NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.1p.1 craneware.com How University Hospital Reduced Revenue Leakage: Keys to Optimizing Pricing & Charge Capture Brian Patterson Chargemaster Coordinator University Hospital Augusta, GA Laura Gilmour Senior Territory Sales Manager Craneware, Inc. Atlanta, GA

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.2p.2 craneware.com Objectives Outline strategies & factors for modern revenue management processes Realize keys to establish collaboration between clinical, HIM & financial teams for consistent, accurate charge capture across departments Identify revenue leakage gaps in revenue management processes & documentation Define systematic revenue improvement processes & prioritize focus areas for sustained revenue management

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.3p.3 craneware.com Augusta, Georgia 150 miles east of Atlanta 2nd oldest & 2nd largest city (est. 1736) Masters Golf Tournament World’s Largest Ironman 70.3 triathlon Godfather of Soul

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.4p.4 craneware.com Augusta, Georgia 195k+ residents in the city 500k+ residents in metro area 116th largest city in the US University Health Care System

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.5p.5 craneware.com University Hospital - Augusta University Hospital - McDuffie University Home Health University Extended Care Brandon Wilde Retirement Community University Health Link PHO Community clinics & satellite campuses Surgery & Imaging centers University Health Care System

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.6p.6 craneware.com University Health Care System is anchored on its main campus by 581-bed acute care University Hospital. University Hospital

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.7p.7 craneware.com Facts 581 bed not-for-profit 50 bed ED with 76,000+ annual visits 36 OB suites with 3,000+ births annually Serve a 25-county region in GA & SC Programs Cardiac & Vascular Center Oncology Services Breast Health Center Women’s Center Satellite Medical Centers University Hospital

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.8p.8 craneware.com The Finance Headache Denials Lower Reimbursement Rates RACS Incorrect CPT/ICD-9 Bill Errors

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.9p.9 craneware.com Potential for significant revenue leakage exists in complex & manual processes Modern Revenue Management: Transparency Importance to Prevent Revenue Leakage

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.10 craneware.com Identify disconnects causing missed charges & denials Address disconnects by improving processes, documentation & ongoing education Modern Revenue Management: Transparency Importance to Prevent Revenue Leakage

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.11 craneware.com Modern Revenue Management: Pick the right person to lead revenue integrity Clinical background Finance background

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.12 craneware.com Establishing Collaboration & Workflow Shared workflow facilitates communication & accountability

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.13 craneware.com Establishing Collaboration & Training Process review – determine ownership of key functions Validate preliminary reports with root cause analysis Recommend ongoing process improvements

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.14 craneware.com Clinical accountability Preparation Set expectations early & reinforce Tools Huddle Process to report variance In-person meetings CFO & clinical leadership at meeting Collaboration & Training

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.15 craneware.com Clinical departments Subject matter experts with current information Charge or Revenue Champion Documentation Access to software Aware of changes - services & physicians Daily reconciliation Collaboration

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.16 craneware.com Collaboration Clinical teams need to feel ownership Charging is the most successful when you have a partnership between clinical & billing applications Chargemaster Management: Increases productivity Ensures compliance Enhances revenue Reduces errors

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.17 craneware.com Collaboration & Charge Design – CDM Matrix Lessons learned Multiple applications + multiple service lines Clear ownership = “go-to” person

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.18 craneware.com Lessons learned Provider participation Collaboration & Training

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.19 craneware.com Lack of synch & integration between info systems Inefficient operations causing increased labor Missed charges Lack of data transparency & believable data No defensible pricing strategy (reflection of cost, market share & sustainability) Mismatched units of measure purchased/dispensed Inaccurate CPT/HCPCS codes, modifiers, & revenue codes in the chargemaster Physician preference & device vendor pricing Common Causes of Revenue Leakage

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.20 craneware.com CDM Management / Clean-up Why do it? Optimal & compliant reimbursement Mitigate risks as RACs escalate Preparation for projects & partnerships Medical Necessity

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.21 craneware.com CDM Management / Clean-up Why use tools? Automate review of each chargemaster line-item, flag potential problems & organize by priority Receive routine delivery of Web-based updates – regulatory rules & coding logic for your CDM Strengthen accountability for the organization with updates & audit trails Maintain a sustainable business process beyond an individual’s best efforts & experience

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.22 craneware.com CDM Management / Clean-up Why use tools? (cont’d) Demonstrate a defensible system for compliance education across entire charge capture team Assign coding modifiers & benchmark prices against payer’s fee schedules & competitors Reconcile pharmacy & supplies purchases with billing CDM changes can be immediately implemented Increases productivity Speeds up maintenance Immediate optimization Direct communication with the department head New charges easily established

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.23 craneware.com CDM Management / Clean-up Automated CDM maintenance is vital for success Before automation, CDM was maintained using MS Excel Each line-item had to be reviewed individually to ensure accuracy CPT, HCPCS, & revenue codes had to be compared to the corresponding manual Year-end updates were labor intensive Addendum B had to be downloaded & compared to the MS Excel CDM CDM maintenance always took longer than expected & sometimes took a back seat to other issues Lack of maintenance increases compliance risks CDM optimization never happened due to resource limitations Lack of optimization resulted in loss of payments

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.24 craneware.com CDM Management / Clean-up Full pull of Current CDM Mapping of charges based on departments Dollar value of charges based on APC rates Lessons learned Review with department managers Tricky scenarios Pre-consolidation clean-up

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.25 craneware.com $ Results: Automated chargemaster solution quickly optimized CDM Compliance risks reduced by immediate identification Revenue increased & payments enhanced $1.5 million in additional net payments were identified in radiology charges were identified as being priced below the 2006 Medicare APC. CDM Management / Clean-up

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.26 craneware.com CDM Management / Clean-up Is the CDM clean? Few or no items with zero volume Descriptions match AMA short description All CPT/HCPCS are current Rev codes are appropriate for CPT/HCPCS &/or location of service Multipliers are correct No/minimal line items with modifier -59 hard-coded

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.27 craneware.com Pricing Optimization Value Proposition Ensure market competitiveness Verify pricing policy compliance Ongoing review of pricing Routine pricing review is integral to strategic pricing initiatives Quickly identify when cost exceeds charge Compare charges to defined pricing algorithms

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.28 craneware.com Pricing Optimization Start identifying: All charges below fee schedule All charges not within benchmark range for overall CDM & five selected department Inconsistent pricing of same service in the CDM Review when pricing is: Significantly below policy price Below policy price Above policy price Significantly above policy price

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.29 craneware.com Coding Accurate HCPCS code assignment vital to reimbursement Codable analysis Assess if correct HCPCS codes are assigned to currently coded items Assess which items lack a required HCPCS code Revenue Cycle data analysis Bi-weekly graph package review Managed Care Organizations’ negotiations Continually ensure accurate & maximized reimbursement Ensure CMS compliance Proactive Internal Assessments

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.30 craneware.com Creating a Revenue Integrity Program Monthly Data analysis o Coding issues o Pricing issues o Volume reconciliation issues Department process review o Understanding procurement to delivery to charge process Root cause analysis of issues discovered through data analysis o Assignment of ownership of issues o Action plan for resolution with frequent check ins

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.31 craneware.com Compliance - Avoid RAC Medical Necessity LCD’s & NCD’s CMS Edits CPT Code Updates/Flags Catch compliance updates Stay on top of AR & Billing

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.32 craneware.com Summary Define processes for systematic revenue improvement & prioritize focus areas for ongoing revenue management Identify revenue leakage gaps in financial management processes Implement controls & technology into revenue management processes Improving Financial Performance in Revenue Cycle

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.33 craneware.com The Revenue Integrity Survival Guide

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients, & may not be shared with vendors outside of Craneware. p.34 craneware.com Questions & Answers