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The pink MAP to optimizing revenue cycle
success..
Eric Schick, SVP/CFO
Renee Edwards – Health System Director Patient Financial
Services, SBO, Scanning. Home Health and Hospice Billing.
Andria Stolhand – Director of Professional Billing and Collections
and Health System Cash posting.
Agenda
• Saint Francis Health System by the Numbers
• Challenges
• Culture and Accountability
• Approach to Process Improvement
• Outcomes and Measures
Page 2
Pink City on a Hill
Page 3
Saint Francis Health System Operations
• 1,081 Beds
• 307 employed physicians
• 8,300 employees
• $1.2 billion in net patient revenue
• 60,000 admissions
• 130,000 emergency room visits
• 370,000 outpatient visits
• 1,100,000 physician office visits
Page 4
Saint Francis Health System
Epic Journey
• Went live with Epic ambulatory May 6, 2014
- Big bang all physician offices
• Went live with Epic inpatient June 29, 2014
- All three inpatient facilities at once
Page 5
Challenges
• Industry shift
• Need for change
• What we are up against
Page 6
Changing a Culture
Goal…..
Create a structure to drive accountability in order to
improve financial metrics
Post EPIC implementation revenue cycle key performance
metrics back to baseline
Page 7
Chief Financial Officer
Managed Care/Contracting
Hospital Billing
Physician Billing
Health Information Management
Admitting/Registration
Centralized Scheduling
Pre-Arrival
Revenue Cycle Reporting Structure
Page 8
Keys to Performance Improvement
Management
Identify opportunities for improvement1.
Set effective performance targets2.
Implement process improvement3.
Measure effect of change4.
Monitor and sustain the improvement5.
Page 9
Identify Opportunities to Improve
• Analyze data
- Candidate for bill
- Coding days
- Discharge not final billed errors
- Days in accounts receivable
- Aging trending
- Aging by financial class
- Payment variances from contract
- Denials
• Prioritize improvement opportunities- Quick wins
- High-impact improvement opportunities
- Long-term strategic
Page 101.
Net Contract Under Performance
Realization to Expected
0
20
40
60
80
100
120
140
160
Payer 1 Payer 2 Payer 3 Payer 4 Payer 5 Payer 6 Payer 7
Vo
lum
e (
Mil
lio
ns
$)
Variance in projected value of contract and actual
5%
5%
8% 7% 2%
5%
7
6%
40%
27%
16%
10% 7%
Eligibility Invalid payer info
Other insurance
primary
Subscriber not on file/
invalid member #
Patient Information
needed
Insurance not in effect
at TOS
Pended In Review
Information Requested
Clinical Authorization
conflict
Inpt/Outpt overlap
Line level service
denials
Claim Submission Duplicate claim filing
Passed timely filing deadline
Incomplete billing attachments
Coding error
Payment Capitated/Case Rate
Site of Service
Payment Variance
Partial Payment
Reasons for Claim Denials
Page 12
Set Effective Performance Targets
• Set KPI based goals
- Reduction in accounts receivable over 90 days
- Denial prevention
- Increase realization on managed care contracts
- Coding days two days or fewer
- Candidate for bill fewer than five days
- AR days less than 35
• Develop standardized and predictable processes for
denial resolution
• Instill a sense of ownership for denial management
across the entire revenue cycle (prevention)
2.
Implement Process Improvement
• Identify key stakeholders (director level and above)
- Patient accounting
- Case management
- Pre-arrival
- Managed Care/Contracting
- Coding
Clinic Managers
Information Services
• Establish regular weekly work sessions
• Develop payer expectations
• Develop action steps
- Denials assigned to key stakeholders
- Denial resolution expected
- Create payer dashboards Page 143.
Create a structure to drive accountability
• Dashboards for each of your key stakeholders in the
revenue cycle
• Goals with performance expectations
• Weekly meetings with each of the key stakeholders of
the revenue cycle
• Instill a sense of ownership across the entire revenue
cycle
• Weekly monitoring of assigned tasks
• Regular scheduled meetings with managed care
payers
Page 15
Accountability: The ability to measure and
report on a routine basis in a predictable
manner with set expectations.
Page 16
Measure Effect of Change
• Report results
- Reduction in accounts receivable
- Insight into payment delays and denials
- Hold payers accountable
- Better contract language
Page 174.
Contract Realization
0
10
20
30
40
50
60
70
80
90
Payer 1 Payer 2 Payer 3 Payer 4 Payer 5 Payer 6 Payer 7
Vo
lum
e (
Millio
ns
$)
Variance in projected value of contract and actual
SAINT FRANCIS HOSPITALPPO Products - Volume by Payor
Variance Between Negotiation and Actual Performance
3%
3%
0% 2%2%
3%
7
0%
Today this is 0%
Page 184.
Page 194.
The Revenue Cycle Journey ……
You cannot manage a process
unless you can measure your
progress….
Hospital Billing
41
39
37
30
29
31
30 30
25
27
29
31
33
35
37
39
41
43
2007 2008 2009 2010 2011 2012 2013 2014Page 20
4.
Days in Accounts Receivable
18.7%
9.7%
6.5%
4.3%
2.3%
0.98% 1.02%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
2008 2009 2010 2011 2012 2013 2014
Page 214.
Commercial Accounts Receivable Greater than 90 Days Old
Hospital Billing
1.24%
0.93%
0.83% 0.82%
0.72%
0.62%0.59%
0.00%
0.20%
0.40%
0.60%
0.80%
1.00%
1.20%
1.40%
2008 2009 2010 2011 2012 2013 2014
Page 224.
Denials as a Percentage of Gross Accounts Receivable
Hospital Billing
Professional Billing
Page 234.
38.4
41.1
42.0
31.8 31.8
38.2
33.0
28.0
30.0
32.0
34.0
36.0
38.0
40.0
42.0
44.0
2009 2010 2011 2012 2013 2014 2015
Days in Accounts Receivable
Professional Billing
Page 244.
Commercial Accounts Receivable Greater than 90 Days Old
23.4% 23.6%
12.6%
15.6%15.1%
7.7%
12.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
2009 2010 2011 2012 2013 2014 2015
Professional Billing
Page 255.
$2,963,927
$3,271,134
$2,684,991
$3,226,799
$3,386,494
$1,444,392
$3,195,409
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
$4,000,000
2009 2010 2011 2012 2013 2014 2015
Epic Conversion
Monitor and Sustain
• Proactive daily management
• Maintain the engagement of the key stakeholder
• Realize not a focused project but ongoing process
• Look to identify trends in denials earlier
• Evaluate performance targets and set stretch goals
Celebrate Successes Page 26
5.
Your Challenge
• Organizations must continue to do more with less
• Culture must elevate the importance of process
improvement
• Greatest opportunity is engaging key stakeholders
• The way to achieving financial metrics is through
performance tracking and implementing successful
practices
Page 27
Page 28
Revenue cycle results
post go live with EPIC
The true PINK test …
AR Days (of Revenue)
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Blue Line: Saint Francis Health System
Tan Line: Average of all Benchmarking Survey participants
Green Line: Average of survey participants in Top Quartile of System Page 29
Hospital Billing
DNFB Days (of Revenue)
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Blue Line: Saint Francis Health System
Tan Line: Average of all Benchmarking Survey participants
Green Line: Average of survey participants in Top Quartile of
System Page 30
Hospital Billing
CFB Days (of Revenue)
0.0
2.0
4.0
6.0
8.0
10.0
12.0
Blue Line: Saint Francis Health System
Tan Line: Average of all Benchmarking Survey participants
Green Line: Average of survey participants in Top Quartile of
System Page 31
Hospital Billing
Coding Days (of Revenue)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Blue Line: Saint Francis Health System
Tan Line: Average of all Benchmarking Survey participants
Green Line: Average of survey participants in Top Quartile of
System Page 32
Hospital Billing
Claim Edit Days (of Revenue)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Blue Line: Saint Francis Health System
Tan Line: Average of all Benchmarking Survey participants
Green Line: Average of survey participants in Top Quartile of
System
Page 33
Hospital Billing
Billed Lag Days (Calendar Days)
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Blue Line: Saint Francis Health System
Tan Line: Average of all Benchmarking Survey participants
Green Line: Average of survey participants in Top Quartile of
System Page 34
Hospital Billing
Claims with Open Denials Days (of Revenue)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Blue Line: Saint Francis Health System
Tan Line: Average of all Benchmarking Survey participants
Green Line: Average of survey participants in Top Quartile of
System
AR Days Page 35
Hospital Billing
Page 36
Professional Billing
Results post go live with
EPIC
Page 37
AR Days (of Revenue)
Professional Billing
Page 38
Charge Review Days
Professional Billing
Page 39
Claim Edit Days
Professional Billing
Page 40
Open Denials
Professional Billing
Page 41
Undistributed Days
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Professional Billing
Value That is Created
Improve cash flow
Create efficiencies and improve workflow processes
Create ownership of process
Prepare for future changes
It is not enough to do your best; you
must know what to do, and then do
your best.
- W. Edward Demmings
Page 43
