Briefing: TPCP Claims Follow-up and Denials Management Date: 21 March 2007 Time: 1300 - 1350

1. Briefing: TPCP Claims Follow-up and Denials Management Date: 21 March 2007 Time: 1300 - 1350

2. Objectives • Demonstrate three interdependent approaches to enhance and control the revenue cycle associated with the third party collection program • Remote OHI Discovery • Pre-Admission/Pre-certification • Denials Management

3. Agenda • TAMC Collection Target • TAMC Experience • TAMC Initiatives • OHI • Pre-Certification • Denials Management • Initiatives Progress • Conclusion

4. TAMC Collection Target TAMC Collected to Billed Ratios: FY02 thru FY07* MEDCOM Ratio 40% *1st Quarter FY 07 Inpatient collections only

5. Industry-wide Issue • Health Insurance Association of America (HIAA) Study 2002 • 900,000 claims examined • 14 Payers • 26 Million Insured’s Findings: • 86% Approved (Industry Benchmark) • 14% claim denial rate • 1 in 7 claims need rework, resubmission and/or appeal (TAMC: 57,000 claims in FY 06 = 8,142) HFMA Publication, August 2004

6. TAMC Experience Why is this important? Recapturing revenue is key! FY02-06 $29 M Total (I/P and O/P) Billed and $12.7 M Collected

7. Interdependent Revenue Initiatives Keys to Success: HIPAA Compliance MEDCOM Coordination Contract: February 2006 Data Sharing: September 2006 OHI Revenue Initiatives Pre-Authorization Pre- Certification Denials Management Processes: March 2006 GS Nurse: April 2006 Software/Data Sharing: February 2006 Consultant Contract: April 2006

8. Automated OHI Identification Automated OHI Identification Goal: To discover and verify other health insurance coverage's from TAMC beneficiaries in advance of their visit through the utilization of national database queries. The query is conducted prior to the patient visit and insurance information is updated in the DEERS and TPCP processes. High cost of care, High Revenue • Phases: • Inpatients / Ambulatory Procedure Visits / Emergency Room • Implemented March 2006; Clinic APVs remain • Outpatients / Ancillary • Estimate remote OHI cost to rise as increase Contractor support High volume, Lower Revenue “Desire is to enhance the Patients Experience by reducing the hassle factor”

9. Automated OHI Identification Tasks: • Establish a contract for Benefit Recovery, Inc. • Challenge: write a statement of work/ non- competitive contract (Oct’05); implemented in April 2006 • Build CHCS Ad-hocs to identify non-military APVs; multiple methods of appointing (or central appointments, ER visits) manual process to send contractor data • Open the ports for Contractor access; • September 2006 • Send beneficiary information to Contractor for Insurance identification HIPAA Compliant

10. Results • Maximized FY06 OHI identification by utilizing Electronic Search Engine • Increased OHI Discovery by 6% • Identified new OHI policies • Increased Collected to Billed Ratios • 100% Pre-Authorization of Admissions and APVs where required by Third Party Insurance - Reduced denials • Increased reimbursements by $309,075 to date • ROI was 8.5:1

11. Pre-Admission / Pre-Certification Goal: To review and verify the admission to include: demographics, insurance carrier (if applicable), concerns of the patient, and completion of required forms prior to admission, permitting patient to bypass the administrative processes on day of admission and report directly to the point of care VOB process success: Number of Claims, and amount known we will receive • Phases: • Establish the hospital processes • Ongoing • Establish the team; hired the nurse • Completed April 2006 “Public Relations and Revenue Enhancement Effort”

12. Pre-Admission Clinics to Date APV Center • ORTHOPEDICS • OPHTHALMOLOGY • ENT • PLASTIC SURGERY • UROLOGY • GENERAL SURGERY • ORAL SURGERY • VASCULAR SURGERY • GYNECOLOGY • OBSTETRICS • PODIATRY • NEUROSURGERY • HAND SURGERY • A&D Office • INTERVENTIONAL RADIOLOGY • GASTROENTEROLOGY • BRONCOSCOPY CLINIC • GENERAL SURGERY • PEDIATRIC SURGERY • CARDIOLOGY • ENT • PLASTIC SURGERY • ORTHOPEDICS • GYNECOLOGY

13. A&D Clerks Available 24/7 Based on Customer Preference For Pre-Admitting Services 2569 Clerk GS-5 Nurse GS-9 Treasurer’s Office and Cashiers Cage 2569 Clerk GS-5 Pre-Cert Clerk Contract Pre-AuthorizationPre-Certification Team Centralized Location “Insurance Mission Oriented” Hub Co-Located with A&D O C E A N S I D E E N T R A N C E ADMISSIONS AND DISPOSITION

14. Pre Authorization/Certification Process For Scheduled Appointments • Run list through OHI • Pre Cert Phone Calls to Patients • Verify Surgery Date/Time • Verify Ins. Coverage and Demographics • Inform patient where/when to arrive • for pre-op and procedure • Answer any questions • Informs patient will be transferred to • A&D clerk to set up time to come in and • sign paperwork (24/7) Pre-Cert Office obtains listing of future surgery schedules 2 weeks in advance Clinic Schedules Procedure for Patient Patient arrives at Pre-Cert Office for PRE-OP paper work Patient signs documents Pre-Cert Office completes Authorization Form Copy given to Patient for file Patient brings Authorization Form to Pre-OP Clinic Clinical checks completed Patient informed date/time for procedure • Pre-Cert Office • Enters Auth # into CHCS/TPOCS • which feeds Claim Saver Pro Pre-Cert Office calls Ins. Co, verifies benefits, obtains Auth # Day of Procedure Patient receives treatment Customer satisfaction achieved Objection from Ins. Company All objections handled by Nurse Nurse can speak clinician to clinician

15. Denials Management Goal:To preclude claim denials; develop an expertise for appeals management; and increase the bill-to-collection ratio to 70%! Tasks: 1. Find and Purchase an Industry Denial Management Software • ClaimSaver Pro: Cost $55K • Began work in November 2005 • Implemented February 2006 • Establish CHCS/TPOCS PAS interface to share data • Completed February 2006 • ClaimSaver Pro User/Management Utilization • Completed February 2006 2. Establish Consulting Contract to Identify Missed/Future Revenue Opportunities • Denials Management, Inc. • Commenced April 2006 HIPAA Compliant

16. Software Benefits • ClaimSaver Pro: • Eliminated time-consuming manual claim entry and spreadsheets • Automatically assigns cases to users • Easily transfers notes and other information • Tracks denials by: • Payer • Department • Status • Root Causes • Code Sets • Denial Reason • Financial Impact • Context sensitive help references • Provides over 100 standard reports and graphs • Custom report writing

17. Consulting Benefits • DMI Consulting Contract: • Identified revenue opportunities (Past and Present) • Improved interdepartmental coordination and processes • Collected newly identified revenue • Discovered denial prevention opportunities • Trained TAMC staff on the following: • Obtaining necessary documents for appeal • Drafting appeals and doing resubmissions • Principals of health insurance collection • Effective communication with Third Party Payers • Exhausting administrative claim remedies • Preparing accounts for litigation

18. Conclusion/Reasons for Success • Automation Technology • Eliminated need for outsourcing • Better metrics • For-profit mentality • Control payer performance • Improve MTF operational strategies • Denial prevention

19. Denials Management Workflow Process Necessitates well defined operational disciplines for the MTF staff and procedures

20. ROI So what’s our ROI to date?