Using Technology to improve Your ASC Colorado Ambulatory Surgery Center Association

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Using Technology to improve Your ASC Colorado
Ambulatory Surgery Center Association
Contact Information MediGain Inc. 1-877-237-9539
mel_at_medigain.com www.medigain.com
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Some Technology Usage Facts
MediGainPreserving Healthcare Profits

• Before
• First IBM PC is launched in 1981
• Motorola releases first mobile phone for 3,995
  in 1985
• Cellular Technology Industry is formed in 1988
• The world wide web as we know it today launched
  in 1991
• Hotmail is launched in 1996
• HIPAA Introduced in 1996
• Now
• Computer ownership in the USA 80 of population
• Mobile phone ownership in USA 81 of population
• Internet usage in USA 73 of adults
• Google maps show pictures of your street and
  house
• YouTube used to watch movies and elections
• More than 80 of ASCs and Physician practices
  still use paper medical records

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Healthcare vs. other Industries
MediGainPreserving Healthcare Profits

• Retail Industry
• Find your favorite store, clothes and sizes
• Purchase online, and track shipping to your
  doorstep
• Understands customer needs and trends
• Airline Industry
• Find destinations, schedules, type of airline
  that flies
• Purchase tickets online - select seat, food
  etc.
• Check status via internet, phone or text
  notifies schedule changes
• Receive promotions based on customer preference
  and history
• Healthcare Industry
• Minimum or if any web presence
• Most cannot schedule appointments online no
  notification on delays
• Minimum knowledge and tracking of information
  about patient habits
• No infrastructure to share information loads of
  paperwork
• Medicare takes 6 months to issue or change a new
  provider number

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Why Utilize Technology in the ASC
MediGainPreserving Healthcare Profits

• One of the key building blocks of an ASC
• Technology
• Processes
• Resources
• Can provide the following benefits
• Increase revenue
• Decrease costs
• Improve efficiencies
• Decrease errors
• Improve visibility to operations
• Use it as a strategic advantage over competition
• Meet government and regional mandates
• Meet consumer expectations

Technology
Processes
Resources
ASC
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MediGainPreserving Healthcare Profits
MediGainPreserving Healthcare Profits
Typical ASC Structure
Front Office
Back Office
Clinical
gt80 of Revenue From Insurance
lt 20 of Revenue From Cash
Patient Care
Customer Service Transcription Coding Billing Coll
ections Follow up Medical Records
Scheduling Insurance Verification Patient Info
Electronic Claim Processing Paper Claims and
Statements
Patient Forms
Reporting Analytics Business Intelligence
Diagnosis Procedures Dictation
Inventory Management
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MediGainPreserving Healthcare Profits
MediGainPreserving Healthcare Profits
Potential Revenue Losses in an ASC
ASCs Have Already Done Work and is Owed 100
Revenue Lost by Typical Facility
Patient Registration/ Eligibility Verification
Lack of proper front office processes and systems
impact reimbursements
-5
Fee Schedules/ Charge Master
Charges need to be updated and compared with
national averages
-4
Poor transcription and inaccurate coding can lead
to denials and lost rev.
-10
Transcription/Coding
Almost 3 of claims are lost by insurers after
positive receipt by clearing house
-3
Claim Submission
Secondary Insurance Patient Portions
Many do not send or follow up on secondary and
paper statements
-3
Inaccurate posting can result in inaccurate
statements, follow up, and collections
-5
Payment Posting/Follow up
Loss of 20 to 30 of the money you have already
worked for!
Potentially Lost Revenue
20 - 30
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What Processes Do You Automate?
MediGainPreserving Healthcare Profits
Process
Manual
Solutions

• Scheduling
• Ins Verification
• Patient Confirmation
• Chart Preparation
• Dictn./Transcription
• editing
• Signature
• Distribution
• Document mgmt
• Medical
• Reports
• Forms
• Coding

Web integration to PM System Scheduling and
clearing house integration PM Sys and
Telephone/Email integration Electronic Forms and
Document Mgnt Sys Integrated Transcription and PM
System Online editing capability Electronic
signature system Web, fax and Email
distribution EMR and Electronic Forms with
Bar-coding Scanned or electronic health
record Scanned or electronic health
record Scanned and indexed EMR/Coding Engine
X x X gt82 gt26 X X X gt82 X X X X
Pre-surgery
Post Surgery Claim Prep.
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What Processes Do You Automate?
MediGainPreserving Healthcare Profits
Process
Manual
Solutions

• Charge Entry
• Claim Scrubbing
• Claim Submission
• Claim Acknw.
• Payment Receipt
• EOB/PMT Posting
• Denial Mgmt.
• Reporting
• Prescription/Labs
• Materials mgt.
• Patient info.
• Marketing

X X X X X X X X X X X X
Integrate Registration and EMR Integrated coding
engine and edits Clearinghouse integration with
PM System Clearinghouse integration with PM
System Bank lockbox with web based doc. view ERA
with integration to PM System Denial tracking,
automated appeals Data capture and business
analytics Prescription and Lab integration with
PM system Integration of PM Sys. and
Clearinghouse Web portal with Integration - Med
Rec PMS Data capture through PM System/Web/Tel
Post Surgery - Claim Proc.
Post Surgery -Other
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Asses Current ASC Situation
MediGainPreserving Healthcare Profits

• Technology
• Age and efficiency of current systems
• Tasks that are done manually but can be be
  automated
• Staff
• Knowledge of IT staff, and time allocated for
  technology planning
• Management
• How the organization implements and integrates
  technology related decisions
• Financial
• Budget and availability of funds for technology
  implementation, support and maintenance
• Conduct needs assessment by functions
• Front office Scheduling, patient access
• Clinical Materials management, lab/pharmacy
  integration
• Back office - Billing, Collections, Patient data
  gathering and distribution

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Items to Consider When Investing in Technology
MediGainPreserving Healthcare Profits

• List benefits and calculate ROI
• Staff time that will be saved per month x /hr
• Increase in revenue per month i.e. reduction in
  claim denial
• Set IT roadmap and priority based on highest ROI
  and budget
• Selecting vendors
• Ability to customize, web based
• Customer service, and customer feedback
• Other key IT considerations
• Capability to integrate to other systems and
  other facilities i.e. physicians, hospitals via
  HL7
• Web enabled access for ease of management and
  maintenance
• Data exporting, mining and reporting capabilities
• Phased deployment
• Phase the deployment to ensure all stakeholders
  become familiar with new systems MDs, staff,
  patients
• Set project plan and realistic timelines

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MediGainPreserving Healthcare Profits
MediGainPreserving Healthcare Profits
Ideal ASC Workflow
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MediGainPreserving Healthcare Profits
MediGainPreserving Healthcare Profits
Example of Opportunity
Assuming an average ASC
Current revenue generated 5,000,000/yr
Conservative estimate of improvement 10-15
Total revenue increase/yr 500,000 to
750,000
Total revenue increase/mo 41,666 to 62,500
Note This does not include any cost savings due
to increase in efficiencies.
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Where do you want your ASC to be?
MediGainPreserving Healthcare Profits
ASC Technology Maturity Model
Level 1
Level 2
Level 3
Level 4
Some Scanned records Min. automation of
processes Some delays in billing Some electronic
claims Ave. collections Poor cash-flow Minimal
reporting New but disparate systems Overworked
staff Reactive management IT is an afterthought
Standalone EMR Some Automated processes Smooth
workflow Min delays in billing Consistent
collections and cash-flow Basic reporting Some
integration of systems Adequate staff
levels Some proactive management Embracing IT
Paper records Manual entry Manual processes Paper
claims Delays in billing Poor collections Poor
cash-flow No reporting Obsolete systems
Overworked staff Reactive management Afraid of IT
EMR accessible to patient/ext. entities Automated
processes Optimized workflow Automated billing
and coding Optimized cash flow Dashboards Buss.
Intel Fully Integrated systems Optimized
staffing Leader in industry Proactive
management Using IT as its advantage
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Questions and Answers
MediGainPreserving Healthcare Profits