidation; advanced analytics; strategic performance dashboards ROI analysis Discovery reconciliation to Claims + Remit data for concrete ROI User experience Discovery specific workflow, action oriented specific alerts, enriched address + identity data for action clarity Safety net process Leverage industry intelligence rules based triggers and data mining technology for non-user-triggered primary and secondary coverage opportunities Connected intelligence Front End / Back Office Combined data for all discovery touchpoints for actionable insight; Leverage additional data assets and industry intelligence to continually enhance the discovery engine 25

26 Coverage Discovery 2.0 Key Components Enterprise Functionality Detail Comprehensive Workflow: Patient Centric View Maybe Work Queue Address + Identity Data Actionable + Informational Alerts Goal: Continually empower and educate users and managers with easy to understand, actionable data and directed workflow. Learning Intelligence: User Disqualification Process Auto-Exclusion Queue + add-back workflow Account Question + Resolution Process Goal: Create an evolving engine to continually reduce noise for the users, streamline questions, quantify non-productive found coverages + policy limitations, and focus efforts on actionable data. ROI + Billing Reconciliation: Lifetime Value Dashboard Fiscal Year Value Dashboard ROI + A/R Days improvement No Claim Submitted Report Payment Pending Report Goal: Provide executive level reporting on value of the discovery touchpoints, and highlight both high and low performing departments/users for ongoing process optimization insight Advanced Analytics: Monthly Trending: User, location, account trigger analysis Source and Trigger Analysis Data-Based Training Recommendations Goal: Provide all levels of Coverage Discovery users with actionable intelligence for process improvement, with specific recommendations based on usage to find patterns. 26

27 Current Feedback + Open Discussion Did my team act on the found coverage? Why was coverage missed initially? Could it have been prevented? Is there additional coverage opportunity in my non-self pay accounts? What was the actual value of the found coverage to my organization? 27

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