Best Practices – System Implementations

1. Best Practices – System Implementations WV HFMA May 16, 2013

2. Quick Questions • Role in software selection: • Recommend • Review what others have found • Little to None • Involvement in system implementations: • Currently involved in one or more implementations • Will be involved within the next 6 months • Not involved within the past 12 months • Thinking about the last 2 system implementations you have been involved with, would you characterize them as: • Highly successful • Successful, but implemented behind schedule • Marginally successful, still recovering in some areas

3. Getting It Right • Implementation – Step 1 • Design the project • Gap Analysis – Current state vs Future state • Metrics – Current metrics vs Future metrics (goals) • Fix process first! • ROI (CFO’s sweet spot!) • Buy-in from RCM group within organization • Select your technology path • Full-service solutions – “off the shelf, one size fits all” • Bolt-on solutions – “land of smorgasboards” • Beta option • Vendor buy-in to your critical success factors up front • Remember one important fact – most projects end up costing way more than the initial proposal

4. Getting It Right, continued • Project Planning – Step 2 • Understand why projects fail!* • Technology ROI numbers = mostly fiction • ROI rarely drives the investment decision-know what does in your organization • Lack of long-term accountability in technology area • Detailed project plans can become the enemy • Using the big outside guns only ensures that someone will get shot • Role of the project team in developing the project plan • Oversight of the project plan • IT support *Why Technology Projects Fail: 5 Unspoken Reasons, by Coverlet Meshing, Information Week, April 22, 2013, pp8-10.

5. High Performers and IT Support Level of IT Support or Collaboration “Please describe your organization’s level of support and collaboration for the revenue cycle 1 = none to 7 = extremely high. (Percentage indicating 6 or 7)” Source: Strategies for a High-Performance Revenue Cycle, HFMA, 2009, page 20.

6. Getting It Right, continued • Testing and Training– Step 3 • After costs, typically the most underestimated activity – both volume and time • Trust nothing – prove everything • Use teams but with management participation • Watch out for “we’ve always done it THIS way!” • Test teams must understand future state work flows • Redesign workflows testing reveals a better way, not just because the software would have to be modified to allow you to implement your desired future state • Hardware full load tests • Training workbooks and real exercises

7. Getting It Right, continued • Go Live – Step 4 • Identify in advance how you will know when “things” fail • Balancing • Metric variations outside the normal range • Manage by walking around-everywhere • Watch for backlogs • Put the patient experience first • Keep your boss in the loop-sooner, rather than later!

8. Getting It Right, continued • Post Go-Live – Step 5 • Monitor critical success factors and metrics • Track requests for fixes and timeframes involved and hold vendor and staff accountable for timely resolutions • Communicate, communicate, communicate!

9. Revenue Cycle Technology • If you have a process issue, there is probably a technology solution out there! • Solutions evolving at an amazing pace • Ask the question: is there a way to automate “X” so that my team can work smarter, not harder!

10. Appendix A – QA Programs • QA programs are designed to check accuracy rates to: • Reduce denials • Ensure compliance with government regulations • Identify patterns of poor work • Identify training needs • Manual vs. automated • Automated examples include: • DaVincian • AHIQA • AccuReg • CPSI • Emdeon Denial Management • Compass and Epic • McKesson • Majority still manual and daily

11. Appendix B - Revenue Cycle IT Components • Scheduling technology • Access options: • Physician practice based • Centralized scheduling operating using call center based technology • Patient internet access based • Core functionality: Ancillary and OR; electronic order capture; fully customizable to support resource scheduling, automated rules and patient information; electronic communication with departments and patients • Links into electronic medical record • Links into clinical systems • Supporting applications: • Medical necessity screening and ABN tools with electronic signature feature • Robot calling for patient reminder calling • Workflow rules-based application to move accounts through the scheduling and registration work flows 11

12. Appendix B - Revenue Cycle IT Components • ADT – Preregistration, registration, census management • Call center technology for pre-registration processing • Patient kiosks for self service arrival processing, including electronic signatures, payment processing and receipting, positive patient identification • Real-time automated registration data QA • Additional applications: • Electronic insurance verification • Electronic transactions for managed care processing • Patient charge and liability calculator • Electronic patient folders • Integrated scanning • Payment receipting and treasury processing • Electronic address validation • Electronic credit scoring and/or electronic account segmentation tool • Electronic charity application processing • Electronic referral for Medicaid eligibility processing • Patient portal for electronic communication r.e. directions, instructions, billing inquiries and payments • Patient satisfaction survey capabilities linked to call center contacts, kiosk utilization, etc. 12

13. Appendix B - Revenue Cycle IT Components • Electronic medical record (EMR or EHR) • Real time charge capture and service documentation from clinical systems into core revenue cycle system • Workflow technology to monitor managed care requirements, case management tools • Prebill claim scrubber application • Workflow technology to manage DNFB workflows; automated coding validation • Billing and collections system application: • Electronic claims scrubber for 837I and 837P • Tools to capture all charges within the ACO framework, appropriately bill and distribute payments • Clearinghouse connectivity for claims processing to individual payers – 837I and 837P • Calculation of contractual adjustments and patient discounts at time of final billing • Workflow technology to monitor clean claim payment cycles and follow-up processing requirements • Automated follow-up processing using electronic processing and call-center technology • Electronic payment receipt and posting • Real time payment validation vs payer contract terms 13

14. Appendix B - Revenue Cycle IT Components • Billing and collections system, continued • Electronic payer logs and data warehousing of claims data with reporting capabilities needed to model payer contracts • Electronic modeling tools for ACO analysis • Automated bad debt processing to and from collection agencies • Electronic tracking of KPI’s and other dashboard data for performance reporting within the organization on daily, weekly, monthly and annual basis • Intranet-based staff training application • Applications training • Workflow procedures • Policies and procedures • New regulatory requirements • Customer service … 14

15. Contact Information Sandra J Wolfskill, FHFMA Wolfskill & Associates, Inc 13430 Bass Lake Road Chardon, OH 4402 440 285 4094 swolfskill@cs.com