MAP Award Journey - Departmental Collaboration to Improve
Revenue Cycle Performance Joseph Koons, MSA, FHFMA, CPAM Managing
Director, Revenue Cycle August 1, 2012
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About Centra Financial Impact DNFB Green Belt Project Review
POS Collections Continuous Process Improvement Technology &
Other Components Agenda 2
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About Centra Health Available Beds: Acute463 Acute Rehab 20
Acute Psych 41 Post Acute447 Acute Care Hospitals: Lynchburg
General Virginia Baptist Southside Community
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Payer Mix and Hospital Demographics Medicare - 50.9% HMO / PPO-
25.3% Medicaid - 14.2% Self Pay -5.8% Commercial -1.9% Other -1.8%
Admission: 26,824 ED Visits: 92,212 Employees: 5,000+ 4 Service
Lines: > Home Health > Hospice > Substance Abuse >
Mental Health > Child & Adolescent Residential Treatment
> Skilled Nursing > Reference Lab > Rivermont Schools >
Cancer Center > Mammography Centers
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Revenue Cycle Metrics for Centra Gross Revenue: $1,194,866,318
Net Revenue: $ 591,616,570 Gross AR Days:39 Bad Debt % GR:1.7%
Charity % GR:3.7% DNFB Coding:4.6 Gross Revenue Days
Inhouse/Unbilled:2.9 Gross Revenue Days Cost to collect:3.0% (HIM,
CCD, Pt Access, Pt Accting) Cash % of NR:99.7% 5
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Charity and Bad Debt Trending Charity Policy Payment options
Statements Presumptive Charity Discounts SP Outsource
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Revenue Cycle Structure Managing Director of Revenue Cycle with
Direct Reports of: Director, Patient Access - centralized and
decentralized in16 locations 5 Managers, 2 Financial Counselors
80.42 FTEs Director, Clinical Coding - centralized and
decentralized in 5 locations 1 Manager 28.35 FTEs Director, Health
Information - centralized in 2 locations 2 Managers 56.1 FTEs
Director, Patient Accounting - centralized business office 2
Managers 45.68 FTEs Director, Revenue Cycle Physician Practices IT
Specialist, RAC Coordinator, and Manager Revenue Integrity 7
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Courage is rightly esteemed the first of human qualities
because it is the quality which guarantees all other. Winston
Churchill
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DNFB PROJECT
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DNFB GREEN BELT PROJECT 10 Scope of the project focused on
inpatient (IAL & IAV) stays
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POINT OF SERVICE COLLECTIONS
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Bringing It All Together Point of Service Collections =
Financial Counseling 18 POS Collections Local Economy Training
Payment Policy Uninsured Discount Support Prompt Pay Discount Payer
Mix Charity Program TechnologyIncentives
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2007 Before State 19 Inconsistent upfront collections No
automated payment posting Limited pre-registration No measurement
for accuracy Limited insurance verification Chargemaster was the
only estimation tool Estimates contract pricing non existent
Implemented medical necessity checking and ABN issuance
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Continuous Review and Change 20 Implement best practice for all
work processes across patient access points. Hold staff
accountable. Centra continually trains staff, implemented staff
promotion path, and paid testing for certification Analyze Work
Processes Identify Barriers and System Shortfalls Process
Optimization Communicate with Service Lines Elevate Staff
continuous process improvement Director and VP level communication
with leaders, educating front line clinical staff Emphasis should
be on any process that continues to be manual can it be migrated.
or does it have system optimization potential.
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2008 The Journey Begins Collections policies and procedures
created Senior Executive and Board approval Trained staff on
collections policies introduced scripting Completed implementation
of pre-registration unit (call center) Introduced incentives and
tied them to accuracy of registration Implementation of staff
scorecards to include productivity, accuracy and collections.
Posted on departmental webpage Upgraded existing systems to include
integrated payment posting, separate estimation tool to include
contract pricing Daily progress emails from department Director
Rolled out process in May 2008 Total collected $753,638 21
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Staff Training and Communication Online policies and procedures
Workflows Role playing Scripting HFMA CBTs Videos Daily updates on
departmental webpage Training documents available on departmental
webpage Utilization of tools to enhance workflow, not encumber
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Incentives for Collections Annual reset of departmental goal
Annual reset of unit goals Annual resets of individual goal
Departmental goal adjusted monthly based on historical data
Individual accuracy goal must be met for payout for staff 24
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Incentives for Productivity and Accuracy 25 Example: Jane
worked 13 shifts during month Her average per shift was 58 accounts
Janes registration accuracy is 98% Jane productivity exceed
standard by 23 accounts Productivity bonus = (23 accounts * 13
shifts) * $0.20 = $59.80 Accuracy bonus = (23 accounts * 13 shifts)
* $0.10 = $29.90 Productivity is pulled from account transactions,
divided by common denominator, and averaged against hours worked to
determine accounts managed
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It all starts with registration accuracy REALTIME! 26
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Sample Daily Error Report 27
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Sample Scorecards 28 ManagerRegistrar
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29 Staff in Access work as members of multidisciplinary groups
to improve service scores Departmental KPIs are published on
webpage, open the entire organization Scores are shared at
departmental meetings, service areas and with senior
executives
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30 Tool runs estimates based on insurance plan and contract
pricing Estimates returned include negotiated rates so as to help
explain to the patient their final responsibility
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2009 Gaining Traction Redefined goals, set thresholds based on
historical data Refined scripting provided retraining Focused on
1st of year deductible & out of pocket Added staff to
pre-registration unit to increase percentages Estimation tool
integrated in registration screens Refined estimation tool
parameters to increase accuracy Continued recognition of high
performers Total collected $1,896,240 31
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2009 Gaining Traction Redefined thresholds based on % of net
revenue and potential cash collections Reviewed collections in
service lines and communicated with those leaders to enhance POS
collections activity Staff training on new financial aid programs
Implementation of prompt pay discounts and payment plans
Implementation of Financial Counseling for inpatient and high
dollar outpatient Implementation of Financial Counseling software
(RevRunner) Refocus on inpatient accounts and balance after
insurance Centralized staff & implemented collections in
mammography centers Continued to refine pre-registration practices
Continued daily/weekly recognition of high performers Total
collected $3,418,058 33
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2011 - Continuous Process Improvement Refined reporting tools
for management HFMAs Map App Advisory Board Patient Compass Horizon
Business Insight (HBI) customized drilldowns Further empowerment of
Financial Counselors and Pre-reg team Referral workflows reviewed
Continued build for common procedure file in estimation tool and
continued refinement of lookback criteria Revised repayment plans
to include >12 months Revised scripting to emphasize deposits
toward service Continued rule builds in FCW to enhance accuracy
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37 End of Year 2011 $5,471,296
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Integration is Key 38 Instant notification of approval for
credit cards Daily reconcilement report from vendor Run estimates
from workstation Directly access other tools Automated receipts
Ability to post cash, credit card, e-checks, and other transaction
codes as defined Ability to post directly from registration
screens
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Whats Next? eSignature for ABNs Patient friendly signature pads
Kiosks and Biometric security Revisit service lines with
inconsistent collections Continued communication to the
organization providing education as to collections program and
purpose Continue comparison to % of net revenue and cash
collections using determination of projected potential in threshold
calculation Use management tools to further enhance departmental
processes, focusing on patient experience Consistency, consistency,
consistency 39
