Title: Financial Performance and Operations Improvement: Integrating Revenue Cycle Improvement and Clinical Process Change to Accomplish Greater Financial Results
1Financial 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
2Defining Potential Improvementsthe Opportunity
Evaluation Process
- Adding the horizontal viewpoint to identify
systemic opportunities for financial and
operations improvement
3Using 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
4Quantifying 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
5Value 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.
6Financial 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.
7Technology-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
8Key Results Of The Opportunity Evaluation
ProcessImproved Definition of Prioritized
Tasks, Project Teams and Achievable Budgets
9Key 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
10Summary Questions and Answers