Elevating Staff and Front End Processes to Optimize Revenue Cycle Results

1. Elevating Staff and Front End Processes to Optimize Revenue Cycle Results Presented by Melissa Viohl, CRCR Director, Patient Access Centra Health – Lynchburg Virginia

2. Objectives • Effective methods of motivating staff through training, communication and incentives. • Create a culture of cross-departmental collaboration • Implementation of technology solutions through continuous process review • Ways to reorganize front end processes and staffing to best fit revenue cycle initiatives

3. About Centra HealthThreeAcute Care Hospitals Based in Lynchburg, Virginia Lynchburg General, Virginia Baptist, Southside Community • Admissions: 36,000+ • ED Visits: 128,000+ • Employees: 6,000+ • Medicare 50.9% • Medicaid 14.2% • Self Pay 5.8% • HMO / PPO 25.3% • Commercial 1.9% • Other 1.8% Available Beds: Acute 575 Acute Rehab 20 Acute Psych 41 Post Acute 447

5. Departmental Structure

6. Bringing It All TogetherPoint of Service Collections = Financial Counseling

7. ContinuousReviewandChange continuous process improvement Implementbest practice for all work processes across patient access points. Hold staff accountable. Process Optimization Centra continually trains staff, implemented staff promotion path, and paid testing for certification Elevate Staff Director and VP level communication with leaders, educating front line clinical staff Communicate with Service Lines Emphasis should be on any process that continues to be manual – can it be migrated. or does it have system optimization potential? Analyze Work Processes Identify Barriers and System Shortfalls

8. 2007 – BeforeState • 1st full year with new system implementation • Change in Director level leadership and reporting structure • No career ladder, or expectations for staff, basic job descriptions • Limited pre-registration • Limited insurance verification, no measurement for accuracy • Inconsistent upfront collections • No automated payment posting • Chargemaster was the only estimation tool, no estimates for contract pricing • Non-Compliance – resulted in implementation of medical necessity checking software and ABN issuance

9. 2009 Gaining Traction End of 2007 into 2008 The Journey Begins… • Collectionspolicies 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 departmental and 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 Director • EOY Results • Total collected $753,638 • Accuracy Rate 95% • Ins Verification Rate 85% • Pre-registration rate 66% • Pre-reg abandonment rate 12.8% • Redefined goals, set thresholds based on historical data • Added staff to pre-registration unit • Refined scripting – provided retraining • Focused on 1st of year deductible & out of pocket • Estimation tool integrated in registration screens • Refined estimation tool parameters to increase accuracy • Continued recognition of high performers • EOY Results: • Total collected $1,896,240 • Accuracy Rate 97.58% • Ins Verification Rate 98.79% • Pre-registration rate 79% • Pre-reg abandonment rate 11.4%

10. 2011 – Continuous • Process Improvement 2010 – Momentum Achieved • 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 • Refocus on inpatient accounts and balance after insurance • Centralized staff & implemented collections in mammography centers • Continued to refine pre-registration practices • Continued recognition of high performers • EOY Results • Total Collected $3,418,057 • Accuracy Rate 98.5% • Ins Verification Rate 99.13% • Pre-registration Rate 84% • Pre-reg Abandonment Rate 9.66% • Refined reporting tools for management • HFMA’s 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 • EOY Results: • Total collected $5,471,297 1.6% adj net rev • Accuracy Rate 98.84% • Ins Verification Rate 99.17% • Pre-registration Rate 81% • Pre-reg abandonment Rate 9.18% • Staff Turnover 12.6%

11. 2012/2013 Continued Staff Development • Revision of job descriptions, adding level III • Introduced new certification paths (CRCR, CPAT, CCAT) • Built in process improvement initiatives to job descriptions • Offered computer training in addition to extended Patient Access system training • Offered “remedial” classes for “low” performers… (is 90% low?) • 2012 EOY results: • Collected $5,800,929 (1.7% adj net rev) • Accuracy Rate 98.7% • Ins Verification Rate 98.44% • Pre-registration Rate 82% • Pre-reg abandonment Rate 8.15% • Staff Turnover 8.3% • 2013 EOY results: • Collected $6,333,030 (1.8% adj net rev) • Accuracy Rate 98.68% • Ins Verification Rate 98.5% • Pre-registration Rate 86% • Pre-reg abandonment Rate 9.24% • Staff Turnover 7%

12. Continuing Education • Grow your staff • Offer opportunities – sponsorship • Pay for certifications • Educate clinical units on the value of accurate registration • Educate front end staff on the value of a clean claim

13. Don’t Underestimate Leader Involvement • Rounding • Personal emails or Other Electronic Methods • Regular Meetings with Staff • Regular Meetings with Managers/Direct Reports • Daily, Weekly and Monthly Updates • Continuous Communication Concerning Organizational Budget and Direction

14. Employee Results for Patient Access • Staff turnover reduced from 12.6% in 2011 to 7.14% in 2013 • Staff certification rates – 67% Single – up to 40% Dual • 2012 Engagement Surveys – and 1st 2013 resurvey • Director & Pre-reg Manager Tier I • 3 front line managers Tier II • 1 Manager tier III – moved to tier II within 6 months of resurvey

15. Budgetary Improvements

16. Sample Scorecards Manager Registrar

17. Staff in Access work as members of multidisciplinary groups to improve service scores Departmental KPI’s are published on webpage, open the entire organization Scores are shared at departmental meetings, service areas and with senior executives

18. Incentives

19. Other Revenue Cycle Project Initiatives • Reorganization of management based on role, not location. Placement of staff based on “best fit” • Use of EAP and holding staff accountable through use of improvement programs • Insource of “early out” collections • Sponsoring COBRA payments - $10,881 investment - $330,932 return • Change in moving financial aid write offs to front end with Financial Counselors

20. Self Compare 2010-2012 But…. don’t drink your own koolaid…

21. 2013 Rankings (per HFMA MAP)

22. 2013 Comparison to Peer Hospitals 2012 Comparison to Peer Hospitals 2011 Comparison to Peer Hospitals

23. Peer Comparison 2010 Comparison POS Collections 2011 Comparison POS Collections

24. Peer Comparison 2012 Comparison POS Collections 2013 Comparison POS Collections

25. Registration Accuracy Rate Benchmarksas published by HFMA 9/2011 in Healthcare Financial Management MagazineArticle – “the hidden KPI – registration accuracy, by Paul Shorrosh”as provided by AccuReg Software

26. 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

27. Integration is Key • 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

28. Revenue Cycle Project Initiatives • DNFB – team working unbilled reports for edit rejections

29. CharityandBad Debt Trending 2007 - 2012

30. Questions/Answers Questions about Centra’s program? What part do you think Access processes play in overall Revenue Cycle improvements? Do you have a defined development program for front end staff? How does your organization work collaboratively to increase Revenue Cycle awareness

31. In closing…. Partnerships • Partner with your leadership • Partner with your service lines • Partner with your vendors • Most importantly, partner with your employees