Practice Optimization Package:

Transcription

1 Practice Optimization Package: Maximize the Success of your Practice

2 You want to continue providing your patients optimal care. We can help you do it. In today s environment it takes more than clinical expertise to maintain a successful oncology practice. Now more than ever practice leaders must possess keen foresight in a diverse set of areas, including revenue cycle management, inventory management, business operations, technology integration, and financial reporting. This can seem like a daunting task, and if you are feeling overwhelmed, you are not alone. In fact, since 2008, 288 community oncology practices have closed, 407 practices are struggling financially, and 469 practices have entered into a contractual agreement with a hospital. 1 We can help you improve your profitability through our suite of solutions - our highly experienced practice consultants partnered with best in class practice management tools. What is the Practice Optimization Package? The Practice Optimization Package is a combination of tools and services designed to help you maximize the economic health of your practice. We are excited to offer consulting services that bring fresh perspective and pragmatic recommendations to how you operate your practice today. Our consultants are well known, highly experienced former practice leaders who can understand your challenges and have seen multiple situations. Furthermore, we have strategically partnered with Unlimited Systems to offer you the best in class g4 Enterprise Studio with our services in one single highly competitive rate. 1 Community Oncology Impact Report: The Changing Landscape of Cancer Care. Community Oncology Alliance, June 25, 2013.

3 How does the Practice Optimization Package work? Revenue Cycle Management Business office processes Denial trends by payer, drug, CPT and diagnosis Accounts receivable PM system functionality Inventory Management Level of practice integration Advanced functionality Report utilization Purchasing efficiency Procurement Drug contracts, formularies, ordering methodology, and payment terms Med/Surg contracts Practice Workflow and Staffing Current workflow Patient scheduling Optimal staffing ratios Payer Strategy and Tactics Contract review Payer value proposition The Process Discovery Phase: Our team of experienced consultants will collect and review your practice data to rapidly build our understanding of your unique situation. Assessment Phase: Our team will then visit your practice, meet with your personnel, and study your processes in an effort to get a complete view of your operational performance in the areas mentioned previously. We will conduct interviews and small group sessions to identify areas for improvement and to get a better understanding of existing roadblocks. Depending on the go-live date for g4, we will conduct the assessment either before or concurrent with initial g4 implementation activities. Implementation Phase: After the analysis is complete, we will work with your team to share our comprehensive findings, including recommendations for improving efficiencies, and where you may be able to find increased revenue. Our consultants will confirm your areas of strength and lay out a written plan of action for you to attack any areas of deficiencies. The report will detail the anticipated financial impact of recommended solutions, the potential for revenue recovery, and any possible reduction in overhead costs. We will then work with your practice and Unlimited Systems to address potential opportunities during the g4 implementation process.

4 G4 Enterprise Studio/GE Centricity Practice Management System Healthcare is an evolving and ever-changing environment. Oncology practices have been significantly affected by decreased reimbursement and constant changing payer and federal guidelines. Leading edge technology is essential for an oncology practice to manage the current requirements and have the ability to maneuver through upcoming payment reform and changing healthcare environment. Modern, automation enabling practice management systems provide the tools needed to keep a practice well positioned and financially stable now and in the future. Through our partnership with Unlimited Systems, we are pleased to offer the g4 Enterprise Studio through the Practice Optimization Package. The G4 studios is designed to drive automation in every step of the RCM process resulting in a clean AR, increased reimbursement by avoiding payer edits and clean claim submission, decrease in staffing costs and financial analytics to manage your practice. Current practices on the system have experienced the following benefits after transitioning to the system: Faster payment. G4 s leading edge technology automates the RCM process flow from the point of patient check in and copay collection, through the payer submission remittance process, to final resolution and payment of the claim. G4 practices, on average, receive insurance payment 6-10 days faster than with other PM systems. Improvement in clean claim submission. This results in quicker turn around on payments from the payer, accurate payer payments, decreased payer denials, and facilitates electronic secondary payer claim submission. Complete charge capture increases reimbursement by ensuring all services are captured and billed. More efficient staffing. Increased automation eliminates cumbersome manual processes in the business office, inherent to oncology practices, requiring fewer staff to manage the RCM process. Some oncology practices have experienced 30% or greater reduction in business office staffing needs following implementation of the G4 system. Example: A practice on the West Coast had 26 FTE business office employees and reduced to 13 within the first year of their G4 implementation, resulting in a savings of $585,000 annually. Better visibility into your practice. Reflect (Microsoft Access based reports) provide productivity tracking on employees, physicians and payer contractual compliance. Reflect provides the financial analytics required to determine current practice profitability, project future earnings and determine practice viability.

5 As part of the Practice Optimization Package, the g4 studio helps your practice achieve the above through the following extensions: Registration Overlay: Streamline financial workflow Assurance: Automate eligibility workflow Advanced Claim Edits: Achieve peak reimbursement Resolve: Automate denial management Focus: Archive / search documents Reflect Share: Distribute enterprise reports ROI is approximately 1 year when G4 Best Practices are implemented and followed. Examples of Our Work: Common Findings: Revenue Cycle Management In our work across multiple practices, we ve identified several trends that negatively impact the revenue cycle. We often find: $1 million in primary payer claims greater than 45 days in unpaid status $500,000 in secondary payer claims greater than 75 days in unpaid status $985,000 in claims greater than 60 days that had been previously denied and were awaiting resolution $260,000 in credit balances greater than 60 days 36% average denial rate, not including duplicate claims Depending on the opportunities found, we customize our recommendations to reduce unpaid claims, reduce denials, and work the claims denied to each practice.

6 Case Study: Managing Ghost Inventory (a large practice in the West) This practice kept ghost inventory in an effort to save time during heavy treatment days, but was unaware of the significant cash flow issues this could cause. ION performed consultative work to quantify the effects of this practice on their bottom line, and, after seeing the findings, in a four-month period ghost inventory, was reduced from $483, to $1, Savings continue to rise for this practice, which has significantly improved cash flow. Case Study: Improving Inventory Management (a large practice in the Midwest) After completing a consultative assessment, the ION team identified significant issues with the accuracy of this practice s charge capturing processes, and their ability to maintain appropriate inventory. After a successful training program, the practice has realized a reduction in inventory of $411, and a reduction in recorded inventory shrinkage of $74, Case Study: New Payer Strategy and Implementation (large practice in the Midwest) ION s payer team assesses the practice s commercial payer contracts and capabilities. With this practice, we devised a strategy to engage their commercial health plans in a discussion of quality and value. After discussions with their top three commercial payers, the practice has an opportunity to increase their current revenue by 10% through market rate adjustments, payments for additional services, administrative requirement relief, and long term incentives to reward quality. Case Study: Patient scheduling issues (Multiple practices) In assessing multiple practices, a common problem that has been discovered is patient scheduling issues. Due to inadequate scheduling processes combined with a lack of clinical input, patient scheduling caused bottlenecks in the lab, exam rooms and chemo suite. By breaking down each part of the process, with both clinical and administrative input, and taking into consideration physician availability as well, the patients are able to move through the clinical experience with a time savings of minutes per visit.

7 Getting Started Our consultants are ready to help you find additional value in your practice today. Getting started is easy. Here s what to do: Contact your ION SAM and let them know you d like to learn more A practice consultant will follow up with you within 2 business days to review the package and answer any questions Unlimited Systems will provide a demo of the g4 Enterprise Studio The consultant will follow up after the demo Should you decide to move ahead, here s what we ll do: The consultants will review and analyze your existing data and reporting before coming on site The consultants will perform a comprehensive on-site analysis of your revenue cycle management, inventory management, and business operations Our revenue cycle expert and Unlimited Systems will work with your designated personnel to develop recommendations and propose an implementation plan for the g4 studio The timeline for completion of the discovery and assessment phase will vary based on each practice, as we are doing customized work and making thoughtful recommendations specific to the needs of your practice. No two practices operate in exactly the same way, or face the same challenges our goal is to uncover ways to help you operate more efficiently and improve your revenue. Improve the Health of Your Practice We believe that the most effective, efficient, affordable, and accessible care is provided by independent, community oncologists. We understand that you re facing extreme legislative and reimbursement pressures that make it increasingly difficult to stay above water this is not an indictment of your staff or your procedures it s a reality of the current market dynamics. We can offer recommendations on where you can improve processes, and we can provide the solutions to do so. Please allow us to help you continue your mission to serve your patients. For more information on how our consulting services and process improvement solutions can help you, or to schedule a consultation, please consulting@absg.com or contact your ION Solutions strategic account manager.

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