engaging touch free practices carolinas healthcare system ......system - a case study on automation...

Engaging Touch Free Practices – Carolinas HealthCare

System - A Case Study on Automation in the Revenue

Cycle

Elizabeth P. Staas, Recondo Technology

Katie Davis, Carolinas HealthCare System

Who we are…Elizabeth Staas

Elizabeth Staas serves as an Advisory Revenue Cycle Consultant for Recondo Technology. She brings a deep

understanding and working knowledge of the revenue cycle and all its associated components to include

workflow, human factors, and technology. Elizabeth has worked with for 20 years with numerous hospitals

and other healthcare providers in her career concentrating on increasing prompt and proper payment for the

services they provide.

She currently serves on the Board of Directors and as President Elect for the Virginia-DC Chapter of

HFMA. She has organized a wide variety of HFMA and AAHAM Educational Events centered on Revenue Cycle

and Payment Reform.

She serves as Legislative Chair for The Virginia Chapter of AAHAM with concentrated efforts in lobbying at

both state and federal levels to reduce wasted efforts affecting the healthcare revenue cycle.

Who we are…Katie Davis

Katie Davis, AVP Corporate Patient Access for Carolinas Healthcare System. Katie holds a Bachelor’s Degree

in Healthcare Management and has 25 plus years of experience in Patient Access plus 8 years of physician

practice management experience. Katie has been with Carolinas HealthCare System for 25 years and serves

as the Assistant Vice President for the Western Division of Corporate Patient Access which includes the Pre-

Service Department for 9 facilities, the Patient Financial Specialists, PRN Pool, the Patient Identity

Management team, and the Access Team for CMC-Cleveland and CMC-Kings Mountain.

Katie has been a member of the National Association of Healthcare Access Management since 1992 and has

been a speaker at the national meeting on three occasions and has been a member of the North Carolina

Association of Access Managers since 1989, serving as President from 2004 – 2005. Katie has also been a

member of HFMA’s North Carolina chapter since 2004.

Overview

Transforming today’s manual revenue cycle activities into an automated “no touch”

process dramatically improves staff productivity and financials.

This transformation enables staff to spend less time on payer websites (and phone calls) and more time with patients which leads to increased patient satisfaction.

Attendees will learn/confirm:

• Current challenges across Patient Access and Business

Office areas

• The importance of “getting it right upfront” to avoid delays

/ rework / unnecessary reimbursements

• Technology, data, and automation capabilities to

improve operations

• Best practice considerations to increase patient

satisfaction and improve financials

US Health Spending continues to increase at a higher rate than

other Industrialized Nations

Healthcare Revenue Cycle is becoming more challenging

• Increasing volume and complexity of healthcare transactions

• Verifying Eligibility is a challenge today and is expected to be more challenging with the

Affordable Care Act Health Exchanges

• Confirming Authorizations are highly manual and often require staff to call the payer or verify

on payer websites

• Industry administrative costs will grow by about 10 percent annually over the coming years—

higher than the rate of growth of medical inflation.

- Source: McKinsey

Manual vs. Electronic Per Transaction Cost

Authorization Potential

Opportunity Savings $13.33

$0.00

$2.00

$4.00

$6.00

$8.00

$10.00

$12.00

$14.00

$16.00

$18.00

$20.00

Claim

Submission

Eligibility Prior

Authorization

Claim Status Claim

Payment

Remittance

Manual

Electronic

Transforming Patient Access allows refocusing on patient care

Case Study: Carolinas HealthCare System

Breadth of CHS

Rehabilitation Hospitals

LiveWELL Carolinas

Primary Care Practices

Health Clinics

Urgent Care Centers

Hospitals

Behavioral Health

Nursing Homes

Home Health

Continuum of Care

Emergency Care Centers

Ambulatory Surgery Centers

Hospice & Palliative Care

Specialty Care Practices

Summary of System

• 60,000 employees

• 2,535 physicians

• Close to 800 care locations

• Nearly 7,500 licensed beds

• 11 long-term care facilities

• 12 home health agencies

• 9 hospice providers

• 8 freestanding EDs

• One of 5 academic medical centers in

the state of North Carolina

CHS ExperienceCarolinas HealthCare System

affiliates and physician networks in NC,

SC and GA.

Corporate Patient Access

CMC Anson

Pre-Service Department

In 2000 as a result of an Ernest and Young Revenue Cycle Review,

a dedicated Pre-Service Department was established to focus on

the following goals:

• Decrease Denials

• Improve Patient Satisfaction

• Increase POS Cash Collection

Areas of Responsibility

Scheduled Services

• Pre-Registration

• Insurance Verification

• Non-Clinical Authorization

(NCA)

• POS Cash call

Inpatients & Observation Patients

(unscheduled/ED admits)

• Insurance Verification

• Non-Clinical Authorization (NCA)

• If needed, communication with Clinical

Care Management

Pre-Automation Process

Prior to April 2007

Individual ApproachRegistrar works account to completion

including:

• Pre-Registration

• Insurance Verification

• Non-Clinical Authorization

• POS Cash Call

After April 2007

After April 2007

Team Approach

• Pre-Registration Team

• Insurance Verification and Non-

Clinical Authorization Team

• Cash Team

Pre-Automation Process for Estimation and Cash

• PCON Estimator

• Cash Collection

Our Automation Story

• Replace our Price Estimator

• Better Customer Service when Providing Estimates

• Better Verification Data

Key Components

• SurePayHealth (automated patient estimator)

• AuthDP (automated authorization)

• Working by Exception

Roll Out Plan

• Radiology

• Surgery

• OP Areas

• Inpatient

18

Front Line Communication

Support

KPI’s for Scheduled Services

2013

• 242,014 Scheduled

• 241,941 Pre-Registered

• 99.9%

2014

• 264,061 Scheduled

• 263,982 Pre-Registered

• 99.9%

Completed Days Out

• Surgery 10 in Advance of Scheduled DOS

• Radiology 5 in Advance of Scheduled Procedure

KPI’s for Radiology Denials

2013

• 961 Accounts

• $3,282,947.00 Denied

Dollars

2014

• 723 Accounts

• $1,747,259.00 Denied

Dollars

24.7% decrease in accounts

46.7% decrease in denied dollars

Adjustments

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

H R C F U L K M S

2014 Actual 2.15% 2.66% 0.74% 0.53% 0.65% 0.49% 0.96% 0.40% 0.66%

2015 Goal 2.04% 2.52% 0.70% 0.51% 0.62% 0.47% 0.91% 0.38% 0.62%

2015 YTD 0.74% 0.63% 0.57% 0.35% 0.17% 0.13% 0.07% 0.05% 0.04%

Denial Adj as % of Net Mgd Care Revenue

Jan 2015 YTD Performance

2014 Price Estimation Report

12,11511,428

15,07115,712 15,682

14,881 15,174

13,618

17,919

22,345

16,998

21,429

227

140

193 201

233258 267

245258

324

276

151

0

200

400

600

800

1,000

0

2,500

5,000

7,500

10,000

12,500

15,000

17,500

20,000

22,500

25,000

Pri

celin

e C

alls

Recondo Estimates Priceline Calls

FTE Staffing

1290

1366

1888

76

67

62

60

62

64

66

68

70

72

74

76

78

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2001 2013 2014

Beds vs. FTEs

# of Beds # of Pre-Service FTEs

Pre-Service vs. Corporate Facility YTD Cash Collections

$2,3

71,8

71.0

0

$3,0

33,1

36.6

8

$3,0

17,4

22.4

7

$2,4

76,0

31.4

9

$2,4

09,8

69.9

2

$2,5

33,2

92.1

5

$2,6

81,1

22.3

7

$3,2

02,0

27.9

2

$3,0

48,8

81.1

8

$4,1

90,9

75.5

2

$11,4

93,0

33.0

0

$1

2,9

27

,34

4.0

0

$13,5

45,0

93.0

0

$11,8

71,5

47.0

0

$12,8

49,0

91.0

0

$10,0

07,5

40.0

0

$11,2

72,4

39.0

0

$11,5

25,4

76.0

0

$10,9

59,6

40.0

0

$0.00

$2,000,000.00

$4,000,000.00

$6,000,000.00

$8,000,000.00

$10,000,000.00

$12,000,000.00

$14,000,000.00

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 (Jan-

Feb)

Pre-Service YTD Total Corporate Facility YTD Total

Collections Percent of Net Revenue Overall

• 2012 0.70%

• 2014 0.80%

Questions/Comments

Thank you for your time and interest……

Katie Davis Katie.Davis@carolinashealthcare.org

Elizabeth Staas Elizabeth.Staas@RecondoTech.com