Best Practices – System Implementations WV HFMA May 16, 2013

Quick Questions  Role in software selection:  Recommend  Review what others have found  Little to None  Involvement in system implementations:  Currently involved in one or more implementations  Will be involved within the next 6 months  Not involved within the past 12 months  Thinking about the last 2 system implementations you have been involved with, would you characterize them as:  Highly successful  Successful, but implemented behind schedule  Marginally successful, still recovering in some areas 2

Getting It Right  Implementation – Step 1  Design the project  Gap Analysis – Current state vs Future state  Metrics – Current metrics vs Future metrics (goals)  Fix process first!  ROI (CFO’s sweet spot!)  Buy-in from RCM group within organization  Select your technology path  Full-service solutions – “off the shelf, one size fits all”  Bolt-on solutions – “land of smorgasboards”  Beta option  Vendor buy-in to your critical success factors up front  Remember one important fact – most projects end up costing way more than the initial proposal 3

Getting It Right, continued  Project Planning – Step 2  Understand why projects fail!*  Technology ROI numbers = mostly fiction  ROI rarely drives the investment decision-know what does in your organization  Lack of long-term accountability in technology area  Detailed project plans can become the enemy  Using the big outside guns only ensures that someone will get shot  Role of the project team in developing the project plan  Oversight of the project plan  IT support *Why Technology Projects Fail: 5 Unspoken Reasons, by Coverlet Meshing, Information Week, April 22, 2013, pp

High Performers and IT Support 5 Level of IT Support or Collaboration “Please describe your organization’s level of support and collaboration for the revenue cycle 1 = none to 7 = extremely high. (Percentage indicating 6 or 7)” Source: Strategies for a High-Performance Revenue Cycle, HFMA, 2009, page 20.

Getting It Right, continued 6  Testing and Training– Step 3  After costs, typically the most underestimated activity – both volume and time  Trust nothing – prove everything  Use teams but with management participation  Watch out for “we’ve always done it THIS way!”  Test teams must understand future state work flows  Redesign workflows testing reveals a better way, not just because the software would have to be modified to allow you to implement your desired future state  Hardware full load tests  Training workbooks and real exercises

Getting It Right, continued 7  Go Live – Step 4  Identify in advance how you will know when “things” fail  Balancing  Metric variations outside the normal range  Manage by walking around-everywhere  Watch for backlogs  Put the patient experience first  Keep your boss in the loop-sooner, rather than later!

Getting It Right, continued 8  Post Go-Live – Step 5  Monitor critical success factors and metrics  Track requests for fixes and timeframes involved and hold vendor and staff accountable for timely resolutions  Communicate, communicate, communicate!

Revenue Cycle Technology 9  If you have a process issue, there is probably a technology solution out there!  Solutions evolving at an amazing pace  Ask the question: is there a way to automate “X” so that my team can work smarter, not harder!

 QA programs are designed to check accuracy rates to: ◦ Reduce denials ◦ Ensure compliance with government regulations ◦ Identify patterns of poor work ◦ Identify training needs  Manual vs. automated ◦ Automated examples include:  DaVincian  AHIQA  AccuReg  CPSI  Emdeon Denial Management  Compass and Epic  McKesson ◦ Majority still manual and daily Appendix A – QA Programs 10

 Scheduling technology ◦ Access options:  Physician practice based  Centralized scheduling operating using call center based technology  Patient internet access based ◦ Core functionality: Ancillary and OR; electronic order capture; fully customizable to support resource scheduling, automated rules and patient information; electronic communication with departments and patients ◦ Links into electronic medical record ◦ Links into clinical systems ◦ Supporting applications:  Medical necessity screening and ABN tools with electronic signature feature  Robot calling for patient reminder calling  Workflow rules-based application to move accounts through the scheduling and registration work flows Appendix B - Revenue Cycle IT Components 11

 ADT – Preregistration, registration, census management ◦ Call center technology for pre-registration processing ◦ Patient kiosks for self service arrival processing, including electronic signatures, payment processing and receipting, positive patient identification ◦ Real-time automated registration data QA ◦ Additional applications:  Electronic insurance verification  Electronic transactions for managed care processing  Patient charge and liability calculator  Electronic patient folders  Integrated scanning  Payment receipting and treasury processing  Electronic address validation  Electronic credit scoring and/or electronic account segmentation tool  Electronic charity application processing  Electronic referral for Medicaid eligibility processing  Patient portal for electronic communication r.e. directions, instructions, billing inquiries and payments  Patient satisfaction survey capabilities linked to call center contacts, kiosk utilization, etc. 12 Appendix B - Revenue Cycle IT Components 12

 Electronic medical record (EMR or EHR)  Real time charge capture and service documentation from clinical systems into core revenue cycle system  Workflow technology to monitor managed care requirements, case management tools  Prebill claim scrubber application  Workflow technology to manage DNFB workflows; automated coding validation  Billing and collections system application: ◦ Electronic claims scrubber for 837I and 837P ◦ Tools to capture all charges within the ACO framework, appropriately bill and distribute payments ◦ Clearinghouse connectivity for claims processing to individual payers – 837I and 837P ◦ Calculation of contractual adjustments and patient discounts at time of final billing ◦ Workflow technology to monitor clean claim payment cycles and follow-up processing requirements ◦ Automated follow-up processing using electronic processing and call-center technology ◦ Electronic payment receipt and posting ◦ Real time payment validation vs payer contract terms 13 Appendix B - Revenue Cycle IT Components 13

 Billing and collections system, continued ◦ Electronic payer logs and data warehousing of claims data with reporting capabilities needed to model payer contracts ◦ Electronic modeling tools for ACO analysis ◦ Automated bad debt processing to and from collection agencies  Electronic tracking of KPI’s and other dashboard data for performance reporting within the organization on daily, weekly, monthly and annual basis  Intranet-based staff training application ◦ Applications training ◦ Workflow procedures ◦ Policies and procedures ◦ New regulatory requirements ◦ Customer service … 14 Appendix B - Revenue Cycle IT Components 14

Contact Information 15 Sandra J Wolfskill, FHFMA Wolfskill & Associates, Inc Bass Lake Road Chardon, OH