Revenue Cycle All-Stars

1. Revenue Cycle All-Stars Kenny Koerner MBA, CPAM President, Illinois AAHAM On behalf of Illinois AAHAM

2. Today’s All Star Line Up • CGH Medical Center Overview • Revenue Cycle by area • Community partnering • Measuring Success • Employee Management • The Future

6. CGH MedicalCenter’sIT infrastructure

7. The Traditional Revenue Cycle

8. The Impact of the Traditional Revenue Cycle

9. Post - Service Time of Service Pre - Access The Upside Down Revenue Cycle

10. Integrates Financial & Clinical Processing & Quality Reduces Management levels and involvement Brings customers in to direct contact with process-owners and vice versa Benefits of the Upside Down Revenue Cycle

11. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

12. Central Scheduling • 5 RN’s • 1 LPN • All located in the same office within hospital registration

13. Central Scheduling • Schedule 90% of all outpatients • Medical Necessity checking • Education and Training

14. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

15. Pre-Authorization • 2 FTE’s • Located within the hospital registration office

16. Pre-Authorization • Work Que’s that come directly from scheduled accounts • Hospital and clinic both • Web based authorization

17. Pre-Authorization • Receptionist/Nursing Education • Authorization Denial Lists • Utilize Cerner and Passport iAgent

18. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

19. Financial CounselingFront End • 1 FTE • Passport PPE software • Charge estimates and patient out of pocket estimates to all scheduled outpatients

20. Financial CounselingFront-End • Claims history • Validate Charge Estimates • Validate Patient out of pockets

21. Financial CounselingFront-End • Charity Care • Presumptive Charity • Illinois Charity Care Laws • Contracted employee for active Public Aid enrollment

22. Financial CounselingFront-End • Affordable Care Act • Health Insurance Exchanges • Public Aid Expansion • 2 FTE’s

23. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

24. Registration • 2 offices (outpatient and ED) • 1 Assistant Director • 1 Supervisor • All certified through NAHAM • Front line registration pay equal to biller pay

25. Registration • Cerner Millennium for • Electronic Eligibility • Imaging insurance cards and driver’s licenses • Photos of patients taken at each registration • Esignature utilized for quality

26. Registration • Bed Side in ED • Press Ganey Patient Satisfaction • Mandatory Patient Accounts training for all employees • Combined Unit Meetings

27. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

28. Health Information • Coders • Coders work bill edits by logging in to electronic billing vendor • Each coder works their specific DNFB report daily to identify high dollar accounts not yet coded • New job descriptions in preparation for I-10 that include pay raises and retention bonus

29. Health Information • Revenue Integrity Coordinator • One person ultimately responsible for the additions, deletions, changes to our charge master—weekly meetings • Meets with department managers and supervisors to discuss revenue and new service lines • Proactively audits potential OIG risk areas to protect revenue • Unique skill set –LPN, Certified Coder, CPAT

30. Health Information • RAC Coordinator • Logs, Analyzes, Reports all RAC requests and appeals • Utilize Executive Health Resources • for appeals • PEPPER report summary • Observation/IP Status Confirmation

31. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

32. Patient Accounts • Utilize NEBO Systems for electronic billing and remittance posting • Electronic follow up and billing system notation on claim status • All certified CPAT’s through AAHAM

33. Patient Accounts • Partner for expertise • MRA for MVA • Esolutions for Medicare follow up • NEBO for discharge disposition • Utilization of volunteers for manual follow up • Payment Analyst position validates every insurance payment to contracted rate • Telecommuters

34. Revenue Cycle – Our All Star Line Up • Central Scheduling • Pre-Authorization • Financial Counseling/Charity/Price Estimates • Registration • Health Information • Patient Accounts • Financial Counseling/Collections

35. Financial CounselingBack End • Currently 1 FTE dedicated to calling patients • On-line web portal accepts payments and patient questions • Partner with local bank for pre approved loan program

36. Financial CounselingBack End • Written collection policy known by all staff • Ability to handle hospital and clinic accounts • Utilize 2 collection agencies for bad debt

37. Community • Monthly Community Focus Group Meeting • Quarterly Insurance Broker Meetings • Board and Physician Education • Deal or No Deal Presentation • Community Education • Medicare and You Presentation

38. Measuring Success • Track Everything, Manage what needs attention • Shared goals with other revenue cycle areas • Examples of what we report