Informing Patient Responsibility Early in the Revenue Cycle

Transcription

1 Informing Patient Responsibility Early in the Revenue Cycle Andrew Frost, Product Manager Alyssa Igo, Solution Specialist Kim Lorusso, Product Marketing Manager

2 2011 General Electric Company All rights reserved. This does not constitute a representation or warranty or documentation regarding the product or service featured. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE. DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GE S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE. * GE, the GE Monogram, Centricity and imagination at work are trademarks of General Electric Company. General Electric Company, by and through its GE Healthcare division.

3 Centricity Business Today s Agenda About Centricity Business Market trends Low Touch Billing story Demo Next steps Question and answer session

4 GE Healthcare About Centricity Business

5 Centricity Business An innovative revenue cycle management solution for hospitals, academic medical centers, integrated delivery networks and large practices that drives greater profitability and efficiency. Best metrics in the business Versatility for any environment Interoperability

6 Market leadership 8 of of 17 Best hospitals in Billing Office Survey honor roll 2 Top Performers in Faculty Practice Solutions Center 1) UHC & AAMC, FY10 Faculty Practice Solutions Center Billing Office Survey, June ) US News and World Report, Best Hospitals : the Honor Roll, July 2011

7 Proven financial performance WESTMED Medical New York St. Vincent Health Indiana University of Missouri Health Total billing costs less than quarter of industry average 99% collection rate on eligible billing Decreased A/R days to 33 days Cut eligibility rejection rate from 2% to 0.8% Reduced cost to collect from 8.3% to 6.3% Decreased A/R days from 39 to 29 Increased monthly revenues by $1.5 million Dropped A/R days by 58% Decreased self-pay bad debt

8 Versatility Highly configurable, flexible and scalable platform Meets the challenges of ICD-10 and emerging healthcare reform needs

9 Interoperability Seamlessly connects clinical and financial information Standards-based connectivity

10 GE Healthcare Market Trends

11 Payer benefit plans are changing Avg deductible: Individual: $2-3K; Family $4-6K For the first time, most of the American workforce is expected to have health insurance deductibles of $400 or more. The Associated Press - PWC Report, June 2010 Higher out-of-pocket spend

12 Consumer costs overall Consumer costs have doubled in 9 years - up 7% since 2010

13 Patient responsibility: Market data Deductibles Source: Physicians Practice.com Source: Physicians Practice.com % of A/R rising for patient responsibility Highest rise is in deductibles

14 Consumer attitudes on medical bills Source : Great West Consumer Study Consumers are unprepared for expenses. Most learn about cost after treatment and have limited idea of what items cost

15 Consumer decision-making Source: Physicians Practice.com Consumers on HDHP/CDHP plans are more likely to use eligibility checking capabilities, ask about cost, and use cost estimators

16 Consumer credit card usage Consumers will pay if good faith estimate is used Will more likely pay if financing/budget plan option is provided, about cost tools and cost estimators are used

17 Patient responsibility problem Market shift toward consumer-directed health plans Fewer patients have insurance Payer reimbursements are expected to decline Increasing concern from CXO s and Business Office Managers regarding ability to be paid High risk for collecting self-pay balances: If patient payment is collected at the time of the visit: 80% of the patient s responsibility is collected If collected after the patient leaves the office: Only 30% is collected, on average Source: Physicians Practice.com Most patients pay their co-pay with a credit card

18 GE Healthcare GE Response

19 Reinventing revenue cycle Reduce cost of the revenue cycle by lowering the number of touches needed to pay a claim

20 Low touch billing First point of contact to final payment Touches only issues that truly need human touch Combines enhanced integrated eligibility transactions with advanced workflows Accelerates patient responsibility collections Reduces A/R days for patient responsibility balances

21 Patient responsibility solution Estimated patient liability Point of service: Enhanced eligibility process Financial Counseling Real-time adjudication Credit card processing ETM/Credit balance Self-pay reporting Patient pays online Accurate insurance/add ress before patient arrives Patient knows what they need to pay Review of patient payment policy Patient Payment at Point of Service* (cc, HSA, cash) Advanced checking for eligibility denials Provider submits in real time and gets remit Insurance follow-up (denials, missing A/R) Patient Stmt sent if remaining liabilityonline/cc payment* 1 Scheduling, Registration, Preadmission 2 Admission Arrival 3 Advise on payment 4 Discharge, Check Out 5 Claim Production 6 Claim Adjudication 7 Pymt/Denial Mgmt 8 Self Pay Collections Services drives enablement and best practice

22 GE Healthcare Low Touch Billing Story

23 GE Healthcare Services Offerings

24 Service offerings Revenue cycle staff want to track and improve overall patient payments 24 / GE Healthcare - Proprietary and Confidential 10/29/2011

25 Service offerings Customer metrics Health Check Self pay assessments 25 / GE Healthcare - Proprietary and Confidential 10/29/2011

26 Enhanced customer metrics Created to provide customers insight into how they are performing against key baseline metrics and better manage self pay New metrics designed to help customers measure success 26 / GE Healthcare - Proprietary and Confidential 10/29/2011

27 Solution description Provide customers with the ability to capture, track and report on key new patient responsibility and collections metrics Enabled in Centricity Business 5.0 through Caché queries and customer metrics program Increasing visibility of these metrics can ultimately help improve customer performance in patient responsibility collections

28 Query uses Customers may run queries on their own and drive performance improvements with data output *Queries are available through Caché SQL interface in DBMS Customers can review data as part of the metrics review and choose to compare their metrics to peer groups 28 / GE Healthcare - Proprietary and Confidential 10/29/2011

29 Metrics included Collection Transfer Amount Average Self-pay Write-Off Amount Self-pay Account Receivable Days Self-pay Cash at Point of Service % Budget Plan Accounts In Default during Most Recent Completed Statement Run Copay Accuracy 29 / GE Healthcare - Proprietary and Confidential 10/29/2011

30 Patient responsibility & simplification tools Implemented to reduce customer effort and touch while improving efficiency and self-pay revenue collection Bad Debt Module, Copay Reallocation Utility and Payment Upload Utility Available for free as part of 5.0 Low Touch offering* (*Post-upgrade) 30 / GE Healthcare - Proprietary and Confidential 10/29/2011

31 Performance improvement assessments Provide best practice workflows to improve self-pay collections Business process redesign and optimization are part of Financial Assistance, Point of Service and Patient Liability Estimator installation Self-pay Health Check included in Health Check offerings Eligibility service optimizations associated with Centricity EDI Services offerings 31 / GE Healthcare - Proprietary and Confidential 10/29/2011

32 GE Healthcare Next Steps Questions & Answers

33 Centricity Business Resources December 1 Clinical Connectivity webinar at 2 pm EST 33 / GE Healthcare - Proprietary and Confidential 10/29/2011

34 Follow Centricity Business Centricity Business website: on Twitter and use #gecb to join the Centricity Business conversation 34 / GE Healthcare - Proprietary and Confidential 10/29/2011

35 Q&A Session Thank you for joining. Contact Info: 35 / GE Healthcare - Proprietary and Confidential 10/29/2011