Implementing Quality Benchmarks within Patient Financial Services Benchmarking for Improvement Implementing Quality Benchmarks within Patient Financial Services

Reasons for Benchmarking Compare to industry standards where applicable Identify current state and reasonable expectations Establish facility specific benchmarks Set goals for progress

Overall- Standard Indicator Standard Net AR Days <55 Days Pt Cash As A % Of Cash Goal >100% Total POS Cash As A % Of Cash Goal >2% Bad Debt Write Offs As A % Of Gross Revenues <3% Charity Write Offs As A % Of Gross Revenues Patient Cash As A % Of Net Revenue DNFB AR Days <5-6 AR Days

POS Cash ED rate Ancillary Set realistic standard

(Excluding S/P and Pending Medicaid) A/R Days Patient Financial Services Hospital Report Report-November Previous Fiscal YR 195,756,157.60 Avg. Daily Revenue 536,318 AR Total AR Credit Balances Weekday Date Gross AR Days (Excluding S/P and Pending Medicaid) Self Pay Pending Medicaid $ # Tue 1 74.41 41,730,884 4,104,301 17,586,518 20,040,066 1,823,072 2,381 Wed 2 74.67 41,875,272 4,104,433 17,776,552 19,994,287 1,829,586 2,386 Thur 3 74.86 41,982,531 4,092,725 17,885,489 20,004,317 1,831,458 2,390 Fri 4 74.17 41,636,243 17,595,862 19,947,656 1,855,325 2,406 Mon 7 75.04 42,090,399 4,092,620 18,097,546 19,900,234 1,842,459 2,410 8 74.11 41,610,072 4,091,934 17,618,968 19,899,170 1,863,930 2,400 9 74.52 41,778,757 4,091,932 17,808,395 19,878,430 1,814,700 2,392 10 74.70 41,814,156 4,091,927 17,851,498 19,870,730 1,751,225 2,368 14 76.67 42,773,539 18,771,738 19,909,874 1,653,004 2,321 15 75.54 42,126,042 4,095,430 18,109,083 19,921,529 1,615,149 2,301 16 75.81 42,314,384 4,077,915 18,301,416 19,935,053 1,657,317 2,275 17 76.42 42,545,125 18,493,594 19,973,616 1,561,401 2,243 18 76.05 42,300,787 4,077,354 18,241,781 19,981,653 1,515,282 2,219

Business Office Indicator Standard Late Charge Hold Period 2-4 Days Late Charges As A % Of Total Charges < 2% First Time Billing From Discharge 5 Days Medicare Suspense File (RTP) < 1 Day Claim Re-Billings After Denial/Rejection 15 Days Secondary Billings After Payment/Rejection Re-Billings % Of Claim Total < 5% HIPPA Compliant Electronic Claim Submission 100% Final Billed/Claim Not Submitted Backlog < 1 AR Day

Business Office Third Part Follow-up Indicator Standard Insurance AR Aged 90+ Days From DOS <15-20% Insurance AR Aged 180+ Days From DOS <5%

Late Charges Track by department for process improvement Volume as percentage Dept. # 3660 3665 4760 Name Operating Room Recovery Room Pharmacy Chemo Total Date   1 - (1,081.00) 2 2,621.00 3 1,533.70 (3,521.00) (1,740.30) 4 4,038.95 584.00 5,759.21 5 14,795.15 464.00 15,488.41 6 0.00 7 (317.00) 8 9 (1,372.00) 19 25,028.15 1,048.00 26,338.31 45,395.95 2,096.00 (4,893.00) 48,727.38 % 93.2% 4.3% -10.0% 100.0%

Held Accounts Held Accounts Medicare RTP ($) Held/Failed ($) Clearinghouse ($) Total ($) Medicare RTP (#) Held/Failed (#) Clearinghouse # Total (#) 36,593 573,342 318,394 928,329 6 68 61 134 3,126 561,864 510,266 1,075,256 2 70 78 149 20,571 543,261 527,843 1,091,675 1 88 21,062 681,174 512,395 1,214,631 69 94 164 20,894 556,480 460,438 1,037,812 81 143 21,679 531,884 464,751 1,018,314 84 146 20,404 537,048 401,672 959,123 54 66 120 553,200 356,908 930,512 58 55 113 716,653 439,022 1,176,078 71 76 148 513,855 392,805 927,063 57 63 431,974 410,016 862,394 52 60 112 411,145 479,007 910,555 49 495,338 438,805 954,546 50 121

Unbilled Inventory Unbilled Accounts 1 7,727,629 6,199,826 1,527,803   Unbilled Accounts Date Total Un-Billed ($) 0-6 Days ($) >6 Days ($) Total Un-Billed (#) 0-6 Days (#) >6 Days (#) 1 7,727,629 6,199,826 1,527,803 2,265 2,123 142 2 7,288,339 5,962,452 1,325,887 2,138 2,015 123 5 7,728,247 6,416,224 1,312,024 2,070 1,954 116 6 7,431,374 6,114,118 1,317,255 2,065 1,942 7 7,162,342 5,768,893 1,393,448 2,006 132 8 8,579,356 5,999,473 2,579,883 2,511 2,031 480 9 8,337,156 6,952,058 1,385,098 2,385 2,250 135 12 7,335,272 5,971,465 1,363,807 2,017 1,860 157

Discharged not final Billed   Summary by Department Department # Accounts Sum of Chgs Oldest Account (Days) ?? Vet 1 26.00 359 Cardiology 1,622.00 9 COMMUNITY 16 185,787.23 24 ED 18 47,009.70 34 ER 112 110,807.05 197 General Surgeon 7 29,491.10 HemOnc 8 71,899.72 37 HOSPITALIST 142 2,902,423.47 39 LOCUM 212 276,402.58 21 OB/GYN 28 151,711.28 50 Psych 27,740.05 25 546 3804920.18

Denials Indicator Standard Overall Denials Rate <4% Clinical Denials Rate <5% Technical Denials Rate <3% Under Payments Additional Collection Rate >75% Appeals Overturned Rate 40-60% Electronic Eligibility Rate Physician Precertification Double Check Rate 100% Case Manager's Time Securing Authorization Rate <20% Total Denial Reason Codes <25

Follow up Production Indicator Standard Account review per employee 400-800 per month Account review period Every 15-20 days

Denials Clinical denials Medical Necessity MUEs NCCI Technical Denials File Limits Incorrect insurance Incorrect Patient identification Failure to respond to payor request for additional information

Contract Management Contract Management software Percent of Charge Adjustment code analysis

Eligibility/Precert Who preforms Eligibility checks? Precert Registration When is Precert performed Before Radiology review?

Customer Service Indicator Standard Correspondence Backlog <1 Business Day Walk In Patients Wait Time <5 Minutes Automatic Call Distribution Hold Time <2 Minutes ACD Abandon Call % of Calls On Hold > 30 Seconds <2% ACD % of Calls Resolved in <5 Minutes >85% ACD % of Calls not resolved in >10 Minutes <5% Calls Resolved W/O Complaint/Referral to PFS Director >95

Collections/Outsourcing Indicator Standard % of Accounts < 90 days of Gross AR 80% % of Accounts 91 to 180 Days of Gross AR 17% % of Accounts Over 181+ Days <3% Bad Debt Expense of Gross <4% Bad Debt Expense of Net <2% Bad Debt Fee % 15-18% Third Party Extended Business Office 6-10% Self-Pay Extended Business Office 10-12% Legal Collections Fee % 20-30% Medicaid Eligibility Fee % 12-18% Cost to Collect Ratio 2%

Reporting Metrics Develop reports to support metrics Use reports to drive change Create expectations that reports be reviewed by department leaders and acted upon Re-establish expectations

Investigate Outliers What happened here? Root causes What can be corrected? What is the future action plan? Other Metrics TODAY MTD DAILY AVG   ACTUAL AVAILABLE BED OCCUPANCY % 76.51% OUTPATIENT REGISTRATIONS 187 129 ER VISITS 132 116 ER ADMISSIONS 15 20 ER LWBS 8 OBSERVATION HOURS 85 277 OBSERVATION PATIENTS 6 19

Thank You Stroudwater Revenue Cycle Solutions was established to help our clients navigate through uncertain times and financial stress. Increased denials, expanding regulatory guidelines and billing complexities have combined to challenge the financial footing of all providers. Our goal is to provide resources, advice and solutions that make sense and allow you to take action. We focus on foundational aspects which contribute to consistent gross revenue, facilitate representative net reimbursement and mitigate compliance concerns. Stroudwater Revenue Cycle Solutions helps our clients to build processes which ensure ownership and accountability within your revenue cycle while exceeding customer demands. Contact us to see how we can help. John Behn, MPA jbehn@stroudwater.com 207-221-8277