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Guaranteed Revenue Improvement ProgramGuaranteed Revenue Improvement ProgramGuaranteed Revenue Improvement Program

OverviewOverviewOverview

Using a comprehensive initial assessment of the revenue cycle, re|solution identifies areas where

the facility has not received the reimbursement for which it is entitled. The assessment looks at all

phases of the revenue cycle including: scheduling, registration, charge capture, coding, billing, col-

lections and reimbursement. The assessment will identify claims to be rebilled, changes in process

that will generate additional dollars and other opportunities to move towards a best practices reve-

nue cycle. re|solution guarantees that the cost of the assessment will be covered by opportunities

found for additional reimbursement.

Once the initial assessment is completed, re|solution works with two departments each quarter to

assist them in improving charge capture, documentation and coding practices to insure that the facil-

ity is being paid the correct amount for all services that are performed. In addition, for a year follow-

ing the assessment, re|solution will monitor the implementation of each recommendation to insure

effective implementation. Once again, re|solution guarantees that the cost of this quarterly imple-

mentation and monitoring is covered by additional reimbursement.

ChallengeChallengeChallenge

The challenges faced by rural and community hospitals are enormous. The same charge capture,

coding and reimbursement issues that plague larger facilities also affect rural and community hospi-

tals with less resources to insure compliance and appropriate reimbursement for services provided.

re|solution’s re|grip program provides a safety net to insure that the provider receives all the monies

they are due.

BenefitsBenefitsBenefits

Using proprietary technology, interviews and a proven continuous improvement and monitoring

process, this no-risk program allows personnel at the departmental level to work with the revenue

cycle personnel in optimizing reimbursement. This is the key to an effective revenue cycle when

you can get the clinicians and the business people working together. The process also allows the

facility to explore other opportunities for improvement such as point of service collections, denial

management, self pay management, contract payment review and EHR implementation for mean-

ingful use. This safety net gives our clients the peace of mind that all services are being reimbursed

at an appropriate level.

For additional information:

Robin Bradbury

[email protected]

toll free 800-355-0410

www.ereso.com

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Cash Acceleration Cash Acceleration Cash Acceleration

Immediate Cash Immediate Cash Immediate Cash

Other benefits include:

• Reduced days in A/R

• Improved bottom line

• On-site training

• Proprietary reporting tools

• Improved management information

• Sustainable results

• Peace of mind

Real Life Results Real Life Results Real Life Results

Carson Tahoe Regional Medical Center (“CTRMC”) is a 140 bed facility just south of Reno, Nevada.

With over 30,000 patient visits per year, CTRMC had a negative adjustment to their net Accounts

Receivable of nearly $6,000,000 when their management embarked on a process to find any and all

opportunities for cash and bottom line improvement.

re|solution was engaged in November 2006 and assigned all insurance accounts over 90 days.

During the first quarter of the engagement, cash collections were 40% higher than cash collections

for the same quarter in the prior year.

In addition, re|solution provided added services for CTRMC’s business office staff, such as training

in billing and follow-up techniques and a detailed revenue cycle assessment at no additional cost.

The hospital administration was ecstatic about the increased cash flow. The improvements identi-

fied and implemented by re|solution were continued after the engagement ended.

MethodologyMethodologyMethodology

• Experienced and knowledgeable analysts work your aged accounts

• On-site training and mentoring of your staff insures long-term improvements

• Inefficiencies identified and recommendations made for customized process improvements

• Safety net of re|solution resources provide post engagement support

• Post engagement quarterly benchmark reports verify your success

“The re|solution team was so helpful

and had so many good ideas that

they quickly gained the trust of the

full-time staff. Everyone was happy

to have them on board and soon real-

ized the value of their expertise.”

John Wilker, Chief Financial Officer

Portneuf Medical Center

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Interim Staffing Interim Staffing Interim Staffing

Immediate Access to Proven, Qualified PersonnelImmediate Access to Proven, Qualified PersonnelImmediate Access to Proven, Qualified Personnel


• Cash increases with improved staff skills

• On-site knowledge transfer produces competent local employees

• On-site training/mentoring increases skill retention

• Temporary or long-term placements


Lavaca Medical Center (“LCMC”) is a 25-bed community hospital in south central Texas providing a

wide range of inpatient and outpatient services. LCMC’s business office manager resigned in 2002.

Months of searching for a replacement resulted in no qualified candidates, so LCMC identified an

individual from another department to become the new business office manager.

re|solution was engaged to mentor/train the individual selected. During the first three months of the

engagement, the on-site re|solution interim business office manager managed the business office while the new business office manager shadowed and learned effective business office manage-

ment. During the second three months, the new business office manager managed the business

office and the on-site re|solution interim business office manager provided support while writing

policies and creating a reporting structure.

During the six month engagement, LCMC also underwent a difficult system conversion. Cash re-

mained relatively steady even with the turnover and system conversion problems. The new business

office manager received continued support from the re|solution interim business office manager

who remained a resource after the training/mentoring engagement ended.


• You select from our elite reserve of qualified personnel

• Mentoring option for training managers or higher level personnel

• Implementation of unique reporting and productivity tools with monthly reports to measure em-

ployee performance

• Safety net of re|solution resources provide post engagement support

“Your placement of an interim business office manager helped us begin the process of implementing the recommendations made in your assessment. Your continued support in the months following the engagement, including assistance in interview-ing candidates for permanent business office manager, enabled us to put the blocks in place during this transitional period as we worked toward long-term stability.”

Bob Ellzey, President/CEO Laird Memorial Hospital

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Training and MentoringTraining and MentoringTraining and Mentoring

Improved Skills Increase CashImproved Skills Increase CashImproved Skills Increase Cash


• Training provided by highly skilled revenue cycle management experts

• On-site, one-on-one training insures retention

• Create well-trained staff without recruiting new personnel

• Application of proprietary software to monitor employee progress and performance

• Sustainable business office process improvement

Training ProgramTraining ProgramTraining Program

re|train is a cost-effective way to provide new or less experienced business office staff and manage-

ment with receivables management skills. The service is conveyed one-on-one by a re|solution

revenue cycle operations expert. Throughout the training, your staff completes a series of written

and oral exercises to verify comprehension and retention of the material. re|solution also applies

proprietary software to monitor employee performance.


• Review and compare your facility’s key revenue cycle indicators to those of best practice organi-

zations, with instructions on how to use benchmarking to monitor, manage and improve busi-

ness office performance.

• A re|solution revenue cycle operations expert will provide in-depth instruction on:

◊ Bad debt and contractual reserves

◊ A/R management influences on the income statement and balance sheet

◊ Determining if changes in A/R are due to revenue fluctuations or process breakdowns

◊ Understanding the causes of key indicator variances and options for corrective actions

◊ Utilizing the Aged Trial Balance and other reports as management tools.

• Create a responsibility matrix that optimizes the skills of individual staff members in assignment

of key business office functions and processes.

• Develop performance expectations and productivity standards including prioritizing tasks and

developing effective time management strategies. Apply proprietary re|solution management

tools and motivational techniques to improve revenue cycle performance.

• Daily performance tracking, monthly site visits or calls to review progress and answer questions.

• Verbal exit conference and written report for hospital senior management at the conclusion of

the engagement.

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Virtual Business OfficeVirtual Business OfficeVirtual Business Office

Guaranteed Performance ImprovementGuaranteed Performance ImprovementGuaranteed Performance Improvement


• No more staffing issues

• Dashboard reporting

• Implementation of new technology

• Peace of mind


When Brownfield Regional Medical Center (“BRMC”) in NW Texas engaged re|solution in a cash acceleration project, BRMC’s AR days outstanding were at 131, compared to a peer average of 48

days, the days of unbilled AR was at 27 compared to the peer average of only 10, and total AR was

at $4.5 million. Motivated by re|solution’s success in cleaning up the large backlog of old accounts (down to just $2 million, BRMC’s CEO Mike Click determined that moving full operation of his busi-

ness office to re|solution was imperative to getting his hospital back on track.

re|solution assumed responsibility for BRMC’s 21 revenue cycle FTE’s in February 2002. During

the re|store engagement, re|solution was able to trim BRMCs business office staff to 10 FTEs, making their revenue cycle much more efficient than ever before.

re|solution was also able to assist BRMC in returning to an in-house Business Office once opera-tions were stabilized and BRMC desired to bring the work back in-house.


• On-site and remote solutions tailored to your needs

• Option to manage and train current staff

• Optimize your current patient accounting system

• New technology upgrades and training provided

• Monthly productivity and benchmarking reports

“We had been without a busi-

ness office manager and our

issues were severe. The transi-

tion was relatively easy, and the

results practically immediate.

re|solution took over only the

necessary positions, trained

those we desired to have stay,

and the billing office began to

function efficiently. I can’t say

enough good things about our

experience with re|solution”

Mike Click, CEO

Brownfield Regional Medical Center

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ICDICDICD---10 Implementation 10 Implementation 10 Implementation Transition Services to ICDTransition Services to ICDTransition Services to ICD---10 10 10

Other benefits include: • Successful migration to ICD-10 • Coding accuracy • Increased compliance • Improved reimbursement ChallengeChallengeChallenge

Compliance and the transition to ICD-10 is in a state of flux with the October 1, 2013 deadline de-layed to some point in the future. However, industry analysts agree that there will be a transition to ICD-10 in the near future. The transition represents a significant impact to healthcare providers and processes. ICD-10 code sets include updated medical technology and are more detailed and clini-cally accurate. There will be an estimated 68,000 codes included instead of the current 13,000 in ICD-9. It is necessary for providers to take steps now to mitigate the inevitable financial impact. The transition to ICD-10 will be time and resource-intensive for all organizations. Every tool, system, report and program must be adapted for ICD-10. Most facilities lack the resources to integrate ICD-10 throughout every aspect of their business and coordinate clinical, financial, claims, analytical, and especially, information technology. The time to begin the planning and preparation for ICD-10 compliance is now. Regardless of any delays that occur, ICD-10 is coming. Methodology and SolutionMethodology and SolutionMethodology and Solution

Most ICD-10 consultants are performing this work for the first time as it is all new for the US. How-ever, Canada and other countries have been using ICD-10 for years. re|solution has teamed up with consultants who have done this work in Canada and have seen the process through from start to finish. Our team will: Review current state coding operations Identify coding gaps across people, process and technology Determine current staffing and training needs Assess ICD-10 readiness and identify heavily impacted providers Develop project implementation plan Provide recommendations and risk mitigation strategies Transition to owner Put our experience to work for you.

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Charge Capture ReviewCharge Capture ReviewCharge Capture Review

Lost and Found Lost and Found Lost and Found --- Cash Cash Cash


• Increased outpatient reimbursement

• Process improvement to capture all charges

• Reduce auditing costs

• Increased compliance

The Office of Inspector General of the Department of Health and Human Services has issued a re-

port indicating that it is doubtful that any hospital in the country is billing correctly for APCs, espe-

cially in the area of drugs. The Center for Medicaid and Medicare Services (CMS) has noted a num-

ber of services in which hospitals have not billed correctly for services. CMS has acknowledged

their errors in the payment of services and has requested hospitals to resubmit the claims containing

these services.


DCH Health System in Tuscaloosa, Alabama is a three hospital system. Management realized that

with the large number of outpatient procedures it was nearly impossible to insure that all services

provided were actually billed. DCH contracted with re|solution in a re|charge program designed to

review two years of Medicare outpatient claims looking for uncaptured revenue. Over $715,000 was

found in additional cash reimbursement at DCH. In addition, several process improvement initia-

tives were started that assisted the facility in improving their charge capture processes in its cardiol-

ogy group.


Using proprietary technology and a process which reviews all claims that have potential for addi-

tional APC reimbursement, re|charge will identify suspect claims, review the medical record associ-

ated with the claim and return a revised claim to the facility. All of this work is done on contingency

with no payment to re|solution unless additional dollars are found. A no risk program that helps

bring your billing back in compliance.

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Revenue Cycle AssessmentRevenue Cycle AssessmentRevenue Cycle Assessment

A Customized Plan to Improve Your Bottom LineA Customized Plan to Improve Your Bottom LineA Customized Plan to Improve Your Bottom Line


• Process improvement

• Comprehensive proprietary reports

• Increase cash and reduce AR

• Peace of mind


Shenandoah Medical Center is a facility serving southwest Iowa for more than 80 years. When

re|solution was engaged to provide re|assess, their A/R over 90 days was increasing. Their new business office manager, though strong in accounting and management skills, was new to the reve-

nue cycle.

With the participation of management, re|solution developed a comprehensive assessment which

included recommendations for A/R cleanup, management and staff training, and consulting in a vari-

ety of areas which ultimately led to a reorganization of their revenue cycle operation.

Based on the re|assess engagement, SMC reduced it’s days in A/R nearly 25% from 73 to 56 during

the project, had increased cash collections, and re|solution subsequently provided targeted training for their staff and management, creating a foundation for their continued success and sustainable

improvements.


• Observations, data review, and comprehensive interviews provide the basis for recommenda-

tions for improvement

• Results compared to peer group and best practices

• Action plan developed and presentation made to key management

• Implementation design and support

“We had just lost our Business Office Director and our A/R was growing. We en-gaged re|solution to assist us. They proposed a comprehensive solution including a revenue cycle assessment to identify root cause problems… The results were ex-ceptional. In addition to the assessment, $2,500,000 in aged A/R was placed with re|solution of which 92% was resolved. re|solution reduced our Medicare A/R over 90 days by 94% and collected nearly $800,000 in cash for us. re|solution’s onsite consultant took the major recommendations from the assessment and worked di-rectly with our revenue cycle staff to improve our operations.” Chris Cronberg, CEO

Northern Cochise Community Hospital

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Unidentified Payer SearchUnidentified Payer SearchUnidentified Payer Search

OverviewOverviewOverview

At the point of registration, obtaining accurate demographics can often be a challenge. Even with today’s sophisticated software platforms, patient data accuracy can easily be compromised by human error. re|search rapidly matches patient records to previously unidentified third party payers. Identifying, correcting, and billing the claims which other automated third party payer validation ser-vices miss.


The portion of accounts receivable that is classified as patient responsibility is growing. The poor economic environment, job losses (with accompanying loss of employer provided insurance) and the overall climate of patients frequently changing insurance cause many patients to arrive at a facility with a lack of insurance information. When the patient lacks the appropriate insurance information, the claim generally ends up in the self pay bucket. In our experience, from three to five percent of the claims within the patient responsibility bucket are actually covered by third party insurance. The majority of these misclassifications relate to Medi-caid, but there are also many Medicare and commercial insurances that are unidentified. This mis-identification results in frustration to both the patient and the facility.

SolutionSolutionSolution

Using proprietary data mining technology that does not replace other Medicaid eligibility or collection agency solutions, the re|search program continuously mines your registration information retroac-tively and proactively searching for insurance programs that will cover patient responsibility balances due. In addition, the technology will find additional DSH days that can be used to recover additional monies through amended cost reporting. re|search works because it is done strictly on a contingency fee where dollars are paid only on found dollars and not on a per search basis. Once the claims are determined to be eligible, re|solution will return the accounts to be billed to the hospital for billing or re|solution can bill the claims on the hospital’s behalf. The hospital experiences additional dollars from self pay accounts, reduced costs of chasing ac-counts that are misclassified and increased patient satisfaction.

Results Results Results

Let us help you increase your reimbursements as we have for our clients listed below:

Hospital System $800,000 recovered

120 Bed Hospital $200,000 recovered

Disbursement Audit

re|solution uses proprietary sophisticated software developed by Oversight Systems that detects disbursement errors

other systems miss. Errors generally fall into one of three categories: duplicate payments, duplicate line items and

pricing not in accordance with GPO or other vendor contract terms. Such results have been proven in healthcare and

with non-healthcare clients such as MD Anderson, The Coca-Cola Company, Yahoo!, McDonalds, Martin Marietta,

Pfizer, Celanese, W. W. Grainger, and the Department of Defense.

re|solution identifies past payment errors for the prior three years, validates the errors with both the client and the

vendor, and then files claims for refund, credit or future discount.

Analyzing the payback for your hospital is simple. All you need to do is provide us data that is representative of your

past three years of disbursements. We will analyze your data and validate suspected errors and analyze the financial

impact. It is as simple as that, there is no cost to the hospital, and it will take just two meetings with you.

Getting Started Hospital Oversight re|solution

Provide Data �

Analyze Data �

Validate Errors �

Present Findings � �

Go/No-Go �

That is the upfront diagnostic. Running the ongoing project is just a simple continuation: You will provide re|solution

the same data as before on a regular basis. Oversight will use our analytics to detect the errors and re|solution will

validate the errors and prepare claims for vendor submission. You pay only for the claims and credits you actually

collect.

Hospital �

Oversight �

re|solution � � �

Robin Bradbury [email protected] toll free 800.355.0410 for additional information www.ereso.com

Confirm Collection

File Claims

Validate Errors

Analyze Data

Generate Report

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Payment ReviewPayment ReviewPayment Review

Optimized PaymentsOptimized PaymentsOptimized Payments


• Contingency fee based service with no up front charges

• Additional cash

• Stronger negotiations of future contracts

• Peace of mind


Are you certain payers are sending reimbursement that complies with the negotiated contract? Do

you currently use a post payment audit process to optimize and identify any reimbursement issues?

Contracts with payers are negotiated, discounts and payment terms change and errors in payment

occur for a number of reasons. Perhaps a contract amendment update was missed, or incorrect

proration applied. Employees posting payments may not have immediate access or time to review

revised contracts. A higher reimbursement rate may be missed for many months while the payer

pays at the old rate. re|pay identifies errors that cause reduced reimbursement.

re|pay will identify underpayments and inappropriate denials. Once identified, our analysts will ap-

peal underpaid and inappropriately denied accounts.

Methodology and SolutionMethodology and SolutionMethodology and Solution

• Payer contracts are reviewed and compared actual payments

• Identify accounts with underpayments and inappropriate denials for appeal

• Initiate proactive communication with payers to optimize reimbursement for identified accounts.

• Provide feedback on specific problem payers and specific contract issues

• Assists facility in staying current in payer contract renewals, updates, and billing policies.

• Monthly status reports of appealed claims

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Transfer DRG reviewTransfer DRG reviewTransfer DRG review

Immediate Cash Immediate Cash Immediate Cash


• Identify additional reimbursement on TrDRG’s

• Improved payment accuracy

• Retrospective cash collection

• Sustainable results prospectively

• Peace of mind


Many times a patient should receive post acute care and is discharged based on this recommenda-tion from their physician. Medicare pays a reduced DRG payment based on the assumption that the patient will comply with the physician’s recommendation. When a patient, for whatever reason, does not follow through in receiving post acute care, your facility is entitled to the full DRG payment. Facilities have no way of knowing that a patient did not follow through and that they should have received the full DRG payment from Medicare. Using a proprietary software with algorithms to check admissions and other medicare payments for each TrDRG patient, re|transfer identifies and assists with rebilling of retroactive claims and continues to verify payments are not missed on a go forward basis. IT support is minimal and the service is provided on a contingency basis with no up front fees.

Methodology and SolutionMethodology and SolutionMethodology and Solution

• Identifies Medicare accounts that have a discharge status inconsistent with claims data

• Improves accuracy of claim payments for designated transfer DRGs

• Validates and documents that patients received post acute care

• Provides a conclusive list of claims that require review for possible rebilling and/or appeal

• Assistance with billing or re-billing of identified accounts

• Reporting demonstrates program’s effectiveness

• Monthly reporting on account statuses and identified issues

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Candidate ScreeningCandidate ScreeningCandidate Screening

Identify Qualified Candidates QuicklyIdentify Qualified Candidates QuicklyIdentify Qualified Candidates Quickly


• Save time and money wasted on processing unqualified candidates

• Expert screening ensures candidate knowledge

• Identify candidates who will integrate seamlessly with your current staff

• Quickly identify permanent candidates

• Interim Staffing assistance available if needed

Screening ProgramScreening ProgramScreening Program

re|view is a cost-effective way to determine a candidate’s business office skills, and management

style. We work with you to asses the position criteria, and then use re|solution’s candidate screen-

ing to combine the best of competency-based selection with behavioral-based interviewing. Using

our competency analyzer, and conducting structured and action interviews, suitable candidates are

quickly identified. The program can be tailored to fit your budget and needs.

Methodology and OptionsMethodology and OptionsMethodology and Options

• Initial resume screening to pre-qualify candidates

• Qualified candidate screening using critical questions to further determine eligibility

• Detailed skills screen

• Detailed structured and action interview

• Report on individual candidate

Service Cost per candidate

Detailed Skill Screen $100

Detailed Structured and Action Interview $200

Candidate Report $100

Transcription Accountability

Transcription accountability management provides a powerful dictation/transcription workflow application that includes a broad spectrum of capabilities for managing in-house, outsourced and speech recognition programs while reducing costs and improving patient care quality. Historically reduces transcription costs by at least 17%.

PROGRAM FEATURES:

• Dictation and document tracking and management

• Advanced outsource and subcontract management module

• Line counting, with standardization and calibration

• Data analysis and reporting capabilities

• Software tracks transcription service utilization at the facility, department, location, and author levels

• Integrated speech recognition services

• Unparalleled security insures access control, Protected Health Information (PHI), and activity logs to meet compliance requirements

Predictability, Visibility, Transparency

Contro l—maintain control and accountability over document creation and management processes, PHI, and compliance with user interface and data organization. Cas h Savings —deliver optimal savings by structuring transcription operations. Usage based fee structure delivers advanced proprietary technology that is continuously upgraded and professionally supported. Quality—standardizes specifications, sets uniform templates, controls security and privacy policies, reduces manual effort, and extends operational methods uniformly to current in-house and outsourced transcription services.

Robin Bradbury [email protected] toll free 800.355.0410 for additional information www.ereso.com

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