Using Technology to improve Your ASC Colorado Ambulatory Surgery Center Association

MediGain Confidential

Using Technology to improve Your ASC

Colorado Ambulatory Surgery Center Association

Contact Information:MediGain [email protected]

MediGain Confidential 2

Some Technology Usage Facts

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 ASC’s and Physician practices still use paper

medical records

MediGainPreserving Healthcare Profits


Healthcare vs. other Industries

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

First IBM PC is launched in 1981 More than 80 percent of ambulatory surgery centers do not use electronic health records, survey indicates.

Healthcare IT News (4/7, Pizzi) reported, "82 percent of ASCs (ambulatory surgery centers) do not use an electronic health record," according to a survey conducted by Renaissance Research. The survey of 175 ASC administrators found “

that 85 percent...use paper perioperative notes, and 74 percent use dictation and transcription for the generation of physician procedure notes." The survey also found that "49 percent of

administrators had concerns that revenue could be lost in the IT implementation process."



Why Utilize Technology in the ASC

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

ProcessesResources

ASC




Typical ASC Structure

Customer ServiceTranscriptionCodingBillingCollectionsFollow upMedical RecordsElectronic Claim ProcessingPaper Claims and Statements

ReportingAnalyticsBusiness Intelligence

ClinicalFront Office Back Office

< 20% of Revenue

From Cash

>80% of Revenue

From Insurance

SchedulingInsurance Verification

Patient Info

DiagnosisProceduresDictation

Patient Care

Patient FormsInventory

Management




Potential Revenue Losses in an ASC

ASC’s Have Already Done Work and is Owed 100%

Patient Registration/ Eligibility Verification

-5%

Transcription/Coding

Claim Submission

Secondary Insurance & Patient Portions

Potentially Lost Revenue

Revenue Lost by Typical

Facility

Payment Posting/Follow up

-10%

-3%

Fee Schedules/ Charge Master

-4%

-3%

-5%

20% - 30% Loss of 20% to 30% of the money you have already

worked for!

Inaccurate posting can result in inaccurate statements, follow

up, and collections

Many do not send or follow up on secondary and paper

statements

Almost 3% of claims are lost by insurers after positive receipt by

clearing house

Poor transcription and inaccurate coding can lead to

denials and lost rev.

Charges need to be updated and compared with national averages

Lack of proper front office processes and systems impact

reimbursements


What Processes Do You Automate? MediGainPreserving Healthcare Profits

Process

1. Scheduling

2. Ins Verification

3. Patient Confirmation

4. Chart Preparation

5. Dictn./Transcription

1. editing

2. Signature

3. Distribution

6. Document mgmt

1. Medical

2. Reports

3. Forms

7. Coding

Manual

X

x

X

>82%

>26%

X

X

X

>82%

X

X

X

X

Solutions

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

Pre

-su

rgery

Post

Su

rgery

Cla

im P

rep

.



Process

8. Charge Entry

9. Claim Scrubbing

10. Claim Submission

11. Claim Acknw.

12. Payment Receipt

13. EOB/PMT Posting

14. Denial Mgmt.

15. Reporting

16. Prescription/Labs

17. Materials mgt.

18. Patient info.

19. Marketing

Manual Solutions

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

What Processes Do You Automate? P

ost

Su

rgery

- C

laim

P

roc.

Post

Su

rgery

-O

ther


Asses Current ASC Situation

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



Items to Consider When Investing in Technology

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 – MD’s, staff, patients

• Set project plan and realistic timelines





Ideal ASC Workflow

ReportingAnalytics

InventoryManagement

Billing/CollectionsPosting

Coding

Transcription

BankReferring MD

Patient MedicalRecord

Insurance

Phone

Web

Digital Forms

Surgery




Example of Opportunity

Current revenue generated = $5,000,000/yr

Conservative estimate of improvement = 10%-15%

Assuming an average ASC

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.


Where do you want your ASC to be? MediGainPreserving Healthcare Profits

Level 1

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

Level 2

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

Level 3

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

Level 4

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

ASC Technology Maturity Model


Questions and Answers MediGainPreserving Healthcare Profits

Using Technology to improve Your ASC Colorado Ambulatory Surgery Center Association

Documents

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