Keys to Successful Financial Clearance, Pre-Registration, and Pre-Service Collections Monday, October 17th, 2016

Steward Health Care Patient Assistance Center Centralized business office function dedicated to financial clearance and pre- registration services for: 8 Acute Care Hospitals 3 Ambulatory Surgical Centers Large Network of Affiliated and Employed Physicians Financially Clear Scheduled Services and Inpatient Admissions Pre-Register Scheduled patients and collect estimated responsibility Coordinate with local registration staff to ensure all patients are financially cleared for service Denial Prevention Analyst II Denial Prevention Analyst I Facility Registration

Scope of Services Urgent Inpatient Admission Notification Complete inpatient notification process for ~380 admissions/day Verify eligibility Notify plan of admission to Steward facility Secure authorization for inpatient stay Financially Clear Elective Scheduled Services Financially clear ~370 High Tech Radiology & ~530 Elective Procedures/Surgeries each day Verify eligibility, validate medical necessity, and estimate patient responsibility Review prior authorization & referral requirements Confirm on file with payer or contact ordering provider to secure prior to service Pre-Register Scheduled Services Pre-Register ~860 patients/day Confirm financial and demographic information prior to service Communicate estimated liability and collect ~$30,000 per day over the phone Place 1,500 outbound phone calls & field 400 inbound calls each day Staggered shift to accommodate inbound calls between 8am – 6:30pm, Monday through Friday

Driving Consistent & Predictable Results Formal On-Boarding Process Dedicated Coach/Trainer Promoting Top Performers from Within Quality Assurance Program Daily & Weekly Reporting Creative Staffing Models Leverage Worklisting Tool Investing in Key Technology Tools for Driving Pre-Service Collections

Recruiting & Retaining Key Talent Hiring efforts focused primarily on pre-registration representatives Formal on-boarding program Dedicated trainer Competitive bonus program Weekly quality assurance reports Financial Clearance vacancies pulled from top performing pre-registration representatives Pre-Registration Rep High Tech Radiology Rep Elective Surgery Rep Urgent Admission Rep Cross-Trained Inpatient/Surgery Rep

Managing Performance Across the PAC Pre-Registration Daily Scorecard

Managing Performance Across the PAC Financial Clearance Daily Scorecard

Daily Reports

Weekly Dashboard Review Standing meeting to review prior week performance Key metrics for all teams Primary focus: Cash collections Call Volume Completion Rates Authorizations Deferral Notifications

Quality Assurance & Customer Service Balance production with quality Robust QA program that evaluates 100% of accounts worked Ability to add new criteria as reporting opportunities are identified Manual review of rep phone calls Appropriate greeting All required questions reviewed Cash collection script followed & attempt made Able to respond to all patient questions appropriately Overall tone of voice and interaction

Creative Staffing Models: Financial Clearance Authorization & Referral Obtainment (5 Reps) High Tech Radiology (7 Reps) 5 Reps cross-trained to cover both functions and float between teams Urgent Admissions (5 Reps) Elective Surgery (9 Reps) 2 Reps cross-trained to cover both functions and float between teams

Creative Staffing Models: Pre-Registration High Tech Imaging Low $ Opportunity High $ Opportunity Elective Surgery

Systems Supporting Our Process Worklist Accounts Eligibility Verification Estimate Liability Medical Necessity Prior Authorization Pre Register Pre-Service Collection Revenue Protect Experian Passport MedAssets CarePricer Craneware Passport eCareNext Cisco Call Queue & Recording ePay Payment Processor

Shared Services Model Scheduling of services Coordinating potential service deferrals Communicating to appropriate resources on site at each facility Transitioning incomplete work to hospital staff

Daily Strategies for Driving Cash Performance Dedicated cash collectors assigned to call on estimated patient responsibilities greater than $500 Assigning new reps only to call on balances under $100 Campaign Hours Competitive in nature – This is a way for Reps to perform at an optimum level Incentivizing Raffling gift cards to boost our collection performance Providing instant gratification to the young professional demographic Constant motivation and reinforcement Encouraging reps to achieve daily goals will ensure quality performance and staff gratification

Cash Collection Scripting Providing a guide to handling all types of interactions with collections Asking “How would you like to ” instead of “Would you like to” has proven to be extremely effective Providing different payment options. (i.e. Payment Plans, Post-dating and Partial Payments) Laminated “hand-holder” guide for all reps to remind of keywords, phrases, and explanations

Challenges We Face An ever-growing list of procedures that require prior authorization. More of a lean on the patient for cost-sharing responsibilities. i.e. Copays, Deductibles and Co-insurances Timeliness of authorization payer reviews, some taking up to 2 weeks. Establishing accountability from all parties: Providers: Ordering exams that are not medically necessary. Payers: Delayed authorization approvals. Patients: Unaware of insurance benefits and their responsibility.