H igh Pe rfo rm an ce Re ve n ue Cycle o n a Sho e strin g Budge t

Transcription

1 H igh Pe rfo rm an ce Re ve n ue Cycle o n a Sho e strin g Budge t Presented By: Michael Smith - Senior Director, Revenue Cycle Services Janet Walthew Director, PFS & Access

2 Backgro un d From 2005 to 2008, Northwest Hospital & Medical Center s Patient Financial Services department was operated by a third party vendor. The operation of Patient Financial Services was returned to Northwest Hospital and Revenue Cycle Support was restructured.

3 Backgro un d In any moment of decision, the best thing you can do is the right thing; the next best thing is the wrong thing; and the worst thing you can do is nothing. Theodore Roosevelt October 27, 1858 January 6, 1919

4 A New Be gin n in g Hospital Key Performance Indicators at Transition Days Revenue Outstanding: 57.8 Bad Debt as Percent of A/R: 4.82% Accounts in A/R: 63,498 Credit Balances: 8,360 Total A/R: $65.4M % A/R >90 Days: 26.9%

5 A New Be gin n in g Immediate Areas of Focus Patient Communication A/R Account Inventory by Payer Bad Debt & Charity Systems Utilization Department Culture Front & Back End Communication

6 Former Patient Communication & Collections Practices: Patient phone calls were routed to outside call center; number of calls handled unreported Statement data was extracted and sent from third party s own processing center Statement format difficult to understand; offered limited information Returned mail not worked in a timely manner Payment options were limited to check / credit card by mail, phone, or in person at the Patient Financial Services office

7 Improved Patient Communication & Collections Practices: Patient Statements Designed a new statement format Established lockbox service

8 New Statement Format

9 Improved Patient Communication & Collections Practices: Returned Mail Processing Created new application: Returned Mail Tracker Tool for process improvement

10 Returned Mail Tracker

11 Returned Mail Pieces Pieces Returned Apr-08 Jun-08 Aug-08 Oct-08 Dec-08 Feb-09 Apr-09 Jun-09 Aug-09 Oct-09 Dec-09 Feb-10 Apr-10 Jun-10 Aug-10 Oct-10 Dec-10 Feb-11 Apr-11 Jun-11

12 Returned Mail Dollars $1.80 $1.60 $1.40 $1.20 Millions $1.00 $0.80 $0.60 $0.40 $0.20 $- Apr-08 Jun-08 Aug-08 Oct-08 Dec-08 Feb-09 Apr-09 Jun-09 Aug-09 Oct-09 Dec-09 Feb-10 Apr-10 Jun-10 Aug-10 Oct-10 Dec-10 Feb-11 Apr-11 Jun-11

13 Patient Credit Card Payment Options Emdeon ecashiering Emdeon Patient Pay Online More Efficient Patient Credit Card Payment Posting Payment Card Industry (PCI) Compliance

14 Patient Pay Online Option 1: Create an Account

15 Patient Pay Online: Option 2: Quick pay

16 Patient Pay Online Usage 3,000 2,500 Transactions 2,000 1,500 1, Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Patient Pay Online Manually Processed

17 Patient Pay Online Usage 40% 35% 30% 25% Percent 20% 15% 10% 5% 0% Jul-09 Sep-09 Nov-09 Jan-10 Mar-10 May-10 Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 % Transactions Processed via Patient Pay Online Trend

18 Improved Patient Communication & Collections Practices: Patient Call Routing & Handling Assembled in house customer service team Installed automatic call distribution phone system Assembled separate collections team

19 Patient Phone Call Volume 7,000 6,000 # of Calls Handled 5,000 4,000 3,000 2,000 1,000 0 May-08 Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 Nov-09 Jan-10 Mar-10 May-10 Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Inbound Calls Received Trend

20 Improved Patient Communication & Collections Practices: Forms Management Updated 5 to 10 year old forms Created forms/processes for pre registration and customer service Reintroduced physician offices to the use of preregistration forms/practices

21 Improved Forms Library

22 Improved Forms Library

23 Improved Forms Library

24 Improved Forms Library

25 Improved Forms Library

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27 De partm e n t Te am s Patient Access Financial Counselors Insurance Verifiers Emergency Dept. Registration Surgery Registration Inpatient Registration Outpatient Registration Bed Control Switchboard

28 De partm e n t Te am s Patient Financial Services Customer Service Collections Billing 3 rd Party Follow Up Cash Application Credit Balances

29 High Performance Revenue Cycle: Department Teams PFS & Patient Access Working Together Financial Counselors & Insurance Verifiers Customer Service & Collections Registration Billing & Follow Up Bed Control & Switchboard Cash Application & Credit Balances

30 De partm e n t Te am s Collaborative Work Environment Clear expectations and goals Accountability and ownership Department results regularly communicated Networking with other hospital departments & physician practices

31 De partm e n t Te am s Centralized Access Control Created standard registration practices Centralized insurance authorization and eligibility Developed communication channels to affected departments

32 De partm e n t Te am s Access Points Bulletin

33 Syste m Re po rts Self Pay Report Source: STAR SQL Frequency: Daily Distribution: Financial counselors Insurance verifiers Customer service

34 Syste m Re po rts Therapy Accounts Report Source: STAR SQL Frequency: Daily Distribution: Insurance verifiers

35 Syste m Re po rts RelayHealth Holds Report Source: RelayHealth Frequency: Daily Distribution: Senior Management Billing & 3 rd party follow up Insurance verifiers HIM coding

36 Syste m Re po rts In House ATB Report Source: STAR SQL Frequency: Daily Distribution: Financial counselors Billing & 3 rd party follow up Insurance verifiers

37 Syste m Re po rts Billing Work list Report Source: RelayHealth STAR Frequency: Daily Distribution: Senior management Billing & 3 rd party follow up All registration departments A/R Days 07/01/09 Date Range 07/29/11

38 Syste m Re po rts Denial Tracking Report Source: STAR SQL Frequency: Monthly Distribution: Senior management Billing & 3 rd party follow up Billing oversight Committee

39 To day Hospital Key Performance Indicators Days revenue outstanding: Accounts in A/R: Total A/R: Bad debt as % of A/R: Credit balances: % A/R >90 Days: ,498 $65.4M 4.82% 8, % ,942 $78.2M 2.07% 4, %

40 To m o rro w Hospital Key Performance Indicators 2011 HFMA MAP Net Days AR outstanding: Bad debt as % of A/R: Cash collections to adjusted net revenue: % 100.2% < 1.0% > 100.0% Cost To collect: 5.1% < 3.0% % A/R >90 days: 15.1% < 10.0% Denial rate: 0.14% < 0.20%

41 H igh Pe rfo rm an ce Re ve n ue Cycle o n a Sho e strin g Budge t