Revenue Cycle ManagementMedical Technology Acquisition and

Assessment

Team Members: Joseph Dixon, Michael Morotti,

Mari Pirie-St. Pierre, David Robbins and Nicole Wayne

July 9, 2009

Introduction of Team Members

Joseph Dixon, Database Analyst Michael Morotti, Medical device manufacturing and

development Mari Pirie-St. Pierre, Health Information

Management Director, Behavioral Health Facility David Robbins, Management Consultant Nicole Wayne, Neonatal Intensive Care Nurse

Revenue Cycle Management at River Center Hospital

What is revenue cycle management Why do we need revenue cycle management Hospital size is 400 beds Case Mix

– 55% commercial heath insurance– 30% Medicare – 12% Medicaid– Remaining self pay

BackgroundSOW Section 1

Current processes encompass– ADT, credit/collections, patient billing.

Future needs– ICD-10-CM– HIPAA 5010– Increase customer satisfaction– Participation in Regional Health Network– Integration of financial and clinical information

ObjectivesSOW Section 2

Maintain ALL of the existing functionality of the current system while supporting the following new requirements:

Transition to HIPAA 5010 claims attachments prior to January 2012.

Transition to ICD-10-CM coding prior to October 2013.

Consistent documentation and coding practices in order to accurately reflect patient severity and care delivered

Objectives (cont.)SOW Section 2

Improve customer satisfaction through expansion of patient services:– Schedule appointments online – Perform online payment for services– Review provider charges and payer reimbursement

Meet standards for interoperability in order to participate in Regional Health Network.

Integrate financial and clinical information Train staff members on new technology. Analyze and apply meaningful use criteria in order to

maximize ARRA incentive pay.

ScopeSOW Section 3

Revenue Cycle Management System (ADT/registration, credit/collections, and patient billing) is obsolete and needs upgrade/replacement to address and support current and future revenue growth in the following areas:

Cash flow improvement HIPAA claims attachment Severity Adjusted DRG ICD-10-CM Coding Outcomes reimbursement Optimizing billing collections and lowering cost Denial management Operational assessments to analyze policies, work flows, staffing, and resource

utilization, etc.

Included & ExcludedSOW Section 3.1 & 3.2

Patient Enterprise Revenue System Decision Support and Reporting Data Conversion and Migration Integration and Interoperability Training and Education

Hardware (excluded item)

DeliverablesSOW Section 4

List all the major project deliverables – ie. Statement of Work List Responsible Party, Acceptance Criteria, Due Date. Define required system documentation and user

documentation. – Require documentation to include customizations and configurations

specific to this project.

Quantities, locations, dates for delivery and period of performance for services.

Interim deliverables may be included in this list if the final deliverable requires a lot of effort and a long time to complete.

Indicate who will review and sign-off for approval. Use tables – rather than a narrative – to enumerate the

deliverables is preferred (even for simple SOWs).

MilestonesSOW Section 5

Milestone Responsible

Target Begin Date

Target End Date

Develop Statement of Work and Responsibility

Matrix

Hospital Executive Committee

06/27/2009 07/9/2009

RFP Completion and Submission

Hospital Executive Committee

07/21/09 08/01/2009

Vendor SelectionHospital Executive

Committee 8/2/2009 8/12/2009

Develop Implementation Plan

Steering CommitteeImplementation Team

Vendor

8/14/2009 9/1/2009

System Implementation VendorImplementation Team

1/2/2010 1/2/2011

Change ControlSOW Section 7

Defined: A change is any material deviation from a baselined and approved scope document.

Process:1. Submission of Change

2. Assessment of Change

3. Analysis of Cost / Project Impact

4. Program Office / Project Management Recommendation

5. Steering Committee Decision

6. Communication & Documentation

Project Reporting & CommunicationSOW Section 8

Overview: Provides information, forms and templates to give personnel a starting point for managing and creating communications for the project

Project Documents: Baselined and resource loaded project plan, Issue log, Risk Log, Change Log, Dependency matrix, Communications Plan, Training Plan

Committees: – Weekly Project Management Meetings– Bi-Weekly Stakeholder Meeting– Monthly Steering Committee Meeting

Responsibilities Sow Section 9

Role Name Organization Responsibilities Time to project

CIO CIO Hospital Oversees vendor, implementation, and installation and monitoring of system, looks at possibilities of consolidation with vendor. Oversee training, give feedback. Approve system specifications and implementation, oversee: data migration and configuration, software validation, validate data sources. Progress review. Member of steering committee.

10%

Project Leader

Project Leader

Hospital Oversees vendor implementation -all aspects. Approve system specifications and implementation, oversee: data migration and integration, and software validation, validate data sources. Establish power users. Progress review. Member of steering committee.

15%

14

Responsibilities (cont.)Sow Section 9

T

14

Role Name

Organization

Responsibilities

Time to

project

Vendor Legacy Legacy Systems Meets the hospitals needs for the plan, gives, information as to how they can best meet these needs including: implementation, trial period, modification and maintenance

To be determined

CNO CNO Hospital Identify specific needs to make the new system work, and give feedback. Oversee training. Member of steering committee.

5%

CMO CMO Hospital Identify specific needs to make the new system work, and give feedback. Oversee training. Member of steering committee.

5%

Responsibilities (cont.)Sow Section 9

Role Name

Organization

Responsibilities

Time to

project

CFO CFO Hospital Identify specific needs to make the new system work, and give feedback. Oversee training. Give return on investment data (of new system). Member of steering committee.

5%

CEO CEO Hospital Keeps the Board of Directors, Chair of Audit, and Finance Committee informed and obtains their support. Member of steering committee.

2%

Questions

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