How Standardized Data Improved Finance-Revenue Cycle Communication at Ascension Health (E06) Bridging the Gap

Transcription

1 How Standardized Data Improved Finance-Revenue Cycle Communication at Ascension Health (E06) Bridging the Gap Kari Clark, CPA Ascension Health Derek A. Bang, CPA, CGMA Crowe Horwath LLP

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3 Ascension Health Our System Ascension Health, part of Ascension Health Alliance, is the largest Catholic health system, the largest private nonprofit system and the third largest system (based on revenues) in the United States, operating in 23 states and the District of Columbia. Care of Persons Living in Poverty and Community Benefit Programs: $1.3 Billion* Financial Information (FY 12 Pro Forma including Marian Health System) Total Assets Operating Revenue $28.6 billion $19.5 billion Daughters of Charity Health System is an affiliate of Ascension Health Facilities and Staff Locations 1,500 Acute Care Hospitals 104 Long-term Acute Care Hospitals 3 Rehabilitation Hospitals 4 Psychiatric Hospitals 7 Available Beds 21,908 Associates 150,000 *Reflects Ascension Health Alliance (excludes Marian Health) 3

4 Ascension Health s Major Healthcare Delivery Platforms Ambulatory Care and Diagnostics Ambulatory Surgery Centers 58 Employer/Occ Health 26 Free-standing Imaging 75 Retail Lab Collection Sites 214 Primary Care Clinics 391 Specialty Clinics 149 Retail Pharmacies 31 Sleep Centers 16 Telemedicine Programs 53 Prevention & Wellness Programs Alternative Care 13 Community/Social Services 106 Wellness/Fitness 13 Inpatient Facilities* General Acute Care Hospitals Long-term Acute Care Hospitals Rehabilitation Hospitals Psychiatric Hospitals Post Acute Service Sites Behavioral Health Acute units 23 Behavioral Health Outpatient 60 Cancer Centers 12 Durable Medical Equipment 13 Home Health Agencies 19 Hospice Agencies 11 Palliative Care Programs 28 Rehabilitation Outpatient 190 Rehabilitation Inpatient units 27 Extended Care Sites Adult Day Care 9 Assisted Living (AL) 3 Independent Living (IL) 2 Skilled Nursing (SNF) 18 CCRC (combined SNF/AL/IL) 3 PACE 2 *Inpatient Facilities data includes Ministry Health Care, St. John Health System and Via Christi Health, which joined Ascension Health effective April 1, All other statistics are as of January 5,

5 Challenges Increased pressure on net revenue from payers Growing provider consolidation and centralized management Prevalence of outsourcing and use of internal shared services 5

6 Why is there a gap? Finance Revenue Cycle 6

7 Whose fault is it? 7

8 Finance vs. Revenue Cycle Disconnects between accounts receivable (A/R) and the general ledger Disparate patient accounting (PA) systems Inability to drill down into detail Lack of visibility into the impact of the revenue cycle on the income statement Different performance metrics Lack of time, resources, or technology for in-depth account analysis 8

9 System Disconnects Finance focuses on General Ledger package and Excel models Revenue Cycle focuses on A/R subledger / PA system Systems are highly specialized and not integrated 9

10 Disparate PA systems Consolidation often results in multiple disparate PA systems Ascension Health uses 13 different PA systems and has 47 different sets of mapping tables (transaction codes, insurance plans, patient types, etc.) just for acute care Cannot perform comparisons and analysis in a timely manner 10

11 Inability to drill down into detail 11

12 Lack of visibility into the impact of revenue cycle on the financials Business office has no way of evaluating impact of an action on financials Before writing off a batch of accounts, no one asks: Have reserves been established for these accounts? Will this write-off be expected by finance? What effect will this have on net revenue? Will finance understand how to adjust reserves? 12

13 Metrics / Goals of Finance Appropriate A/R reserve levels (balance sheet integrity) Explain net revenue activity & budget variances Forecasting (mid-month, fiscal year/budget) Accrual basis 13

14 Metrics / Goals of Revenue Cycle Maximize Cash Collections Minimize Days in Accounts Receivable Cash basis 14

15 Constraints Too many transactions, too little time Insufficient analytical tools and meaningful reporting Lack of FTEs / resources to do research and analysis 15

16 BRIDGING THE GAP 16

17 The Outline of a Solution Standardized approach Data collection and analysis Centralized reporting and monitoring Consistent process 17

18 Solution in Action 2007 to 2013 Deployment of analytical reporting tool Finance and revenue cycle can access the same data in real time, monitor activity daily and collaborate throughout the month creating a common language Standardized collaboration and reporting processes 18

19 Analytical tool 19

20 Creating a common language Nightly data feeds to centralized, dedicated servers that are accessible from every local hospital via Web Standardized database mapping definitions, regardless of PA system Standardized historical analytics, reserve estimation process, and net revenue reporting across all facilities 20

21 New data flow and creation of analytics/reporting Analytical tool 21

22 Shining light on impact of revenue cycle activity on net revenue 22

23 Isolating changes in prior estimate 23

24 Common causes for changes in prior estimate Keying errors Duplicate transaction posting Secondary payer adjustment posting Charge-related activity and clean-up (transfers, removals) Payer changes 24

25 Common causes for changes in prior estimate (continued) Contract modeling or posting issues Large balance accounts Fully reserving accounts Reserve and aging changes Voided or merged accounts 25

26 Revenue cycle insights to frequently share with Finance Claim processing issues Troubled payers Significant accounts New vendor initiatives Changes in A/R management processes or processing delays Significant batch write-offs or postings 26

27 Accelerated close process People, Process, and Technology Four-day close process for acute care facilities Reserve estimates should be ready on day 1 Focus shifted to mid-month preparation and monitoring to avoid month-end scramble 27

28 Accelerated vs. traditional close process Pre-close period During close period Traditional Process Accelerated Process No activity Mid-month net revenue projection & monitoring Prepare analytics Pre-close meeting with key stakeholders (finance, revenue cycle, managed care) Update reserve assumptions Recast prior month reserves Prepare analytics (day 1) Update reserve assumptions Generate reserve estimates (day 2) Close meeting with finance leadership (day 3 or 4) Begin net revenue analysis Finalize entries (day 6/7/8/?) Finalize reserve estimates and generate net revenue reporting (day 1) Close meeting with key stakeholders (day 2) Finalize entries (day 3/4) 28

29 Revenue Cycle Net Revenue Report Day of Month Gross Revenue Current Period Adjustments Prior Period Adjustments Total Net Net Revenue % Realization Sunday, April 1, 12 2,526,053 (1,692,480) (254,851) 578, % Monday, April 2, 12 6,901,355 (4,654,314) 41,249 2,288, % Tuesday April 3, 12 8,103,764 (5,233,291) (443,435) 2,427, % Wednesday April 4, 12 8,206,853 (5,244,225) 76,839 3,039, % Thursday,April 5, 12 7,481,128 (4,814,696) 583,102 3,249, % Friday, April 6, 12 7,590,478 (4,915,557) 16,920 2,691, % Saturday, April 7, 12 2,431,565 (1,613,428) (142,225) 675, % Sunday, April 8, 12 2,077,257 (1,398,890) 131, , % Monday, April 9, 12 7,880,109 (5,074,292) 279,428 3,085, % Tuesday April 10, 12 8,373,829 (5,395,083) 214,935 3,193, % Wednesday, April 11, 12 8,417,113 (5,383,850) 110,013 3,143, % Thursday, April 12, 12 7,993,031 (4,893,759) 220,329 3,319, % Friday, April 13, 12 8,101,591 (4,977,102) (188,171) 2,936, % Saturday, April 14, 12 2,969,091 (2,040,949) (100,453) 827, % Sunday April 15, 12 2,424,546 (1,567,792) (701,680) 155, % Monday, April 16, 12 8,135,772 (5,258,242) 124,065 3,001, % Tuesday, April 17, 12 7,851,508 (5,239,068) (75,239) 2,537, % Wednesday, April 18, 12 7,852,550 (4,904,110) (296,573) 2,651, % Thursday, April 19, 12 9,189,879 (5,824,250) (122,883) 3,242, % Friday, April 20, 12 8,810,748 (5,590,545) (212,956) 3,007, % Saturday, April 21, 12 2,901,403 (1,978,019) (284,621) 638, % Sunday April 22, 12 2,393,379 (1,416,476) (117,068) 859, % Monday April 23, 12 7,834,367 (5,088,736) 3,128 2,748, % Tuesday April 24, 12 8,832,856 (5,893,556) 369,190 3,308, % Wednesday April 25, 12 8,168,787 (5,310,122) 351,860 3,210, % Thursday, April 26, 12 Friday, April 27, 12

30 Automated mid-month projections 30

31 Additional Operational Benefits Daily cash reporting Enhanced benchmarking Ability to set performance expectations and measure performance Finance Revenue Cycle 31

32 Daily Cash Management Historical Month Cash Collected Recoveries Aetna BLUE CROSS MANAGED CARE Blue Cross Traditional BWC Charity ($56,997) ($75) ($1,010,135) $0 ($191,401) $ ($60,562) ($76,474) ($1,643,231) $0 ($149,457) $ ($40,475) ($44,219) ($1,132,830) $0 ($89,635) ($610) ($48,556) ($103,888) ($759,352) $0 ($227,311) ($22,627) ($61,432) ($146,678) ($1,383,089) $0 ($154,352) ($110,780) ($79,205) ($234,860) ($1,067,815) $0 ($202,364) ($56,025) ($48,335) ($341,209) ($967,003) $0 ($137,424) ($10,704) ($43,547) ($288,083) ($1,075,125) $0 ($97,419) ($61,999) Current Month Daily Collection Recoveries Aetna BLUE CROSS MANAGED CARE Blue Cross Traditional BWC Charity November 1, 2011 $0 $0 $0 $0 $0 $0 November 2, 2011 ($3,357) ($21,249) ($990) $0 ($787) $0 November 3, 2011 ($1,265) $0 ($23,542) $0 ($6,042) $0 November 4, 2011 ($5,155) $0 ($73,930) $0 ($8,113) ($5,429) November 5, 2011 $4,518 ($50,032) ($1,047) $0 ($5,678) ($3,726) November 6, 2011 $5,985 ($125) ($1,234) $0 ($16,481) $0 32

33 KPIs single facility view 33

34 Results of Bridging the Gap Common language Collaboration Clarity Accelerated close Increased revenue integrity 34

35 Reminder Please complete session evaluation form! 35