Webinar: Turning Insight Into Action: Analytics & Effective Denials Management

Analytics & Effective Denials Management

June 10, 2014

Introductions

Andy LeBlancSupervisor, Revenue Cycle

Employed at Middlesex Hospital for the past 25 years. Director of Patient Financial Services overseeing patient accounting, patient access, and payer contracting. Active on Ct. Hospital Association committees, and a member of HMFA and AAHAM. Currently using GE Centricity Business for revenue cycle and partner with GE on focus groups, enhancement requests and the hospital user group. Prior employment was with a Connecticut Bank managing two branch offices.

Employed with Middlesex Hospital a total of 6 years. Responsible for implementing, designing and providing support for business and administrative analytics within all revenue cycle functional areas. Works to find revenue opportunities related to cost reductions and/or charging efficiency. Focused on architecture of business intelligence tools that assist in decision support activities. Holds a PMP certification & is an active member of HFMA & PMI communities.

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Michael MastGlobal Director, GE Healthcare IT

Michael Mast is a global director at GE Healthcare IT. Michael manages go-to-market strategy for GEHC’s Integrated Care and Financial Management solutions. Michael has over 10 years of healthcare IT experience. You can follow Michael on Twitter at @mjmast

Pat NeisserDirector, Patient Financial Services

About Us

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Background

● 2009 - Denials were approx $3m annually● Hired a Denial Specialist to better handle analytics & reporting● Leveraged Analytics to identify, by Payor and/or Service Line areas of opportunity● High-level analytics coupled with drill-down capabilities provided direction &

actionable information direct to department leads

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Denial Write-Offs

Appeals Tracking

Denials Team

Progression...

2014

2013

2010

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Denial Write-Offs (2010)

● Analytics

o Categorization of Write-Offs, by Payer, Service & Type of Denial

o Dashboard, single-source of truth

● Workflow/Process Controls

o Formation of Clinical Compliance teams

o Feedback loops direct to departments & physician practices

o Ability to focus on specific targeted denials, as-needed

● Measurable Outcomes

o Service Line dollars written-off, by type

o Time-based trending with goals, overall + departmental

AnalyticsWorkflowOutcomes

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Denial Write-Offs


● Categorization of Write-Offs, by Payer, Service & Type of Denial

● Dashboard, single-source of truth

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Denial Write-Offs


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Denial Write-Offs


● Formation of Clinical Compliance teams

● Feedback loops direct to departments & physician practices

● Ability to focus on specific targeted denials, as-needed

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Denial Write-Offs


● Service Line dollars written-off, by type

● Time-based trending with goals, overall + departments Lab

Radiology

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Appeals Tracking (2013)

● Analyticso Visibility into Payers, Appeal Type, Time to Resolution

● Workflow/Process Controlso Date/Time stampso Support for redistribution of work

● Measurable Outcomeso Win %, by Payer, by Appeal Type for both volume & dollarso Benchmark resolution times comparing payerso Negotiating leverage with payers


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Appeals Tracking


● Visibility into Payers, Appeal Type, Time to Resolution

*subset of total

*subset of total

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Poll Question

What financial outcomes is your organization most

focused on improving?

a. Reduced A/R days

b. Improved net collections ratio

c. Improved point of service collections

d. Greater understanding of activity costs

e. Improved cash flow

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Appeals Tracking


● Date/Time stamps

● Support for redistribution of work

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Appeals Tracking


● Win %, by Payer, by Appeal Type for both volume & dollars

● Benchmark resolution times comparing payers

● Negotiating leverage with payers

*subset of total

*subset of total

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Denial Team (2014)

● What is it?

● Why is it needed?

● How was it staffed?


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Denial Team


● Categorization of Rejections, by Payer, Service & Type of Denial

● Crosstab, time-based tracking tools

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Denial Team


● Reorganized 2 FTE’s to focus on rejection functional area, by payer (Medicare 1st LOB tackled)

● More focus on consolidation & specialized work for greater overall visibility to source of denials, yielding greater results

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Denial Team


● FTE savings

● Cash flow improvement

● Reduction in volume of rejections, by Payer & Type

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Next Steps

Imagination at work.

Michael Mast, Global Director at GE Healthcare IT

Financial Management

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A fundamental transformation of healthcare

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Healthcare IT is at the helm of driving a productivity transformation across the industry

Patients seek… Providers need…

• More face time

• Care that revolves around them

• More active role in care decisions

• More consistent, higher quality outcomes

• Configurable tools to match their workflow

• Integration with existing systems

• View of patient acrosscare pathway

• More consistent, higher quality outcomes

The rapid rise of value-driven healthcare

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Increased government

policiesand financial pressures…

…which require software-enabled

solutions to deliver on cost

and quality

…drive shift to more

integratedand value-based care models…

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Poll Question

What are the biggest challenges that your

organization faces in managing risk?

a.The complexity of contracting

b.Defining attributable costs

c. Managing populations

d.Taking the first step

e.We do not plan to engage in risk-based contracting

Our joint opportunityHealthcare IT transformation to help drive better outcomes

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From treating illness to managing health

Enable patientswith more informed and proactive healthcare experience

Give providerstools to help deliver better outcomesAccelerating

workflows, streamlining processes, improving analytics

capabilities…

Liberate and create new

value from data

Key ingredients to deliver successful outcomes

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All three elements required to improve healthcare delivery

Software & Analytics

Workflow & Domain Expertise

StrongEcosystem

Financial Management

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Customer Challenges GE Solutions Customer Outcomes

1 Baystate Health in Massachusetts: reduced billing lag time by 69% - Source: Baystate Health in Massachusetts Case Study, 20122 University of Missouri Health: decreased days in A/R by 58% - Source: University of Missouri Health Case Study, 20123 Saint Francis Health System: increased up-front collections by $2M to $12M. Source: Optimizing Revenue Cycle Management: A Case Study of Centricity Business at Saint Francis Health System, IDC Health Insight, August 2012

“How can we take on risk and still deliver solid patient outcomes?”

Financial Risk Management Solutions

Reduced billing lag time by 69%1

Decreased A/R days by 58%2

“What type of healthcarereform model is right

for my practice?”

Contract Modeling & Management

Helped reduce cost to collect to less than 4%3

“Which metrics should I focus on to drive

maximum profitability?”

Revenue Cycle Management

Activity-Based Costing

Increased up-front collections by $2M to $12M3

“How do I connect my ITsystems to ensure accuracy and great

outcomes in reporting?”

EDI & Claims Processing

Enterprise Revenue Cycle: Centricity Business

Core Tenets

Reform ready. Now.• Whether implementing full capitation or taking

your first steps in managing risk, Centricity Business is your foundation for success.

Enterprise-wide visibility & control • Improve financial performance with a

consolidated approach to managing both acute care hospital billing and ambulatory billing

Comprehensive Task Management• Flexible enterprise task management enables you

to control every aspect of your accounts receivable; every payer, every edit, every rejection.

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Questions for Our Speakers?

Andy LeBlancSupervisor, Revenue Cycle

Michael MastGlobal Director, GE Healthcare IT

Pat NeisserDirector, Patient Financial Services

Webinar: Turning Insight Into Action: Analytics & Effective Denials Management

Healthcare

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