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Control

Revenue RecoveryFebruary 23, 2007

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Control

Project Team

Team Members• Carla Rosier• John Rochelle• Auriel LaValla• Eric Wexler• Keith Poirer• Corey Younger• Dominick Watts

Team Facilitators• Phyllis Collins• Doug Higgins

Sponsor• John Wilson

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Define Phase

Problem statementAccuracy and insufficient QA of Patient Care Reports leaves room for errors thus causing a decrease in potential revenue recovery for Public Safety/EMS. The lack/failure to properly document has resulted in the payment of legal fees, compensation to patients (law suits), audits from Medicaid resulting in penalties paid, non-compliance with Florida Statues 401; Admin. Code 64-E-2.013 reference records and reports.

Justification for projectImproved overall documentation of Patient Care Reports (PCR) should realize an increase of 10% = $1.5 million over the next fiscal year.

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Project Impact

County objectiveGoal 2 Objective 3: Continue to actively

pursue technology systems that increase productivity, efficiency, and decrease costs.

Project goal Improved overall documentation of Patient

Care Reports (PCR) should realize an increase of 10% = $1.5 million over the next fiscal year.

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Control

Project Scope

In scopeMedicare, Medicaid, Insurance payments, Self-

pay, Attorney’s Fees, Penalties, Restitution.

Out of scopeAny other revenues outside of the

documentation/ billing process.

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Control

SIPOC Diagram

Suppliers Inputs Process Customers Requirements

Crews MD offices Patients Family Hospitals Skilled Nursing Fac

Step 1:Call Dispatched with PCR number

Outputs

Step 2: Crew inputs data to Healthware and uploads

Step 3:Admin Svcs reviews for completeness and codes call

Step 4: Admin Svcs pulls billable calls and uploads .txt files to billing vendor

See Below Accurate PCR Pt. Invoice Insurance Inv Hospital Inv Legal Document

EMS Patient Gov’t/Pvt Ins Hospital/ER Atty /Court

Step 5: Billing Vendor verifies data and bills patient.

Patients name, SSN,

DOB, Billing Address,

Phone, Insurance Info,

Treatment, procedures,

supplies, Key statements

and Narrative, All

required Signature,

Personnel, Medical Record

Number

Complete

Accurate and timely

Documentation of

Patient Care Report

from start to

finish of call.

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Control

Process Flow ChartRevenue Recovery

12-1-06

911 call to Dispatch

What resources are

needed?No Unit

Unit Dispatched

Information loaded to MDC for call

Transfer information from

MDC to Hammerhead

Patient contact made

All hands needed for treatment

EMT gathers information

Patient treatment started

No

Yes

No

Yes

Continue next page

Transport decision

Call ends with all data gathered

Transport and treatment

Arrive at destination

Medical Record # obtained from Hospital and

Transfer of Care

Written report given to receiving

hospital

Upload PCR Station

Hospital

Stop

Yes

No

Yes

Yes

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Control

Process Flow ChartRadio Log printed

for verification

Administrative ServicesProcess

MIA’sOn list

Review Heatthware for

MIA’s and contact EMS Command if

no notation

Compare Radio Log information with each PCR

record in Review Manager and

correct.

Pickup location, zip

code, mileage, and destination

hospital correct?

Correct PCR in Review Manager to match Radio

Log

Patient’s information

reviewed and addresses and zip

confirmed

No demographics in formation

Use MR # if available and get information from

Hospital

Address and zip code verified with

USP website

Procedures listed?

Must then read narrative for

coding of call

Review procedures and

code call

Yes

No

No

Yes

No

Yes

No

Yes

Cont. next

page

When Radio Log completed and all

calls coded pull .txt file for ADPI

Transfer .txt file via secure website to

ADPI

ADPI runs file and sends us a file to recheck coding

and mileage

Does ADPI’s report match Radio Log coding?

Make changes and email back to

ADPI for corrections

Notify ADPI that records are correct

and ready for billing.

Stop

No

Yes

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Control

Histogram

% of Information Missing

72.00% 70.72%

51.99%

31.63%

14.01%

0.88% 0.11%0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

MedicalRecord

Signature Insurance Phone #'s SS# DOB Name

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Analyze Phase

Author, Page Number, Date

Unable to Collect approximately 45 % of

Billable Revenue

Machinery Methods Materials

Mother Nature Measurement Manpower

Hammerhead

Training (2)

Time Constraints

Data

Collection

Healthware

Data Collection (1)

Data Collection

Training

Hospital Staff

Lack of Ownership

QA/QC for Compliance

ID False Info

Accountability/ Ownership (3)

Language Barrier

AMS

Time Constraints

Homeless

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Control

Analyze Phase

Author, Page Number, Date

Data Collection

Machinery Methods Materials

Mother Nature Measurement Manpower

Device Compatibility

HH Reliability

Hospital Standards

Input Errors

Collection Techniques

Healthware (3)

Accountability

Personal & Corporate (2)

Training (1) (1)

(2)

Agency Standards

Consistency

Multiple Pts

Time Constraints

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Control

Analyze Phase

Author, Page Number, Date

Training

Machinery Methods Materials

Mother Nature Measurement Manpower

Training Ewuipment

Mandatory/ Optional

Technique

Learning/ Teaching Methods

Equipment Usage/ Utilization

Use Subject Matter Expert

Delivery Media

Training Equipment

Quizzes

Compliance (2)

Subject Matter Experts

Participation (1)

QA/ QC Issues

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Control

Analyze Phase

Author, Page Number, Date

Participation

Machinery Methods Materials

Mother Nature Measurement Manpower

Available Equipment

Define Expectations

Multi-track Sessions

(BLS/ALS)

Staff Development

Training Diversity

Teaching Learning Styles

Available Equipment

Attitude

Define Expectations

(2)

Staff Development

Ownership (1)

QA/ QC

Survey Needs and Expectations

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Control

Root Cause Summary

Unable to collect approximately 45 % of Billable Revenue →

↓ ↓ → Data Collection →

↓ ↓

Training ← ← ← ← ↓ ↓

Ownership ← ← ← → → → DefineExpectations

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Improve Phase

Prioritization Matrix

Expectations

Ease/Speed Sustainable Measurable Feasible Total (49) Rank

Project/Wt. 0.24 0.29 0.14 0.33

Friendly Competition 28 6.86 28 8 20 2.86 26 8.49 26.20 1

Progressive Discipline 16 3.92 24 6.86 20 2.86 22 7.18 20.82 2

Incentive Program 18 4.41 17 4.86 23 3.29 17 5.55 18.10 3

Peer Pressure 15 3.67 14 4 8 1.14 14 4.57 13.39 4

Reason to Attend 10 2.45 11 3.14 15 2.14 12 3.92 11.65 5

12 14 7 16 49.00

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Improve Phase

Prioritization Matrix Expectations

Ease/Speed Sustainable Measurable Feasible Total (64) Rank

Project/Wt. 0.20 0.20 0.22 0.38

Data Collection Handbook 24 4.88 22 4.47 21 4.59 25 9.38 23.3125 1

Goals for Data Collection 19 3.86 26 5.28 23 5.03 20 7.5 21.671875 2

Bulletin Board (Desktop) 15 3.05 19 3.86 17 3.72 18 6.75 17.375 3

Supervisory F/U 17 3.45 9 1.83 18 3.94 13 4.88 14.09375 4

.

13 13 14 24 64

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Control

Patient Treat No Transport and Refusal Signatures

7%3,360258Billing Sign. Captured:

94%1963,298Refusal Sign. Captured:

% CompliantNoYes

3,556Total ePCR Considered:

Call Disposition Considered: "Refusal of Medical Assistance" (40) and "Treated, No Transport" (45)

7%3,360258Billing Sign. Captured:

94%1963,298Refusal Sign. Captured:

% CompliantNoYes

3,556Total ePCR Considered:

Call Disposition Considered: "Refusal of Medical Assistance" (40) and "Treated, No Transport" (45)

Refusal Signature Captured

94%

6%

Billing Signature Captured

7%

93%

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Measure

July 05 to Aug 05 we had 316 new accounts with bad addresses and this equates to $179,282 in lost revenue.

This is 11.82% of the calls for that month at an average cost per patient $567.34.

For a one year period this could equate to 4186 calls with bad addresses and lost revenue of $2,374,885.

If we were to increase the accuracy and input of the Medical Record Number collection from LMH hospitals by 63% we could increase revenue by $1.5 million.

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Control

Signature Pilot

At the in-service for January 16, 17, 18, 2007 a presentation was made to announce the Pilot of the two signatures that are required on patient’s refusal calls. Staff were only obtaining the “refusal of service” signature and not billing signature. Screen captures were shown to staff who attended to ensure everyone was obtaining the correct two signatures (refusal and billing). A total of 181 personnel attended the in-service training. The remainder of the personnel are required to receive the information through a recorded presentation.

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Control

Signature Pilot

A more aggressive solution to the signature “bottleneck” was discovered and implemented after the in-service training.

This involved a change in the Healthware software that was previously thought to be impossible.

The change was made to the refusal screen in the software to allow for both the refusal statement and the billing statement to be combined on one screen and thus only requiring one signature.

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ControlIn-service Participation FY 06

  # Employees Attended % to total Field Personnel

Jan 62 32%

Feb 110 56%

Mar 63 32%

Apr 91 47%

May 98 50%

July 94 48%

Sept 137 70%

     

  81.875 42%

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Improve PhaseMedical Record Number/ Supervisory

Follow-up Pilot

A second pilot has been designed and will be implemented.

Utilizing the PCR Compliance website, the supervisors will be instructed to follow-up daily on any missing Medical Record Numbers of LMH Hospitals not collected by the crews.

Duration: 0700 hrs, 15 Mar 2007 to 0700 hrs, 15 Apr 2007 Each EMT and Paramedic will verify for their supervisor

that they know how to utilize the PCR Compliance site. Supervisors will ensure that any trends of missing Medical

Record Number can be rectified. All data collected will be analyzed upon completion of the

pilot.

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Control

Improve Phase

Two separate solutions are being developed in addition to the above pilots:

• A Data Collection Handbook will be implemented as a guide and reference for data collection activities and training.

• An active-desktop/ whiteboard will be incorporated into our current software and hardware at each station to allow for timely statistics and data dissemination. This will foster friendly competition and respectful peer pressure.

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Control

Control Phase

Phyllis Collins – Administrative Support Supervisor will monitor the signatures needed for billing purposes and PCR Compliance will be tracked by supervisors and the Administrative Support Supervisor.

This data will be tracked utilizing an “Average Dollars per Call” collected due to the differing timeframes in which bills are paid by our customers. We will also track the Signature and Medical Record Collection rates.

This results in a significant lag time in verifying and obtaining our goal.

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Control Phase

Refusal Signature Jan Prior 19th 7%Feb 91%MarAprMayJunJulAugSeptOct

Refusal Signatures CollectedMonthly

0%

20%

40%

60%

80%

100%

Refusal Signature

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Control Phase

Rev Collected# of Calls Avg Per call

FY04 11,507,829 41672 $276.15

FY05 13,900,943 45873 $303.03

FY06 15,629,409 47475 $329.21

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Control Phase

Lee Memorial Health SystemMedical Record Numbers Obtained

28%35%

63%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2/20/2007 % to Achieve Goal Goal

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Control

Hand-off Issues(Parking Lot Issues)

Healthware Solutions needs to be replaced with a user friendly software that will help with accountability on all levels of a PCR. This will make us proactive instead of reactive.

Enhance In-service to entice more individuals to attend and obtain information that is provided.

Accountability – include in performance appraisal for field personnel

Focus on Billing and Coding Process.

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Control

Conclusion

Questions?