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Cerner Soarian Physician Revenue Management: from implementation to optimization

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Objectives

• 1. Analyze implementation considerations

• 2. Describe how the solution is set up to accomplish Medicare Regulations around Provider Based Billing

• 3. Compare different clients' tips to full optimization

Julie Floyd & Chris Walters

November 15, 2016

Soarian Financials ImplementationConsiderations

Kentucky Medical Services Foundation, Inc.

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The Kentucky Medical Services Foundation, Inc. (KMSF) was founded in 1978 with two primary missions that have guided its activities and focus for more than 35 years: To bolster efforts to recruit and retain the best clinicians to ensure the provision of high-quality health care for the region and the Commonwealth; To serve as a charitable organization to support the education, research, service and patient care missions of the University of Kentucky and UK HealthCare®.

KMSF offers services for UK and UK Healthcare in the areas of Human Resources, Revenue Cycle Management, Billing Services (Insurance Follow-Up, Customer Service, and Provider Enrollment), Compliance, Information Technology, and Finance & Accounting.

We are the Central Billing Office for all professional billing and bill approximately $626M in gross charges, as a result of roughly 5M CPT codes, annually. The health system is comprised of 18 clinical departments, 4 hospitals, and approximately 1,100 providers that service our patient population.

KMSF was a previously a Signature client, for over 30 years, that implemented Soarian Financials Physician Revenue Management in December 2015. KMSF was a beta site for both systems. We implemented Soarian Financials with foreign front end systems for registrations, therefore making us a beta client for academic physician revenue cycle functions and management.

Who is Kentucky Medical Services Foundation

Inc.?

Julie Floyd

Director, Revenue Cycle Management

November 15, 2016

Business Operations considerations

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Business Operations Considerations

• Understanding where you are, and where you are going

• What you do today? How you do it? Processes?

• Where do you expect to be? Where do you want to be?

• Pro: Engagement from executive leadership down to front line staff

• Organization ready for change

• Barriers to change? Identify barriers and promoters of change upfront

• Dedicated project space - uninterrupted/focused “safe” environment

• Client/Vendor Relationship - Developed and maintained solid professional relationships within the functional business side of Cerner and those of KMSF

• Con: One of the first foreign front end customers

• Greater than 65 add on systems that needed to be interfaced

• Employee fatigue; all directors were 100% on the project as well as their respective functional areas

• Needed more variety in employees involved

• Were not clear on where “we” wanted to go in future state

• Outsourced PMO- choose carefully and manage appropriately

• Predefined business scenarios for testing

• Clear reconciliation process with vendors

“There is no greater force than the ability of Soarian Financials to highlight your strengths and weaknesses – i.e. You don’t know what you don’t know.”

-Cerner proverb

Chris Walters

Director, Information Technology

November 15, 2016

IT Operations considerations

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IT Operations Considerations

First 100 Days of Implementation

• How you perform in the first 100 days in the role is critical to your success or failure

Key Findings

• IT and business leaders often inherit an event-driven, transaction-focused, collection interactions, rather than a disciplined structure designed to maximize value.

• For the program to succeed, it must be sponsored, supported and continuously reinforced by executive messaging and actions

• Success depends on developing solid and collaborative partnerships with all lines of business to avoid territorial issues and conflicts in approach.

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IT Operations Considerations

Recommendations

• Create, document and communicate a mission and charter that defines the scope and roles and responsibilities, in addition to how value and performance will be measured.

• Determine the core functions for performance with the business and IT stakeholders and then address organizational reporting.

• Regularly meet and assess against your stated goals and road map.

First 100 Days Road Map

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IT Operations Considerations

Implementation Management Framework

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IT Operations Considerations

Key Challenges To Avoid Blind Spots Post Implementation

• Have a clear understanding of the acceptable risks, identify and mitigate these risks or determine how these risks should be evaluated relative to business goals.

• Define ownership and authority for mitigating identified risks. As a result you will not have blind risks accepted without proper vetting, go unmanaged or go entirely unidentified from the outset.

• Shorter timelines make it impractical to follow established processes of risk assessment, and often result in the business engaging directly with vendors. Thus, risks are often improperly addressed, and risk practices bypassed.

• The project must be owned by the business and driven by technology

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“Howard, you know me to be a very smart man. Don't you think that if I were wrong, I'd

know it?”

-Sheldon The Big Bang Theory

Manuel Pineiro

Sr. Manager Physician Revenue Cycle

November 15, 2016

Physician Revenue Cycle

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Cape Cod Healthcare Overview

Cape Cod Healthcare has two acute care hospitals:

• Cape Cod Healthcare named Top 100 Great Community Hospitals in 2016 by Becker’s Hospital Review

• Historical Utilization

• More than 21,000 discharges

• More than 119,00 ED visits

• Financial Characteristics

• A+ credit rating by Moody’s Investors Services

• $773 million in revenue

• 8.5% operating EBIDA margin

• 180 days cash on hand

CCHC also includes the largest home

health services network on the Cape,

skilled nursing and rehabilitation

facilities, and an assisted living facility.

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CCHC Service Characteristics

• Cape Cod Consists of Barnstable County, with slightly more than 214,000 residents in 2015

• Cape Cod Healthcare has a dominant 72% of the inpatient market share in its primary service area

• More than ¼ of the county’s population is older than age 65 and Cape Cod’s population is estimated to nearly triple in the summer months

• Wealth and income indicators generally exceed state and national averages

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Scope of the Project

• 329 Health Professionals

• 32 Service lines

• 6 Hospital Based Practices

• 4 Urgent Cares

• Hospitalist at two acute care facilities

• Emergency Room

• Nursing home

• Inpatient Mental Health

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Why?

• Reduce Duplication of efforts

• Leverage Encounters created for the technical side

• Leverage Soarian workflows

• Leverage Soarian Reporting capabilities

• Leverage Soarian Contract Management tools

• Single statement for both professional and technical receivables

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How?

• Created 4 new receivable owners• CCH Pro for Cape Cod Hospital based practices and hospitalist

• FH Pro for Falmouth Hospital based practices and hospitalist

• FH ER Pro for Falmouth ER

• MACC Pro for the Urgent Care Centers

• Charge Master • Uniform charge master across all entities

• Created a relationship between the Service Provider Service ID and the CPT code

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How ….Charging

• Practices use charge batch entry as they did before for the technical charges

• Hospitalist charges are interfaced from Patient Keeper

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Charge Validation

• Reports created to identify encounters with:

• Missing charges

• Professional Charge/No technical

• Technical Charge/ No Professional

• On IP ensure one professional charge is available for each date of service

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Insurance Allocation

• Create special rules for manipulating insurances to properly create receivable groups based on modifiers

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Billing

• Billing process was absorbed by current billing staff.

• Claims held and reviewed manually

• After review CRDT edits where built to hold claims

• Example: CCHC_INPT_CPTMISMATCH - Inpatient claim has non-inpatient codes

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Post live

• Benefits• Single guarantor statement for both professional and tech.

• Single insurance validation process

• No additional staff was needed

• Leverage Contract Engine

• Lessons learned• HDM

• Cash Posting Impact

• Increase in obsolete receivables

Arthur Tomczak, PMP

Financial Alignment Executive

November 15, 2016

Medicare Provider Based Billing using Shared Encounters in Soarian Physician Revenue Management

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Objectives

• 1. Understand what the current Issue in Soarian Financials Physician Revenue Management(PRM) are to Bill Provider Based Claims.

• 2. Understand the Changes Made to Support Provider Based Billing for Medicare and Non-Medicare Claims in SoarianFinancials PRM.

• 3. What Master File changes are needed to support Provider Based Billing in Soarian Financials PRM.

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Provider Based Billing

Medicare Non-Medicare • One Shared Encounter

• Prof Charge from Physician RO

• Doctor Tech Charge from Hospital RO

• Hospital Tech Charge from Hospital RO

• 837I for the Doctor Tech Charge From Hospital RO and Hospital Charge from Hospital RO

• 837P for the Prof Charge from Physician RO

• One Shared Encounter

• Prof Charge from Physician RO

• Doctor Tech Charge from Hospital RO

• Hospital Charge from the Hospital RO

• 837I for the Hospital Charge from the Hospital RO

• 837P for the Prof Charge and the Doctor Tech Charge from the Hospital RO Billed Globally

The ability to split bill Medicare for the Technical portion of physician

charges for separate reimbursement to the Hospital.

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Issue/Resolution

• Issue

Share encounters for a Physician Visit and any services performed from the Hospital

Charges for Global Billing need to be in the same participating provider to combine Professional and Technical Charges.

Tech Charges for Medicare Billing need to be in Hospital RO to bill with the Hospital claim.

Need to post charges independent of which Insurance is billed.

• Resolution

Create a Generic Linking rule for Shared Encounter

Allow the linking of Charges to a Primary Charge based on User requirements to keep the Professional and Technical charge together as if they were from the same Participating Provider

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Master File Set Up

• HPO• Service Provider(SP) for the Physician Department in the Physician RO• Service Provider(SP) for the Physician Department in the Hospital RO

• Service Catalog• Professional Charge 99214 Physician SP Physician RO• Technical Charge 99214 Hospital SP Hospital RO• Explode Set off the Professional Charge to include the Technical Charge from the Hospital RO

• Map Set• Add Professional Charges with a Y for Global• Connect the Map set to the Non-Medicare Insurances• No Map set needed for Medicare

• Health Plan Master• Set up a Generic linking rule in the Non-Medicare Plan, using the Option for Shared Encounter.• “Service Expression to Identify the Primary Charge” should be an expression for Professional

Charges• “Service Expression to Identify which Charges are Included with this Primary Charge”

should be an expression for the Tech Charge for Global Billing• No Generic Linking Rule is needed for Medicare

• Contract Master• For the Non-Medicare insure that there is a Package that places the Professional and Technical

Charges in the same Receivable

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Soarian Feature

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Questions?

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Education sessions: Complete a post-session survey for each session in Cerner Events app

Continuing education: Complete the attestation survey, available Nov.16 - Dec. 16

General reminders