Presentation on theme: "HFMA Hawaii Chapter Conference April 10, 2015 Kern Medical Center."— Presentation transcript:
HFMA Hawaii Chapter Conference April 10, 2015 Kern Medical Center
KERN COUNTY MEDICAL CENTER TOTAL BEDS : 222 ANNUAL ADMITS: 32,000 ANNUAL OUTPATIENT CLINIC VISITS: 140,000 ANNUAL ED VISITS: 45,000 ANNUAL OPT SURGICAL PROCEDURES: 4,0000 HOSPITAL FINANCIAL SYSTEM: MCKESSON-STAR PRACTICE MANAGEMENT SYSTEM: MCKESSON PRACTICE PLUS EMR: OPEN VISTA PAYER MIX: 75% M/CAID AND M/CAID MANAGED CARE 8% MEDICARE 12% COMMERCIAL/WORKER’S COMP./JAIL 5% SELF-PAY
KERN MEDICAL CENTER STATISTICS A/R DAYS AS OF 6/30/13 TOTAL A/R 166 DAYS- BILLED A/R 151 A/R DAYS AS OF 3/01/14 TOTAL A/R 94 DAYS- BILLED A/R 84 A/R DAYS AS OF 6/30/14 TOTAL A/R 77 DAYS- BILLED A/R 57 CASH COLLECTIONS AS OF 9/30/13 $6 MILLION CASH COLLECTIONS AS OF 9/30/14 $13 MILLION FTE’S 6/30/13 TOTAL FTE’S 30, PLUS 3 SUPERVISORS FTE’S 6/30/14 TOTAL FTE’S 12, PLUS 2 SUPERVISORS
OVERVIEW – MAJOR BARRIERS 2 Registration platforms Star for hospital services Practice Plus for clinic visits & pro fees Clinic and OP diagnostic registration staff reported to clinic leadership Hospital registration staff only responsible for ED, INPT and scheduled surgeries Zero quality and Zero authorizations
OVERVIEW MAJOR BARRIERS Multiple scheduling systems Surgery -open vista Diagnostic and pre-op – star Clinic visits- practice plus EMR is non-functional and not user friendly Diagnostic test performed during clinic visit, were posted in STAR but manually credited and debited in practice plus. TOTAL DISASTER
OVERVIEW MAJOR BARRIERS Case management focused on Medicare certification M/Caid and M/Caid Managed care No concurrent review or authorizations for commercial payers No authorization bill hold in financial system. business office had to scramble once claim was produced or just bill with records
PROCESS IMPROVEMENT ENGAGEMENTS AT KMC Various firms and solutions had already failed consulting was a bad word Process improvement opportunities are not visible to everyone. Most common practice is to just add bodies to broken process Adding bodies, is like adding layers of clothes to hide your extra weight Nothing is solved
PROCESS IMPROVEMENT DAWNING OF A NEW DAY Kern was bitten with the improvement bug Once they were given some direction and ideas they took off and continue to look for opportunities Watch words are- maximize technology pre-register every type of scheduled service streamline check in- Customer first automate claims submission expect 100% clean claims don’t take no for an answer
PATIENT ACCESS JOURNEY Divided registration No pre-registration No insurance verification No co-pay collection Full registration Long wait times Surgery scheduled w/out pre-op
PATIENT ACCESS TURNS THE SHIP Implement pre-registration On-line payments Quality control over registration Assembly line for patient packets Developed check-in process Assumed registration for diagnostic testing Assumed registration for clinic services
PATIENT ACCESS HAS SAILED Quality and eligibility software implemented Focus on every error Build edits to correct errors Pre-Registration a day On-line credit card and check processing No bottle-neck at registration Maximize reimbursement
HOSPITAL BUSINESS OFFICE PAPER, PAPER EVERYWHERE Inpatient claims produced without authorizations Staff had to secure the authorization or claims were billed with medical records, majority of time Room charges were often missing designated staff member was forwarded acct. to add missing charge Auto insurance was always billed as prime California does not subrogate and only ERISA health plans require payment or denial. This does not include Medicare. claims were often written off as commercial payer was not billed timely
HOSPTIAL BUSINESS OFFICE PAPER, PAPER EVERYWHERE Correspondence was passed around until it ended up with the appropriate person once dealt with it was filed in a daily folder Payment process staff analyzed each EOB to determine if contractual was accurate dramatically slowed down payment posting Medicare billing was handled by 2 fte’s, even though average daily volume is less than 15 accounts. Commercial billing and follow-up was handled by 3 fte’s and even though the average daily volume is 25, more often balances were written off to timelines.
HOSPITAL BUSINESS OFFICE MANUAL WAS THE WORD OF THE DAY Adjustments were manually documented, forms completed and forwarded to supervisors to data enter M/Caid reimbursement is low but current processes required multiple staff to achieve reimbursement. o KMC spent more then actually received in reimbursement Remittance advice were manually reviewed by 1 fte denials were documented in account notes someone else reviewed denials and re-worked claims that claims editing system had deemed “clean” Inpatient was handled by yet another fte M/caid physical therapy was billed by anther fte M/caid managed care was handled by 2 fte’s.
PATIENT FINANCIAL SERVICES A NEW DAY ARRIVES Replaced existing claims editing vendor 10% clean claims and even then “clean claims were rebilled New claims editing vendor programmed majority of errors to improve clean claims, now at 60% M/Caid paper claims can now be sent electronically with automated program Continually striving to improve clean claims to virtually eliminate errors
PATIENT FINANCIAL SERVICES A NEW DAY ARRIVES Claims editing vendor automatically validates eligibility & changes destination and rules of claim as appropriate report indicates the appropriate payer so financial system can be updated. report indicates patients with no coverage Eligibility errors are non-existent due to front-end efficiencies M/caid denials are automatically adjusted, as defined Non-covered charges are automatically adjusted Eliminated re-work and re-processing of denials
PATIENT FINANCIAL SERVICES A NEW DAY ARRIVES Payment processing posts payments and denials as reflected on EOB, staff merely post what they see Zero payments posted have the Claim Control Number and reason, documented in the account notes. Correspondence is answered and documented by 1 fte, same fte also answers all requests for records by attorney’s or subpoena's Medicare and Commercial 1 fte performing billing function quit, but it was not a full time job anyway. Outsourced function to claims editing vendor.
PATIENT FINANCIAL SERVICES A NEW DAY ARRIVES Commercial Follow-up is performed by 1 fte focused on making outgoing calls, by payer. Benchmark is resolving 40 claims per day Established Underpayment review of daily payments, 1fte created ACCESS database payment files are imported the day after posting accounts are reviewed against contracts underpayment identified, account is documented and is sent to Collector
PATIENT FINANCIAL SERVICES A NEW DAY ARRIVES Self-Pay was outsourced from Day One eliminated statement production eliminated mail returns Eliminated staff required to answer patient calls increased self-pay collections 1 fte is the designated as the hospital liaison assists with resolving issues between vendor and KMC.
PATIENT FINANCIAL SERVICES BRAVE NEW WORLD Continually striving to identify new opportunities to maximize technology and minimize staff intervention Cash collections continue to exceed prior year Billed A/R Days are hovering in the 50’s but we are working to decrease Billed A/R days to mid 40’s.
PATIENT FINANCIAL SERVICES A BRAVE NEW WORLD 12 staff members and 2 Supervisors Working toward 100% clean claims Goal for Medicare and M/Caid A/R greater than 30 days from billed date – 10% Goal for Commercial A/R greater than 90 days from billed date- 10% Automate anything and everything Empower staff to be fierce agents of war
PROCESS IMPROVEMENT CONCEPTS Process improvement cannot be achieved with a cookie cutter approach one solution does not fit all nor does one product solve “everything” Equally dangerous is the self-help approach Staff take courses and obtain certificates and titles the process involves others outside of the focused area the problem is – you don’t know what you don’t know. how can the best solution be achieved without experience garnered at other providers
LESSONS LEARNED Challenge everything Why can’t it be automated? Does the task add value Ask your colleagues Network with fellow financial leaders Don’t be afraid to ask the people presenting, we are more than happy to help. THANK YOU Susan Labow- Helen Cullen – Andree Campa –