Financial Performance and Operations Improvement: Integrating Revenue Cycle Improvement and Clinical Process Change to Accomplish Greater Financial Results

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Financial Performance and Operations
ImprovementIntegrating Revenue Cycle
Improvement and Clinical Process Change to
Accomplish Greater Financial Results

• Presented for MCOL by Nancy Chapman
• Superior Consultant Company, Inc.
• Nancy_Chapman_at_superiorconsultant.com

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Defining Potential Improvementsthe Opportunity
Evaluation Process

• Adding the horizontal viewpoint to identify
  systemic opportunities for financial and
  operations improvement

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Using Technology to Support Improved Processes
Financial Performance and Operations Improvement
are goals for every process and department in the
organization. The traditional, vertical focus of
revenue cycle improvement falls short of
exploiting all possible opportunities for
financial improvement and positive change. When
the horizontal focus is added, exponential
results can be achieved.
Prior To Services
Following Services
During Services
Portfolio Optimization Patient Access Design Denial Management Charge Capture and Pricing Clinical Management Integration Documentation and Coding Billing Process Design Accounts Receivable Management Cash Collections
Svc Line Growth Capacity Management Referral Management New Venture Partnerships Clinical Process Improvement POC Med Admin Bar Coding Electronic ICU Clinical Alerting Scheduling Pre-registration Insurance Verification Point-of-Service Collections Call Center Technology Registration Points Prior Balance Adjudication Case Management Denials and Appeals Tracking Physician Alignment Appeals Process Electronic Charge Capture / Reconciliation Market-based Pricing / Fee Screen Review Operational Pricing Managed Care Pricing Contracting Strategic Pricing Standardization Consolidation of Charge Description Master (CDM) Medical Management Infrastructure Service Line Redesign Clinical Technologies and Process Improvement CDMP Physician Alignment Bed Management Resource Management DNFB Reduction CDMP Outpatient Documentation APC Process Improvement APC Financial Impact Assessment HIPAA Medical Records Redesign Claim production work flow analysis CDM Review Update Late Charge Analysis EDI Editing Claims management DNFB Reduction Days Revenue gt 90 Days Hold Days Bad Debts Collection Policies Contractual Modeling Third Party Payor Analysis Cash Acceleration Denial Management Self-Pay Collections Management Follow-Up/Collector Workstations Electronic Remittance Enablement/ Payment Posting Agency Management
Svc Line Growth Capacity Management Referral Management New Venture Partnerships Clinical Process Improvement POC Med Admin Bar Coding Electronic ICU Clinical Alerting Scheduling Pre-registration Insurance Verification Point-of-Service Collections Call Center Technology Registration Points Prior Balance Adjudication Case Management Denials and Appeals Tracking Physician Alignment Appeals Process Claim production work flow analysis CDM Review Update Late Charge Analysis EDI Editing Claims management DNFB Reduction Cash Acceleration Denial Management Self-Pay Collections Management Follow-Up/Collector Workstations Electronic Remittance Enablement/ Payment Posting Agency Management
Discharge Not Final Billed Clinical
Documentation Management Program
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Quantifying Potential Improvementsthe
Opportunity Evaluation Process

• It is no longer sufficient to describe potential
  improvements todays buyers need quantifiable
  targets and benchmarks to measure accomplishments
  and sustain progress

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Value Proposition Sample Hospital (000)
Note This estimate of revenue improvement is
based upon information believed to be reliable,
however, the estimate is provided for discussion
purposes only and is subject to material and
substantial changes. Additional validation and
confirmation of the major assumptions and related
revenue potential will be required.
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Financial Performance, Operations Improvement
and the Technology Connection

• While information systems have been expected to
  solve problems for years, the buying market
  largely missed the boat regarding the critical
  need to change operations and processes that new
  technologies could support. This phenomena is
  changing rapidly and returns on investments are
  being realized.

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Technology-enabled approaches to financial
performance and operations improvement
opportunities

• e-Health Solutions
• Integrated processes and technology across all
  departments
• Web-enabled patient access
• Advanced telephony systems
• Self-serve kiosks
• Call center technology
• Workflow automation (from the simplest
  (automating eligibility checking) to the most
  complex (CPOE)
• A core patient record with elements of the
  electronic medical record (EMR) which leverages
  current legacy systems
• Longitudinal patient EMR
• Personalized web pages for physicians with links
  and alerts to IDN physician portals
• Real-time claims adjudication
• Appeal dispute resolution with payors

• Technology Enabled Redesign
• Front and back end process improvement
• Denial management
• Charge capture enhancements
• Clinical documentation and care management
  improvements
• Uniform policies and procedures throughout
  departments
• Electronic schedule (with access notification of
  service)
• On-line access to multiple payors for
  verification
• On-line access to past balances
• Physician alignments
• Outsourcing opportunities
• Consolidated/shared services opportunities

• Traditional Approach
• Cash acceleration
• Back-end process improvement
• DNFB reduction
• System calculation of allowances
• Verify of automated edits
• Electronic work-lists
• System notes and reminders
• Electronic billing folders
• Electronic posting/remittance processing

DERIVED BENEFIT
LEVEL OF TECHNOLOGY ADOPTED
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Key Results Of The Opportunity Evaluation
ProcessImproved Definition of Prioritized
Tasks, Project Teams and Achievable Budgets

• The value statement

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Key Results of the Opportunity Evaluation Process

• Used to quantify and serve as the value statement
  for the level of effort required to accomplish
  change.
• Used to rapidly identify areas for financial
  improvement in clinical service lines and
  operations areas.
• Helps to focus required resources by skill set to
  allow optimized configuration of
  multi-disciplinary project team
• Helps to more accurately project budget
  requirements.
• Projects potential future state both from an
  operations and financial perspective
• Provides key performance metrics and analytics
  for each major clinical and business process and
  related sub-processes. Such metrics and
  analytics include
• Process and sub-process benchmarks and analytics
• Organizations decision triggers and analytics
• Shared risk/reward performance measurement
  analytics

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Summary Questions and Answers