Focusing an Organization on Financial Success 2015 Mollie Drake MBA, CPAM Senior Director, Corporate Access Management

2 Today’s Agenda  About Scripps  Revenue Cycle Functions  A Focus on Measures  A Focus on Structure  A Focus on Training  Outcomes

3 About Scripps  5 Hospitals on 4 Campuses located in San Diego  Not for Profit  More than 2600 Affiliated Physicians  Two Level I Trauma Centers  Extensive Ambulatory Care Network

4 Revenue Cycle Functions  Scheduling / Access Management  Case Management  Charge Description Master  Outpatient Revenue Management  Health Information – Chart Management and Coding  Billing and Follow Up  Transactions / EDI  Self Pay Collections / Customer Service  Underpayment Audit and Collections

5 What’s Measured  Cash Collections  POS Collections  DNFB – Bill Edits  DNFB – User Holds  AR Days  Credit Balances  AR Over 90 Days  Bad Debt Write-offs  Bad Debt Recoveries  Charity Write-offs  Gross Revenue  Aged Accounts by Payer  Cash as % of Charges  Charge Errors  Contractual Adjustments  Underpayment Collections  Saved / Avoidable Days  Medicare / Sr. HMO LOS  Third Party Liens  Interest Collections  Appeals  Denials  IME Payments  Late Charges  RAC Audits  One Day Stays  Pre-admit Percentage  Unapplied Cash

6 The Reports  Daily l Cash Collections  Semi-Weekly l Cash Collections l Adjustments l AR Balances l AR Days l Average Daily Cash l Average Daily Revenue l Average Daily Adjustments  Monthly l Revenue Cycle Summary l PI Initiatives l Revenue Management

7 The Structure  Targets Set l System Goals l Individual Hospital Goals  Systemwide Steering Committee l Meets Weekly l Reviews Key Measures l Reports on Current Initiatives l Policy Review and Approval  Hospital Committees l Meet Bi-Weekly l Review Key Measures l Report on Current Initiatives l Identify Obstacles to Discharge Accountability established at all levels for all goals.

8 The Structure EVP/CFO VP, Revenue Cycle Revenue Cycle Steering Committee: PFS, Access, Case Mgt, HIM, Revenue Mgt, Payer Relations, Contracting, Audit & Compliance, Finance, Accounting, Information Systems Revenue Cycle Steering Committee: PFS, Access, Case Mgt, HIM, Revenue Mgt, Payer Relations, Contracting, Audit & Compliance, Finance, Accounting, Information Systems Mercy San Diego Mercy Chula Vista Mercy San Diego Mercy Chula Vista Encinitas La Jolla Home Health La Jolla Home Health Green Bi-Weekly Facility Subcommittees: Scripps Health Board of Trustees Scripps Health Board of Trustees CEO

9 Reality The Plan Measures Structure Goals Leaders The Team High School Education Trained on the Job Role Specific Front End/Back End Conflict

10 The Gap How to bridge the gap?

11 The Training A three level structured training program l Over 70 courses l Front End to Back End l Consistent Information l Focused Delivery l Dedicated Resources l Advancement Opportunity

12 The First Tier Level I – Core Competencies l 23 Courses l All Revenue Cycle Line Staff l Concepts and Mechanics l Professional and Technical l Fundamental Understanding

13 Level I Courses Billing Terminology Commercial Carriers Customer Service Effective Communication HMO 101 Hospital Billing Overview Insurance Follow Up Introduction to Capitation Introduction to Medi-Cal Patient Accounting Patient Confidentiality Patient Registration Point of Service Collections PPO Plans Regulatory Bodies Senior HMO Coverage Telephone Skills Tri-Care and You Understanding COB and TPL Understanding CMS Welcome to Medicare Workers’ Compensation

14 Boot Camp  9 day program  Comprehensive workbook  Lecture, exercises, role playing  Hands on system practice  Secret shopper  Tour of CBO  Pre-test

15 Core Competency Test  203 Questions l 75 True/False l 75 Multiple Choice l 50 Fill-in The Blank l 3 Insurance Cards  16 Subjects  Passing Score 80% Failure = Loss of Position

16 Level II  Advanced Training  25 Courses  Builds on Core Competencies  Patient Accounting Certification Apply the knowledge and get the promotion!

17 Level II Courses Assigning Liens Business Correspondence Collection Techniques Conducting an Inservice Conflict Resolution Dealing with Difficult People Disproportionate Share Effective Communications Allscripts Reports Follow Up Queues Health Information Overview Medical Terminology Medicare Compliance Medicare Cost Report Patient Confidentiality Payer Contracts Risk Pools Scheduling System Secondary Systems Self Pay Negotiations System Troubleshooting Unbilled Accounts Understanding the ChargeMaster Utilization Review

18 Moving to Level II Complete a Project l Submit the work l Blinded application l Peer review l Follow up review l Promoted once approved Pass the CRCS l Pay in advance l Preparation courses l Reimbursed once passed l Certificate presented

19 Sample Projects  Break Schedule  Disaster Preparedness  Gastric Bypass  Misdirected Checks  Procedure Manuals  Resource Books  Automating Scheduling  Correct Posting Codes  Reimbursement Calculators  Letter Library  POS Collections  Physician Outreach  Insurance Directory

20 Keeping Level II  One Inservice  One Teambuilding Exercise  Less Supervisory Assistance  Assigned Complex Problems  Mentor to New Employees

21 Level III  27 Courses  Builds Professional Skills  Develops Computer Skills Lead a Performance Improvement Project

22 Level III Courses Case Management Cost/Benefit Analysis Customer Service Allscripts Reports II Effective Presentations Ethics in Business Graphing Statistics Leading an Effective Meeting Medical Terminology Medicare Compliance Microsoft Excel; 1,2,3 Microsoft PowerPoint; 1,2,3 Microsoft Word; 1,2,3 Motivational Skills Patient Confidentiality Process Mapping Project Management Revenue Management Technical Writing Time Management Skills

23 Moving to Level III  Propose a Performance Improvement Project  Management Team Approves  Mentor Assigned  Present Final to Management Team  Management Team Evaluates  Promotion upon Approval

24 Sample Projects  Cash Pricing  Blue Cross Prefixes  AR over 90  Boutique Program Guide  Service Line Standardization  Medi-Cal Billing Manual  Interest Calculation and Collection  Front End Work Queues  Maternity Collections

25 Keeping Level III  Represent Department on Committees  Develop / Update Policies and Procedures  Problem Resolution  Mentor to Level II

26 Outcomes  Staff Interaction  Cross Training  Conflict Replaced with Compassion  Role Recognition  Bench Strength  Joint Commission Compliance

27 The Results

28 The Results Reduced monthly average from 74.4 to 70.8 days

29 The Results

30 The Results

31 Last Thoughts  “Knowledge is power.” -- Francis Bacon  “Success in business requires training and discipline and hard work.” --David Rockefeller

32 Questions

33 Fun With Training