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Different Perspectives on Optimizing RCM and Your CBO

Ron AndersonDirector of Business Development

Key Components and Effective Management of a Remote Workforce

Hybrid Outsourcing Options viaShared RCM Services

CHMB Inc. - BackgroundLeading provider of business services and technology solutions for healthcare organizations

• Since 1995• Largest privately held RCM company serving

physician based organizations based in California• 3 Primary Service Lines– Outsourced Revenue Cycle Management Services (85%)– Professional Services (5%)– HIT/IS Services (10%)

CHMB 360 Surround Services

Domain Expertise Scalability Single Source

CHMB History - Where We've Been Year Employees

CHMB Opened for Business 9-25-95(3,000 SF in Mira Mesa business office building) 1995 10Scripps Mercy signs contract 1997 35

Data Warehouse developed… service offering greatly enhanced 2001 70

Company moves to 16,000 SF in Escondido 2003 104

Implementation begins on document imaging system… the paperless office 2004 119

IT Department formalized… IT infrastructure upgrade begins 2005 131

Work-from-home initiative expands… workflows modified and improved to accommodate new workforce 2006 155

Migrate from legacy PM to Allscripts PM & Allscripts Business PartnerBusiness offering expanded to include electronic health records (EHR) services 2007 180

Clinical Services department is added to supplement growing EHR Implementation business. 1st acquisition completed 2008 250

2nd Acquisition completed - Orange County. Strong operational office in Irvine, CA 2009 300

3rd acquisition completed - Northern California. Added Consulting services to business offerings 2010 320

4th acquisition completed – MidwestAdded CBO Operational and Optimization services to business offerings 2011 350

Allscripts begins offering RCM ServicesCombination of Allscripts software and CHMB RCM Services 2012 360

Providing RCM, IT and Professional Services for over 4,000 physicians in all 4 time zonesSigned 1st EPIC Client – Northwest Community Hospital, IL 2014 375

RCM CBO Remote Workforce(Telecommuting)

Key components Set up Monitoring Managing

Telecommuting - Remote Work Force

Telecommuting is more prevalent than ever and will continue to grow as more companies and employees see the benefits of such an arrangement. It can be very successful and actually a competitive advantage in the talent marketplace to attract/retain top talent, regardless of their physical location. However, leveraging the benefits of telecommuting comes with being mindful of the potential issues that can exist and taking steps to mitigate those issues to create a successful telecommuting arrangement. This is even truer for non-exempt telecommuters

CHMB Remote Workforce

Key driver was increasing overhead costs, primarily real estate

Key considerationso Complianceo IT and Securityo HRo Monitoring Productivityo Managing Workflow

Compliance

Workers Compensation

Ergonomics

Legal review

Work from home compliance

Has to be voluntary

IT and Security• All remote access is through remote desktop services so all data

remains on the servers• No information can be downloaded to PC’s• No printing options for remote staff• Secure vpn access. With timeout after 30 minutes of inactivity. It

disconnects VPN• Screen locks on terminal server sessions set to 15 minutes of

inactivity • PM and EHR application time outs after 30 minutes of inactivity• Passwords change every 90 days for windows (Active directory),

PM and EHR • Inquire user identify for all systems. No generic id's allowed.

HR Considerationsfrom a HR compliance perspective Timekeeping of hours for non-exempt staff Ensure compliance with meal/break period requirements for

non-exempt staff Safety; even though the employer doesn’t control the worker’s

premises in a telecommuting situation, the employer is still responsible for worker safety. Employee injuries during the course and scope of the employment will be workers’ compensation claims.

Protecting proprietary or other private information (HIPAA, for example) at the off-site location

Mandatory state/federal employment posters still required to be provided, even for remote workers

• Telecommuting may be a reasonable accommodation under the federal Americans with Disabilities Act (ADA) and California’s disability regulations. Even if the employer doesn’t have a Telecommuting program, may need to provide this arrangement as an accommodation in specific circumstances. (CA’s disability regulations specifically list “permitting an employee to work from home” as a reasonable accommodation.

• If employees work in varying states, need to understand any state specific regulations and comply accordingly.– For example, Massachusetts just enacted a mandated Sick Pay regulation

which could result in a need to comply. Also, there may be specific compliance issues in certain cities (San Francisco has certain rules)

• Ensuring that the state payroll taxes associated with each state in which telecommuters work is followed and paid accordingly. Also other state reporting requirements related to payroll.

HR Considerationsfrom a HR compliance perspective

Best to have a systematic approach to a Telecommuting Program to include:• Criteria for assessing whether an employee can work remotely. • Telecommuting Agreement signed by the employee and the

employee understand this arrangement is a privilege, not a right (with the exception of an ADA accommodation)

• The hours the telecommuter is expected to work so that it is aligned with business needs.

• The manner in which home office expenses and expenses for travel/parking at the company will be handled for periods when the worker comes on-site

• How managers will manage work performance/productivity and adherence to company policies

HR ConsiderationsTelecommuting Program Components

• Logistics to support telecommuters (support staff, equipment, office supplies, etc)

• When the telecommuter will be required to come on-site (meetings, client visits, etc)

• Any special policies that might be necessary, such as abstaining from using their children to help with work tasks and the applicability of policies related to computer/phone usage.

• Clarity about whether the employer will assist with costs of moving, if the telecommuter moves.

• How termination of employment will occur in terms of removing computer access and the return of company equipment. Make sure there is a clear written inventory of all company owned equipment.

HR ConsiderationsTelecommuting Program Components

• Expected Duration of arrangement• Conditions that could require return to office location to

work• Employee Rights and Benefits• Equipment usage• Reimbursement of incurred expenses• Maintenance of company equipment• Use of employee’s personal equipment (particularly related

to protecting information as the personal equipment may not be configured to provide appropriate protections)

HR ConsiderationsWork at Home Agreement Components

• Notification requirements to the employer of equipment malfunctions/failures to that the employee can perform the work necessary.

• Work environment expectations at remote site• Job safety requirements• Expectation of job performance/productivity• Compliance with all policies/regulations• Timekeeping requirements• Defined work day/work week• Process to set up remote work and expected time-frame until

remote work is ready

HR ConsiderationsWork at Home Agreement Components

Challenges

• Employee CommunicationsProbably the biggest challenge in a telecommuting arrangement after the above are handled is how to keep remote workers engaged and feeling a part of their company and their team. There are many small and larger methods to keeping the remote worker involved, and one of the most important is continuous bi-directional communication.

• Employee satisfaction surveys• Company Newsletter• Periodic Company Newsletter/Webinars

Monitoring Productivity

Productivity standards(AR follow-up, charge entry & payment entry)o Integrated with data from our PM systemo Down to the user/employee level

Managing/Monitoringo Electronic workflowo Electronic timekeeping (PayNet)

Performance Metrics

Performance MetricsAR Production Summary

Key Outcomes

Enabled us to retain good employees that move or are geographically challenged

Enabled us to hire employees who don’t live near one of our offices

Don’t have to have bricks and mortar officefor all employees enabling further growth

RCM Shared Services – Hybrid models

Shared Services is a hybrid or partial outsourcing of certain tasks and processes between and internal CBO and an outsourced business services vendor

Why a Shared Services Model?

Local labor pool limitations

Space limitations

Allows you to focus internal staff and resources on key aspects of Revenue Cycle

Key Considerations Identify problems in the Revenue Cycle Define what needs to be done internally and what makes

sense to outsourceo Patient communicationso Data Entryo Follow-upo Patient Collections

Define expectations and responsibilities Monitor and Measure by analyzing results

o Productivityo AR Metrics

Finding the right vendor to work with

Shared RCM Services Examples

Early Out AR sent to outsource vendor(e.g. AR over 60 days)

Internal CBOo Front End – Registration, Verifying Eligibility, Schedulingo Middle – Charge Entry, Claims submissions

Outsource Vendoro Back End – Payment Posting, Claims status checks,

AR Follow-up/Denials, Patient Collections

For Additional Information Contact:

Ron AndersonDirector of Business Development

Office: 760.520.1340Cell: 619.813.3892

Email: randerson@chmbinc.comWeb: www.CHMBInc.com