Revenue Recovery and Optimization

1. Revenue Recovery and Optimization Presented by: Andrew Fischer

2. About The Speaker – Andrew Fischer • Business Development Director for Emdeon’s Revenue Optimization Services, who is responsible educating clients on Emdeon’s Audit and Recovery, Denial Management and Accounts Receivable projects. • HFMA CRCR and has worked in the healthcare industry for over 12 years. • Has worked with hospitals, physicians, and insurance companies across the country. • Passion for advocating fair and reasonable reimbursement from insurance companies and protecting provider rights.

3. Summary : • Discussions around audit and recovery, denial management and accounts receiveables. • Payer contracts are becoming more complex with ever-changing terms. How can you ensure accurate reimbursement in both the ambulatory and hospital space? • How are revenue gaps being identified? • Do you have comprehensive reporting that points to the root cause for Identify and recovery of lost revenue ? • Is anything being missed when modeling contracts? • Are you reviewing both Hospital and Physicians contracts? • Are you recovering more than just easy-to-find debt? • Are you discovering outstanding balances on third –party claims? • Takeaways: • Identify areas to reduce days in AR • Identify areas to reduce claim denial rates • Identify areas to reduce bad debt write-offs • Identify problems to prevent future loss

4. Session Overview • Best Practices for Revenue Recovery and Optimization • Payer Relationship • Technology • Communication • Reporting • Internal Controls • Lessons Learned: Reality of “Best Practices” • How Emdeon Can Help • Questions?

5. Payer Relationship – Know Your Payer • Adopt a culture of Payer accountability • Establish and maintain positive relationships with Payers • Ensure contracts are configured correctly by both parties on the respective system platform • Have productive monthly/quarterly meetings with Payers • Know specific payer requirements and procedures

6. Technology • Utilize resources to support your mission • Utilize electronic claim submission technology and ensure appropriate documentation and tracking of filed claims. • Ensure appropriate bill edits are in place • Ongoing review and oversight of contract configuration and proration set up • Establish and maintain automated authorization and collection work lists • Utilize and maximize electronic payment technology • Establish a mechanism for documenting and tracking denials

7. Communication • Promote a team approach • Provide access to contracts, rate pages, and/or contract matrices • Provide ongoing education to employees in all relevant departments • Maintain a cohesive relationship between the clinical and revenue cycle departments • Encourage ongoing communication between key managers and key payer contacts • Have regular multi-department meetings to review and discuss contract specifics

8. Reporting • Knowledge is power • Develop comprehensive reporting documents to evaluate lost revenue • Maintain consistent practices to evaluate, track and trend unresolved payment discrepancies and denials • Analyze and report payer performance and contract compliance • Measure results and adjust workflow and processes continually

9. Internal Controls • Implement processes that look for revenue leakage • Align resources focused on increasing and maximizing revenue • Maintain processes to review and monitor the quality of data entered by Registration • Implement process to ensure timely and accurate input of CDM and coding updates and changes • Maintain processes to ensure charges are entered timely and accurately • Establish protocols to quickly identify and resolve payment discrepancies and denials

10. Summation of Best Practices Most Providers would acknowledge that they have adopted many of these key points discussed Do you agree?

11. Lessons Learned …The rearview mirror is always clearer than the windshield • - Warren Buffett

12. Case Studies - Actual “Rear View” Recoveries Payer Relationships, Technology, Internal Controls, Communication, and Reporting Best Practices:

13. Case Studies - Actual “Rear View” Recoveries Payer Relationships, Technology, Internal Controls, Communication, and Reporting Best Practices:

14. Case Studies - Actual “Rear View” Recoveries Payer Relationships, Technology, Internal Controls, Communication, and Reporting Best Practices:

15. Questions?