subtitle

Session Title: A Case Study with Orlando Health:  Driving new levels of business performance with revenue cycle efficiencies 

About us

A/R team structure

The need for information

How did we get here

Monthly reconciliation overview

ETM/reports

64,144

5,826

10,000

20,000

30,000

40,000

50,000

60,000

70,00020

0702

2007

0520

0708

2007

1120

0802

2008

0520

0808

2008

1120

0902

2009

0520

0908

2009

1120

1002

2010

0520

1008

2010

1120

1102

2011

0520

1108

2011

1120

1202

CLAIM INVOICES

Physician & Professional Services

82

10

20

30

40

50

60

70

80

9020

0702

2007

0520

0708

2007

1120

0802

2008

0520

0808

2008

1120

0902

2009

0520

0908

2009

1120

1002

2010

0520

1008

2010

1120

1102

2011

0520

1108

2011

1120

1202

Divisions

Physician & Professional Services

510

100

200

300

400

500

600

Providers

Physician & Professional Services

team member training

review notes, assess workload, summarize issues allocation of staffing resources

payer mix, payer trends, workload distribution monthly payer reconciliations

validation of information categorization of issues

Monthly payer reconciliation

Cigna East/West, Humana, Careplus, AvMed, Citrus, Freedom, Prestige, PUP, Sunshine, Wellcare

On going projects & claim events

Aetna, United, Florida Blue (BCBS), Multiplan/Beechstreet

Day 3

Compile

view

Day 12

Finalize

scrubbing

Day 15

Submit to

payer

Day 20-25

Receive from

payer

Day 25-30

Review with

payer

AR Reps

phone follow Up

review  coding denials

medical recs/doc

review fee 

schedules

review provider set up

update info

file appeals

payer portal 

follow up

access sub 

systems

Categories – payer status

Categories – payer status

Categories – payer status

Orlando Health Insurance

See what’s out there

Compile recon view on the 3rd of each month

Work each invoice and clearly document the reason why we believe the claim was processed incorrectly

update payer statusupdate status

Review status field ie: “02eval” – previous month’s carry over

Sort by Balance to review high/low or Division to review patterns

Sort by Corr (charge correction flag) –> Y or Note? –> Y

Scripting of payer notes

Response to our report

Capturing most recent note from both Orlando health and insurance

Going through our secxond round of calls with the insurance directly from the

recon view

Benefits

Review only invoices outstanding

Changes are real time

We are in control

Minimized excel spreadsheets Reduced  days of workflow to xx days

Jose to update 

BAR ETM Informatics

Need to update with full list of CB modules 

used at Orlando

Centricity Business

Next-generation revenue cycle

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Centricity Business overview

GE Healthcare

Centricity Business Revised Positioning and Differentiators

A proven, next generation healthcare revenue cycle managementsolution that supports traditional and accountable carereimbursement models for greater profitability, efficiency and enhanced quality of care.

Interoperable

High performance

Enterprise ready

• Integrated inpatient and ambulatory revenue cycle management across multiple locations for improved transparency and efficiency

• Support for multiple reimbursement models including: fee for service, capitation, pay for performance and shared savings for accurate reimbursements and higher profitability

• Versatile, scalable revenue cycle tools and workflows to support operational excellence across the continuum of care

Centricity Business

Enterprise Ready

Centricity Business

High Performance

• Automated, exception based workflows that provide faster, cleaner claims and accelerated revenue collection

• Ability to manage increasing patient responsibility with integrated tools to manage patient access and revenue cycle processes

• Proven financial performance• 8 of the top 10 Top Performers in Faculty Practice

Solutions Center Billing Office Survey1

• 13 of the 17 Best hospitals in2011-12 honor roll2

1)UHC & AAMC, FY10 Faculty Practice Solutions Center Billing Office Survey, June 20112)US News and World Report, Best Hospitals 2011-12: the Honor Roll, July 2011

Centricity Business

Interoperable

• Revenue cycle management with clinical workflow integration to virtually any EMR

• Standards based connectivity enables freedom to choose your clinical system, while lowering total cost of ownership.

• Connect the enterprise and provide insights across clinicals and financials to drive improved care coordination and streamlined reimbursements

Centricity Business resources

• Stop by the GE Healthcare Booth #343/345• Read more about Orlando Health on our website• www.gehealthcare.com/centricitybusiness• Follow @GEHealthcareIT on Twitter and use #gecb to join

the Centricity Business conversation