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MILLION DOLLAR SOLUTION WITHOUT
THE MILLION DOLLAR PRICE TAG
HFMA Hawaii Chapter ConferenceApril 10, 2015
Kern Medical Center
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/CAID AND M/CAID 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/Caid and M/Caid 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 consulting 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
HOSPTIAL BUSINESS OFFICEPAPER, PAPER EVERYWHERE
Correspondence was passed around until it ended up with the appropriate person once dealt with it was filed in a daily folder
Payment process staff analyzed each EOB to determine if contractual was accurate dramatically slowed down payment posting
Medicare billing was handled by 2 fte’s, even though average daily volume is less than 15 accounts.
Commercial billing and follow-up was handled by 3 fte’s and even though the average daily volume is 25, more often balances were written off to timelines.
HOSPITAL BUSINESS OFFICEMANUAL WAS THE WORD OF
THE DAY Adjustments were manually documented, forms
completed and forwarded to supervisors to data enter M/Caid reimbursement is low but current processes
required multiple staff to achieve reimbursement. o KMC spent more then actually received in
reimbursement Remittance advice were manually reviewed by 1 fte
denials were documented in account notes someone else reviewed denials and re-worked claims
that claims editing system had deemed “clean” Inpatient was handled by yet another fte M/caid physical therapy was billed by anther fte M/caid managed care was handled by 2 fte’s.
PATIENT FINANCIAL SERVICES
A NEW DAY ARRIVES Replaced existing claims editing vendor 10% clean claims and even then “clean
claims were rebilled New claims editing vendor programmed
majority of errors to improve clean claims, now at 60%
M/Caid 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 SERVICES
A NEW DAY ARRIVES Payment processing posts payments and denials as reflected on EOB, staff merely post what they see
Zero payments posted have the Claim Control Number and reason, documented in the account notes.
Correspondence is answered and documented by 1 fte, same fte also answers all requests for records by attorney’s or subpoena's
Medicare and Commercial 1 fte performing billing function quit, but it was not a full time job anyway. Outsourced function to claims editing vendor.
PATIENT FINANCIAL SERVICES
A NEW DAY ARRIVES Commercial Follow-up is performed by 1 fte focused on making outgoing calls, by payer. Benchmark is resolving 40 claims per day
Established Underpayment review of daily payments, 1fte created ACCESS database payment files are imported the day after posting accounts are reviewed against contracts underpayment identified, account is documented
and e-mail is sent to Collector
PATIENT FINANCIAL SERVICES
A NEW DAY ARRIVES Self-Pay was outsourced from Day One eliminated statement production eliminated mail returns Eliminated staff required to answer
patient calls increased self-pay collections 1 fte is the designated as the hospital
liaison assists with resolving issues between
vendor and KMC.
PATIENT FINANCIAL SERVICESBRAVE NEW WORLD Continually striving to identify new
opportunities to maximize technology and minimize staff intervention
Cash collections continue to exceed prior year
Billed A/R Days are hovering in the 50’s but we are working to decrease Billed A/R days to mid 40’s.
PATIENT FINANCIAL SERVICESA BRAVE NEW WORLD
12 staff members and 2 Supervisors Working toward 100% clean claims Goal for Medicare and M/Caid 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 people
presenting, we are more than happy to help.
THANK YOU Susan Labow- [email protected] Helen Cullen – [email protected] Andree Campa –
