Optimizing Revenue Cycle Management

1. Optimizing Revenue Cycle Management

2. HeartPlace • 79 Physicians + 8 Mid-level • 31 Clinics and 343 Total FTEs • 26 Hospitals • ICAEL and ICANL Certified • General & Preventive Cardiology, Interventional Cardiology, Vascular & Endovascular Medicine, Cardiac & Thoracic Surgery, Congestive Heart Failure, Electrophysiology

3. Cardiovascular Provider Resources • Management company consisting of Clinics, Personnel & Equipment • Centralized Billing, Collections, Purchasing, Human Resources and Information Technology • NextGen EPM/EMR (5.6.5.63 & 7.6.5 KBM) • Baylor Heart & Vascular Hospital + Texas Health Heart and Vascular Hospital • SPAC – Self Insured Professional Liability

4. Key Performance Indicators

5. Insurance Verification 2002: 14 FTE Today: 2.5 FTE Charge Entry 2002: 14 FTE Today: 4 FTE Payment Posting 2002: 6 FTE Today: 1.5 FTE 29 Physicians Added Without Growing CBO ROI - EPM • ERA: 85% payment posting now automated. (Medicare, Medicaid, Aetna, BCBS and UHC.) • AR & Denials follow-up automated

6. CPR has selected the best in class to deliver a totally integrated solution.

7. If it aint broken, improve it

8. RTS • RTS provides: • Communication with payer/clearinghouse connections. • RTS Eligibility Worklog Tasks • Translation of X12 transactions • 270/271 Eligibility Request/Response • 276/277 Claim Status request/Response • 278 Referral

9. Eligibility

10. Claim Status

11. RTE • Real Time Edits are configured within your claim edit library. • Real Time Edits fire any time claim edits fire, catching any errors before claim is billed. • Real Time Edits are maintained on Nextel's server, no dependency on EPM updates. • Work with Claim Edits Worklog Tasks. • Ability to set custom edits.

12. BBP • What is BBP • The Background Business Processor is an application that allows for the automation of processes that allows for the automation of processes that would otherwise require manual execution.

13. BBP Benefits • Processes can be done during off-peak hours. • Relieve database traffic. • Reallocate resources devoted to processes that are now automated.

14. BBP Automation Processes • Eligibility • Billing • Claim status download (277u) • ERA import (835) • Post balanced batches • Patient statements • Run and email memorized reports

15. Worklog • Tracking of claim edits and denials. • Streamline payment posting and AR collections. • Eliminate paper and better organized workflow. • Tracking and setting of performance benchmarks and expectations.

16. Nextgen Set-up: Roles • A Role is a category of user and security rights • You might have several collectors whom need the same security access. • To automate tasking we determine the level of access a collector will need and create a role for each collectors. • Ex: CBO AR Rep 1, CBO AR Rep 2

17. Nextgen Set-up: Reason Code Library • Reason Code Library enables you to create and attach a library of reason codes that are unique to a specific payer. • Reason codes are applied at the transaction level or line item level.

18. Nextgen Set-up: Tasking • Tasks can be system generated, user generated, report generated, modified, reassigned, expired, prioritized, tracked, and reported on. • Nextgen Tasks can be created based on five Source Types: • Account • Appointment • Chart • Invoice • Visit

19. Nextgen Set-up: Tasking

20. Heartplace Definition of AR Follow-up • Two types of AR follow-up • Claims X days old with no response. • Claims with denial response (Reason Codes). • Our naming convention for Task Types • Tasks for claims with no response begin with “Y”. • Tasks for denials begin with “Z”.

21. Questions? Danny Conaway Danny.conaway@heartplace.com