RCS Management System Benefit Realization Making healthcare remarkable
Novant Health Revenue Cycle Team Novant Health s Revenue Cycle team combines outstanding financial performance with the positive patient experience in-order to deliver on the remarkable patient promise. The following phrase stands as our guiding principle for the acute Revenue Cycle Services team and was chosen by the leaders as an embodiment of our ideals and beliefs and is used to guide the culture and expectations of our team. Every account you touch affects someone s life. Take time each day to celebrate each and every life you have impacted. Our leaders are known throughout the industry for innovative tactics that produce results. We consistently rank within the top quartile when utilizing industry benchmark data to compare our performance to other organizations of similar size and complexity, while continuing to maintain low costs. 2
Obstacles To Overcome In 2009, Revenue Cycle Services began their journey toward standardization which ultimately ended in the selection and implementation of a single Novant Health Revenue Cycle platform for both ambulatory and acute care services. Implementation for ambulatory began in 2011 and implementation for acute began in third quarter of 2013. With multiple platforms, consolidated reporting was cumbersome, standardized operating procedures were impossible to create and performance metrics were not always industry leading. All of these items ultimately led to an inconsistent patient experience and inefficiencies in operational performance. Cash to net collections were strong, but average days to pay were excessive AR days in excess of 44 days AR >90 days nearing 30% Non-standard patient collection strategy Inability to inform the patient, with confidence, of their out of pocket cost prior to service Inability to consistently collect prior to or at point of service Inconsistent approach to denials management resulting in a loss in net reimbursement Patient confusion regarding who to contact and what services they were being billed for To address these obstacles, we made an organizational decision to move forward with a single platform solution 3
Strategy: Defining the Vision 4
Revenue Cycle Transformation (RCT) In 2007, the Revenue Cycle team began a multi-phased transformation journey that has spanned several years. Each phase of the transformation has been an essential step toward the next. This strong organizational and operational foundation has led to strong financial performance and will facilitate a successful Epic implementation. PHASE 5 PHASE 2 2008-2009 PHASE 3 2009-2013 PHASE 4 2013-2015 2015 - Ongoing, Pairs the information systems with process to further enhance the patient experience and drive financial improvement Establishes the centralized / standardized foundation for future differentiation Involves the planning and preparation of the RCT Roadmap implementation Focuses on stabilization of metrics and consistent quality PHASE 1 2007-2008 5 Involves the creation of the Revenue Cycle Transformation Roadmap which defines the endpoint and outlines the steps to obtain it
Strategy: People (Pre-Implementation) The Novant Health acute RCS team at this time had primary responsibility for front, middle and back end revenue cycle functions only. Our team included the basic functions with a centralized contact center for acute care services only 6
Strategy: People (At Time of Implementation) The Novant Health acute RCS team directly oversees front, middle and back end revenue cycle functions. Our team includes the key areas and their subsidiary functions listed below. Ambulatory and Acute functions are represented within customer service, guarantor collections, contract management, bankruptcies and estates and cash reconciliation The RCS team also maintains strong relationships with other departments that impact reimbursement, such as Clinical Documentation Excellence and Business Development and Sales. 7
Readiness Network for Revenue Cycle Services The Revenue Cycle Advisory Committee was instrumental in shaping overall Revenue Cycle readiness - both onsite and offsite. The RC Readiness Partner served as the liaison to the Implementation team to ensure alignment. Program-Level Roles Site Readiness Network Site-Level Roles Program Director Physician Champion Engagement & Adoption Lead Site Steering Committee Operational VPs, VPMA Site Readiness Owner Revenue Cycle representative VP of Revenue Cycle 8 Designated Application Manager Clinical Readiness Owners Revenue Cycle Readiness Owners (as necessary) Implementation Team *New additions to the RCAC will include the RC Readiness Partner. Site Readiness Owner Revenue Cycle Readiness Partner Revenue Cycle representatives- Operational Directors Site Physician Leaders Department Revenue Cycle Directors Advisory Committee* 8
2016 Key Initiatives / Accomplishments Initiative Details 2013 Year End 2014 Year End 2015 Year End 2016 Year End DNFB 5.87 5.76 6.50 5.01 Successful KPIs Net Days Revenue in AR Denials as a Percentage of revenue Total Billed AR >90 Days (Exclude RAC) Bad Debt (% of Gross) 44.11 44.93 37.80 36.10 N/A 4.04% 4.15% 3.36% 27.41% 22.59% 19.90% 20.80% 2.03% 1.96% 1.67% 1.53% Cost-to-Collect $0.039 $0.038 $0.034 $0.034 9
2016 Key Initiatives / Accomplishments Initiative Details 2012 2013 2014 2015 2016 $ 0.040 $ 0.039 $ 0.038 $ 0.034 $ 0.034 Current Cost-to-Collect remained flat year-over-year 2015-2016 Year Actual Expenses Projected Expenses based on 2012 cost to collect Savings 2012 $ 90,042 $ 90,042 2013 $ 92,661 $ 95,678 3,017 2014 $ 91,669 $ 97,731 6,062 2015 $ 90,806 $ 106,173 15,367 2016 $ 100,458 $ 109,351 8,893 Cost-to-Collect If cost-to-collect remained flat, the organization would have spent an additional $9M more to collect the same cash in 2016. 10
2016 Key Initiatives / Accomplishments Claim edits historically lived in an external claim scrubber Implemented claim status and WQ qualification strategy for electronic claims Implemented NEIC rejections within the host system to qualify for various areas of responsibility prior to claims submission via WQ within Dimensions in an effort to improve claim acceptance percentage and move the claim validation further upstream These system enhancements led to our current clean claim percentage of 96% in 2017 Claim Run Date # ELECTRONIC Claims in Run ELECTRONIC Dollar Amt # PAPER Claims in Run PAPER Dollar Amt # Claims Accepted #claims errored in translation Claim Acceptance % #of claims submitted electroincally dollar amount of claims submitted electronically January Month End 80611 $ 713,960,294.13 3893 $ 35,185,325.71 65726 14885 81.53% 74816 $582,753,037.20 February Month End 70070 $ 599,045,033.39 3101 $ 29,156,289.34 57288 12782 81.76% 69919 $558,227,698.13 March Month End 80042 $ 674,176,715.30 3977 $ 38,132,186.76 66279 13763 82.81% 77517 $620,628,883.98 April Month End 117078 $ 915,847,152.20 5878 $ 52,285,534.43 100189 16889 85.57% 112903 $809,830,269.43 May Month End 91275 $ 694,573,880.45 4607 $ 32,891,712.68 79232 12043 86.81% 87344 $635,170,580.49 June Month End 101077 $ 765,078,563.00 5753 $ 44,003,125.59 87750 13327 86.82% 99174 $675,033,861.35 July Month End 121847 $ 908,370,040.63 6210 $ 43,904,989.16 105758 16089 86.80% 116331 $825,661,677.33 August Month End 107846 $ 760,717,543.60 6400 $ 33,940,132.72 93304 14542 86.52% 105020 $711,340,905.63 September Month End 109461 $ 823,242,394.51 6241 $ 56,961,945.00 94417 15044 86.26% 105501 $721,101,159.27 October Month End 110344 $ 836,360,658.25 5704 $ 50,656,462.74 95471 14873 86.52% 105209 $716,289,838.16 November Month End 105263 $ 800,242,022.48 5280 $ 40,814,221.11 91500 13763 86.93% 100836 $730,504,594.37 December Month End 113926 $ 906,465,898.01 5972 $ 48,742,736.20 103054 10872 90.46% 110343 $786,896,754.04 Outcome = 90.46% demonstrating an increase of 9% since 2015. 11
2016 Key Initiatives / Accomplishments Initiative Details In 2014 we collected $2.424B In 2015 we collected $2.633B In 2016 we collected $2.712B That s Approximately $79M more to reinvest in improving the health of our communities. Cash 12
2016 Key Initiatives / Accomplishments Dept. Specific Initiative Pre-Service/Pt. Access Teams Details 58% increase in Pre-service collections over 2015. Increase from $2.3m to $3.7m with a reduction in staffing The staffing reduction was driven through benefit transparency that could not be built out within the system and readily available for our teams while speaking with the patients 13
2016 Key Initiatives / Accomplishments Dept. Specific Initiative Pre-Service/Pt. Access Teams Details Point of Service Collections for 2016 increase from $18,858,172 (0.77% net revenue) to $24,738,987 (0.97% net revenue). Adding in the almost $9m in payment plans set up by Financial Counseling brings our POS collections to Net Revenue over 1% for the first time at Novant Health. Benefit data was now captured within the system allowing transparency Registration times went from over 6 minutes to less than 5 minutes (4.91) which is below the best NAHAM Access Key of 5 minutes. This was a direct result of shared information between ambulatory and acute as well as patient data that was stored and readily available between visits. Patient Satisfaction scores improved in all Press Ganey areas of Registration (ED, OP and IP) with scores ranging from 88%-93% satisfaction. 14
2016 Key Initiatives / Accomplishments Initiative Details Reduced fatal denial rates year-over-year 2014 2016, through the implementation of targeted operational improvement approaches. December 2014 (4.04%) December 2015 (4.15%) December 2016 (3.33%) Much of this improvement was a direct correlation between access to data and developing action plans based on that data Denials Management 15
2016 Key Initiatives / Accomplishments Dept. Specific Initiative HIM/ROI Details The shared platform allowed for implementation of a comprehensive career ladder across all HIM teams (ROI, Records Management, Physician Services), including an overhaul/modernization of job descriptions, titles and salary ranges Developed and implemented baseline productivity modeling for all HIM teams Reorganized and enhanced both the structure and workflow (people, process and technology) of the Enterprise Release of Information Team Successfully launched MyChart Release of Information functionality to the public Successfully implemented HIMSS 7 Document reduction efforts, totaling an elimination of 67 inches (in Q4 alone) of invalid forms from use in the acute medical record Successful implementation of HIMSS 7 complaint scanning workflows at NHPMC (95% of all patient encounter documentation scanned within 24 hours of admission or creation) Utilization Review Through new WQ development and workflow redesign as a benefit of the single platform, decreased incorrect level of care, medical necessity and inpatient-only procedure write-offs by $4.4M. 16
2016 Key Initiatives / Accomplishments Dept. Specific Initiative Patient Financial Services Details Implementation of a dialer system for guarantor collections inclusive of both ambulatory and acute resulting in increase patient communication and improved patient collections The shared information within the system allowed Novant Health to consolidate Acute/Ambulatory/Medquest to a single statement vendor The transparency within that system and ability to monitor productivity and quality for our team members allowed for implementation of work from home programs for all eligible PFS teams and improved productivity by 10% Implementation of the following Easy For Me strategies: Guarantor Collections (Ambulatory and Acute) Bankruptcies and Liabilities (Ambulatory and Acute) Contract Management (Ambulatory and Acute) 68 contracts loaded for ambulatory and 400+ for acute Customer Service Consolidation (Ambulatory and Acute) ROI collections module implemented and team fully functional resulting in cash collected of $875K Contract Management recoveries for acute in excess of $9M 17
Novant Health Revenue Cycle Customer Service department Novant Health Revenue Cycle Customer Service currently exists to provide patients with the ability to discuss their billing questions and/or concerns from a Novant Health facility, clinic, imaging location, and joint venture locations via telephone, email, and I-Chat. We also provide support for our patients electronic health record (MyChart). We support a variety of needs related to MyChart technical support, proxy access, and activation requests. Services are provided in both English and Spanish. The department also serves as an informational line for patients who are interested in learning more about the Health Insurance Exchange program, Bundled payment care initiatives, and our ACO participation. 18
Reflection In 2008-2011, Novant Health was operating on 12 internal patient accounting systems with over 100 independent clinics hosting their own stand alone patient accounting system. 78 Full time Customer Service Representatives Received 40,000 calls per month Average talk time 5:30 minutes Average wait time: 3 minutes Clinics: 227 physician clinics, 100 independent Facilities: 14
Problem In 2015 we had two customer service departments within Revenue Cycle Services, Acute and Ambulatory. Each department had their own phone numbers, email addresses and different processes. Team members were limited to helping patients based on departmental domain. Our call wait time was 4 minutes and 15 seconds with 53% of calls being answered in less than 120 seconds. Novant Health revenue cycle platform is an Epic PB/HB structure Ambulatory Epic go-live began in 2011 through 2013 for all 464 clinics Acute Epic go-live followed beginning in 2013 through 2016 for facilities and Joint Ventures; 2017 Imaging centers We were challenged due to our brand initiative to operate as one single Novant Health entity. The starting focal point was our Customer Service department. We knew we had to convert the customer service department into a single contact department for our patients and team members. This consolidation needed to be seamless to our patients and allow us to provide one call resolution regardless of where the patient received their services at Novant Health.
Strategy Easy for Me program Identify repetitive patient touch points across the revenue cycle Making revenue cycle processes easy for patients and team members Team member engagement across all levels to maximize participation Use technology to the best of our ability
Department Breakdown: Customer Service Duplicative patient touch points Patient feedback Lack of communication across Acute/Ambulatory Team members could not take payments outside of their service area
Customer Service Obstacles 2 departments that do not interact Two phone numbers for customer service 3 email addresses 2 chat sessions 2 In Basket pools Cannot accept other service line payment Highest call reasons: Make payment and balance inquiry Solution 1 consolidated department 1 phone number 1 email box 1 chat session 1 In Basket pool Dual access/dual screens Implement IVR
Successes 2010 Total Calls Received per Month: 40,000 FTE s: 78 Wait time: 4:15 minutes Calls answered in less than 120 seconds: 53% Clinics billed for: 227, 100 independent Facilities billed for: 14 2016 Total Calls Received per Month: 48,000 FTE s: 53 Wait time: 1:12 minutes Calls answered in less than 120 seconds: 89% Clinics billed for: 484 Facilities billed for: 17
Successes 75% reduction in patient complaints Self serve IVR option yielded an additional $7.2 million Team member engagement Working together as 1 Team members will be able to assist callers with their questions/concerns regardless of place of service within Novant Health. Combined processes, outcomes and aligned best practices
Lessons Learned Ongoing education and training After consolidating the phone tree, we quickly realized that patients were having difficulty with knowing which option to select. We worked with Patient Communications to have more simplistic terms to help with patient navigating throughout the phone tree. Prepare for the unknown, growth initiatives that caused us to alter business plan Understanding of a better education plan needed for the scope of the project. Staggered training sessions were optimal however other departmental needs influenced the training time frames offered. Better understanding of potential turnover
Ambulatory Statistics Stat Pre EPIC Current AR Days 115 37 90+ Aging 68% 17% Billed Providers 1023 2384 Billed Clinics 228 470 Unposted Cash $15.6m $4.1m ADR $2.3m $5m Est Gross Collections 51% 56.50% Cost To Collect 8.36% *4.24% * This is with adding coding, RCA's, Preverification and Enrollment into the RCS-- doing more for less!
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