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CAHAMSeptember 1, 2015Susan Labow, ROI
KERN COUNTY MEDICAL CENTER
TOTAL BEDS : 222ANNUAL ADMITS: 32,000ANNUAL OUTPATIENT CLINIC VISITS: 140,000ANNUAL ED VISITS: 45,000ANNUAL OPT SURGICAL PROCEDURES: 4,0000HOSPITAL FINANCIAL SYSTEM: MCKESSON-STARPRACTICE MANAGEMENT SYSTEM: MCKESSON PRACTICE PLUSEMR: OPEN VISTA
PAYER MIX: 75% M/CAL AND M/CAL MANAGED CARE8% MEDICARE12% COMMERCIAL/WORKER’S COMP./JAIL5% SELF-PAY
KERN MEDICAL CENTERSTATISTICS
A/R DAYS AS OF 6/30/13 TOTAL A/R 166 DAYS- BILLED A/R 151A/R DAYS AS OF 3/01/14 TOTAL A/R 94 DAYS- BILLED A/R 84A/R DAYS AS OF 6/30/14 TOTAL A/R 77 DAYS- BILLED A/R 57
CASH COLLECTIONS AS OF 9/30/13 $6 MILLIONCASH COLLECTIONS AS OF 9/30/14 $13 MILLION
FTE’S 6/30/13 TOTAL FTE’S 30, PLUS 3 SUPERVISORSFTE’S 6/30/14 TOTAL FTE’S 12, PLUS 2 SUPERVISORS
OVERVIEW –MAJOR BARRIERS
2 Registration platforms Star for hospital services Practice Plus for clinic visits & pro fees
Clinic and OP diagnostic registration staff reported to clinic leadership
Hospital registration staff only responsible for ED, INPT and scheduled surgeries
Zero quality and Zero authorizations
OVERVIEWMAJOR BARRIERS
Multiple scheduling systems Surgery -open vistaDiagnostic and pre-op – starClinic visits- practice plus
EMR is non-functional and not user friendly
Diagnostic test performed during clinic visit, were posted in STAR but manually credited and debited in practice plus. TOTAL DISASTER
OVERVIEWMAJOR BARRIERS
Case management focused on Medicare certification M/Cal and M/Cal Managed care No concurrent review or authorizations
for commercial payers No authorization bill hold in financial
system. business office had to scramble once claim
was produced or just bill with records
PROCESS IMPROVEMENTENGAGEMENTS AT KMC
Various firms and solutions had already failed “CONSULTANT” was a bad word
Process improvement opportunities are not visible to everyone. Most common practice is to just add
bodies to broken process Adding bodies, is like adding layers of
clothes to hide your extra weight Nothing is solved
PROCESS IMPROVEMENTDAWNING OF A NEW DAY
Kern was bitten with the improvement bug Once they were given some direction and
ideas they took off and continue to look for opportunities
Watch words are- maximize technology pre-register every type of scheduled service streamline check in- Customer first automate claims submission expect 100%
clean claims don’t take no for an answer
PATIENT ACCESS JOURNEY
Divided registration No pre-registration No insurance verification No co-pay collection Full registration Long wait times Surgery scheduled w/out pre-op
PATIENT ACCESS TURNS THE SHIP
Implement pre-registration On-line payments Quality control over registration Assembly line for patient packets Developed check-in process Assumed registration for diagnostic
testing Assumed registration for clinic
services
PATIENT ACCESS HAS SAILED
Quality and eligibility software implemented
Focus on every error Build edits to correct errors Pre-Registration 250-400 a day On-line credit card and check
processing No bottle-neck at registration Maximize reimbursement
HOSPITAL BUSINESS OFFICEPAPER, PAPER EVERYWHERE
Inpatient claims produced without authorizations Staff had to secure the authorization or
Claims were billed with medical records, majority of time
Room charges were often missing Designated staff member was forwarded acct.
to add missing charge Auto insurance was always billed as prime
California does not subrogate and only ERISA health plans require payment or denial. This does not include Medicare.
Claims were often written off as commercial payer was not billed timely
PATIENT FINANCIAL SERVICES
A NEW DAY ARRIVES Replaced existing claims editing vendor 10% clean claims and even then “clean
claims were re-billed New claims editing vendor programmed
majority of errors to improve clean claims, now at 60%
M/Cal paper claims can now be sent electronically with automated program
Continually striving to improve clean claims to virtually eliminate errors
PATIENT FINANCIAL SERVICES
A NEW DAY ARRIVES Claims editing vendor automatically validates eligibility & changes destination and rules of claim as appropriate report indicates the appropriate payer so
financial system can be updated. report indicates patients with no coverage
Eligibility errors are non-existent due to front-end efficiencies
M/caid denials are automatically adjusted, as defined
Non-covered charges are automatically adjusted Eliminated re-work and re-processing of denials
PATIENT FINANCIAL SERVICESA BRAVE NEW WORLD
12 staff members and 2 Supervisors Working toward 100% clean claims Goal for Medicare and M/Cal A/R greater
than 30 days from billed date – 10% Goal for Commercial A/R greater than 90
days from billed date- 10% Automate anything and everything Empower staff to be fierce agents of war
PROCESS IMPROVEMENT CONCEPTS
Process improvement cannot be achieved with a cookie cutter approachone solution does not fit allnor does one product solve “everything”
Equally dangerous is the self-help approachStaff take courses and obtain certificates and
titlesthe process involves others outside of the
focused areathe problem is – you don’t know what you don’t
know. how can the best solution be achieved without experience garnered at other providers
LESSONS LEARNED Challenge everything Why can’t it be automated? Does the task add value Ask your colleagues Network with fellow financial leaders Don’t be afraid to ask the presenter,
happy to help. THANK YOU
Susan Labow- [email protected] (562) 843-1211