Presented by: Christine Kalish, MBA, CMPE

Brittain- Kalish Group LLC

February 25,2016

If Revenue Cycle is a Team Sport, then Patient Access

is the Offense!

Tackling Patient Access for the New Revenue Cycle

Objectives

• List the market drivers that affect the healthcare revenue cycle today

• Identify the roles and goals of patient access in the revenue cycle

• Discuss the significance of a learning culture for a high performance revenue cycle

• Name the challenges and opportunities in training and educating a truly diverse multi-generational workforce

• Develop the success strategy for the next generation Patient Access Team

Changes in Healthcare

Healthcare Reform

ICD-10 and CDI

Patient – Centered Medical Homes

ACO-Style Models

Value-Based Purchasing

Mergers and Acquisitions

Quality Initiatives/

PQRS

Meaningful Use

Healthcare Reform

Population Health

ICD-10/11 CDI

Merit-based Incentive Payment System

Alternative Payment Models

Mergers and Acquisitions

Market Drivers

• Ever-changing regulatory environment

• Tying quality to financial function

• Reduced payer reimbursement rates

• Rapid growth in consumer payments

• Shifting consumer expectations

Goals of Patient Access • Set a positive tone for the

entire patient experience • Complete the patient financial

clearance process correctly • Collect appropriate monies

due at the time of service • Assure that patients get to

the right place with the right provider at the right time

“Show me that you know me and that you care.”

The Revenue Cycle

Patient Access

Care Delivery

Charge Capture

Claims Submission

Follow-up, Processing

and Rejections

Cash Optimization

Metrics Definition: All administrative and clinical functions that contribute to the capture, management and collection of patient service revenue - HFMA

Learning Changes Things

What about learning?

Today’s Workforce

Traditionalists Baby Boomer Gen X Millennials Date of Birth Before 1945 1946-1964 1965-1978 1979-present

Cohort size 27 Million 76 Million 60 Million 88 Million

Total workforce 8% 43% 21% 27%

Healthcare Workforce

9% 48% 23% 27%

Workplace characteristics

Value practical experience and accountability Strong interpersonal skills Value academic credentials Loyalty to employer Believe promotions and recognition come with job tenure Accept limited resources

Driven by goals for success Believe in teamwork and emphasize relationship building Career = identity Expect loyalty from co-workers Want work-life balance

Self –reliant Highly educated and questioning Risk-averse Want open communication Most loyal employee but invest loyalty in a person, not an organization Value control of their time

Image-conscious Need constant feedback and reinforcement Team-oriented Want open communication Search for an individual who will help them achieve their goals Want to shed stress

Motivation Drives Training

66 years and

older

51-65 years

41-50 years

31-40 years

16-30 years

To maintain/improve skills or knowledge

84% 95% 93% 94% 88%

To learn completely new skills or knowledge

75% 70% 74% 77% 84%

Because employer required/recommended it

68% 74% 74% 70% 79%

To receive a promotion/pay raise 11% 13% 14% 18% 26%

To get/keep certificate or license 35% 35% 34% 37% 27%

To help change job or career field 7% 13% 16% 18% 29%

Reasons for Adults’ Participation in Work-Related Courses % giving reason by age group

Source: Pitt-Catsouphes, M., Smyer, M., Matz-Costa, C., & Kane, K. (2007). The National Study Report (Research Highlight No. 4). Chestnut Hill, MA: Boston College Center on Aging and Work/Workplace Flexibility.

Bridging the Gap

• Align organizational systems with development objectives

• Explain the reasons for the development and learning

• Provide organizational resources • Well-designed and supported training can result

in enhanced job-related knowledge and skills • Transfer of learning to the job is critical

Initial Revenue Cycle Training High Performers 1 day or

less 2-3 days 3-5 days 5-10

days > 10 days

Registrars 0% 14% 14% 14% 57% Billers 0% 14% 14% 14% 57% Collectors 0% 7% 21% 21% 50% Financial Counselors

0% 7% 14% 14% 64%

All Others 1 day or less

2-3 days 3-5 days 5-10 days

> 10 days

Registrars 7% 11% 15% 25% 42% Billers 4% 10% 7% 25% 54% Collectors 5% 9% 10% 30% 47% Financial Counselors

5% 7% 11% 26% 52%

Source: Strategies for a High Performance Revenue Cycle, HFMA,2009

Domain Access Key (KPI) Equation Good Early Implementation Phase or Manual Process

Better Middle Implementation Phase or Semi-Auto Process

Best Mature Implementation Phase or Auto Process

Collections POS Collections to Total Patient Collections

POS Collections Total Patient Collections

30% 40% 50%

Collections POS Collected Accounts Rate

Accounts Collected Total Registrations

20% 40% 60%

Patient Experience

Average Wait Time

Total Minutes Spent Waiting Total Registrations

15 mins 10 mins 5 mins

Critical Process Insurance Resolution Rate

Insurance Failures Resolved Insurance Failures Identified

50% 70% 90%

Critical Process Address Resolution Rate

Address Failures Resolved Address Failures Identified

N/A N/A 98%

Productivity Insurance Verification Rate

Verified Registrations Total Registrations

80% 90% 98%

Quality Registration Accuracy Rate

Error-Free Registration at POS Total Registrations

80% 85% 90%

Measure What You Do

Source: NAHAM Access Keys

Integrate Education with Work Redesign • Create and achieve new work systems that are efficient

and flexible • Use bottom up and top down approach to identify and

work on ideas for change • Recognize the increasing importance of new

technologies, facility designs, and intricate patient protocols

• Build collaborative teams All staff should make maximum use of their present education

and experience

• Incorporate and make human resource techniques easy for staff

Taking a Career Approach

Staff work in support services, pulling data for

management and other staff

Staff progress into billing, credit

balance adjudication, or

payment and adjustment

posting

Staff progress into collections

Staff progress into contract compliance,

transplant claims adjudication and customer service

Staff progresses into management

positions, including

coordinators, managers, directors.

Baylor All Saints – Fort Worth Career Ladder

Source: Strategies for a High Performance Revenue Cycle, HFMA

Blending The Training Delivery

Identify Training Need • Develop content • Develop

curriculum

Training Delivery • Self-directed

learning • Virtual

Instructor-led training

• On-site instructor led training

• Peer led – lunch and learns

Track Progress • Learning

assessment • Measure results

Sustain Learning • Encourage

change • Provide mentors

Transfer and apply

the knowledge

Tie into Performance Plan and Career Ladder

Course Builder

Assessment Builder Learning Paths Reminders Registration Analytics

Watch Mobile Phone

Tablet Mac/PC Television

API CRM APPS HR APPS CONTENT APPS

Compliance 200 Courses

HIPAA, PCI, OSHA

Sales & Customer Service (coming soon)

Healthcare Revenue Cycle

300 Courses Soft Skills Leadership

300 Courses

CO

NTE

NT

AUTO

MAT

ION

/AD

MIN

AP

I / A

PPS

DELIVERY

Mobility and Ease of Use

Improve the Overall Patient Financial Experience

• Discuss trends within the industry, the department and the clinic

• Understand the patient is a consumer • Teach the payment process • Complete training sessions for staff that include a

specific review of patient bills • Create an environment of expectation with patients

that payment will be handled at the time of service • Utilize technology to support processes

Thoughts to Ponder

• Revenue cycle is a team sport

• Maintain a sense of urgency • Measure what you do • Leverage your resources • Find a new normal

Brittain-Kalish Group, LLC

• BKG provides a portfolio of management consulting services to healthcare and non-profit organizations to support strategic, organizational and process improvement initiatives while improving overall performance.

• Our expertise includes: – Business planning and program development – Interim and fractional practice management – Revenue cycle and business process assessment and

improvement – Healthcare reform advisory services – ICD-10 transition services – Clinical documentation improvement services – Workforce management and training – Strategic planning – Trusted advisor services – Project management

Thank You! Please Contact:

M. Christine Kalish MBA,CMPE chrisk@brittainkalishgroup.com

Cell: 817.980.4317

For course and platform information visit: Litmos.com/healthcare