UCSF Medical Group UCSF Medical Group Revenue Cycle Advisory Committee System Improvement Ideas System Improvement Ideas March 6 th, 2007

Agenda: Committee Overview Specific Projects Next Steps

Committee Scope: The primary scope is system changes, enhancements, new applications or products that will improve the pro-fee revenue cycle, either through improved efficiency or improved collections.

GUIDING PRINCIPLES COMMITTEE COMPOSITION PROCESS Ideas Vendor Presentation Priority List

Ingenix Claims Manager

 Software Product. Works with TES. Reduce denials Increase billing accuracy Shorten claim turnaround

Ingenix Claims Manager Encounter editor Comes packaged with: LCD (Medicare Local Coverage Determination) part B edits- update as they change Annual CPT and ICD-9 revisions Medicare CCI (Correct Coding Initiative) edits-updated quarterly Commercial and government edit templates for user defined edits

What we feel Ingenix will bring us Cleaner claims Efficiency tool Revenue cycle shorter Reduce denials Reduce re-work=efficiency on the backend Less paper-DRQ o Reduce opportunity for accounts “falling off radar” o Reduce billing lag

What we feel Ingenix will bring us More Compliant Billing New vs. established edits using claim history Unbundling edits Increased Patient Satisfaction Resolution of potential denials prior to billing will reduce patient inquires Increase Revenue Missing charge edits o Supply billed without service o Primary service not billed-add on service billed

ROI COST: One Time: $90K Ongoing: $145K to $167K / Year RETURN: Est. $700K Year One

E-Commerce Enhancement Existing IDX Feature Eligibility Inquiry with Payor Improve Functionality: Payors? Data? Work Files for Exceptions Expand User Base

ROI COST: One Time: $75K RETURN: $29K per Year (conservative)

Visit Management Enhancement Existing IDX Application Pre-Arrival and Arrival Alerts Copy of Insurance Card NPP/ TACOS Past Due Balances Alerts on IDX vs. ONTRAC

ROI COST: One Time: $75K RETURN: Full Extent not Known DOM Estimate $150K / Year

Rejection Subsystem Existing IDX Module Improve Functionality: Rejections in Workfiles Sooner “Action Codes”: FSC Transfer Better Reporting

ROI COST: One Time: $35K RETURN: One Time: $348K

EOB Resolve Payment Accuracy System Features Actual vs. Expected “Appeals” Letters/ Files Uses EDI Data EOB Image Reporting

ROI COST: One Time: $10K Ongoing: $28K / Year RETURN: First Year: $592K

Enterprise Task Manager (ETM) (ETM)

Description ETM is a tool designed to improve workflow in the GE/IDX Centricity products. Uses workflow automation and role-based portals to drive revenue management processes through an accelerated and more efficient revenue cycle. Provides an interface allowing users to go to the correct place to work

Why ETM?  Decentralized revenue cycle structure with “partially” centralized business office  Access unit, ONTRAC  Focus on front-end  Navigation ease in GE/IDX modules  Eliminate Paper based processes

Benefits Assign tasks to specific users Increase task completion efficiency Improve staff production, quality and accuracy Potential to reduce staff expenses Minimizes training time Optimize revenue cycle throughput Create best practice workflows Potential to replace ONTRAC

Project Plan Multi Year Split Financial Responsibility COST: Year One: $40K RETURN: TBD

Next Steps Board Approval Coordination with Purchasing Implementation Planning General Time Lines

SUMMARY Project Funding Request SUMMARY Project Funding Request ONE TIME ONGOING Ingenix Claims Manager$90K $145 to $167K Visit Management$75K 0 E-Commerce$75K 0 Rejection Subsystem$35K 0 EOB Resolve$10K $28K ETM$40K TBD TOTAL $325K $195K