Methodist Hospitals Revenue Cycle Process Improvement Jacqueline Hoekema, B.S. R.T. (R) August 10, 2015

Overview Of Methodist Hospitals  Two campus Healthcare System located in Gary & Merrillville, Indiana o Safety Net campus in Gary – Receives Disproportionate Share Funds  630 Inpatient beds  589 Physicians, 2,457 Employees, 150 volunteers  Level 3 Trauma Center Highlights for 2014 Ended 2014 with a strong 198 days cash on hand Increased Total Revenue 8% compared to 2013 Amount available for capital re-investment = $26M Ended 2014 with a strong 198 days cash on hand VBP performance in 2014 exceeded both state and national averages earning Methodist a bonus of $200K Invested $14.8M in state of the art new technology Committed to community health through significant contributions totaling over $90M o Unpaid Medicare - $15.6M o Charity Care - $60.5M o Physician and Community Services - $15.2M

Overview of Methodist Hospitals  Quality Awards include: o Chest Pain Center Accreditation by SCPC o Primary Stroke Certification by HFAP o Gold Plus Performance Achievement Award for Stroke by ASA o Breast Imaging Center of Excellence by ACR o National Accreditation Program for Breast Centers by ACS o Commission on Cancer Outstanding Achievement Award 2014 o Diabetes Center of Excellence by ADA o Chicago Tribune’s Top 100 Workplaces by staff o Post Tribune Neighbors Choice Award by residents in Lake County

Site Supervisor Peter Melcher Methodist Hospitals, Director of Revenue Cycle Palos Community Hospital, Director Managed Care Blue Cross Blue Shield, Network Development Consultant Rush Prudential Health Plans, Provider Relations Administrator  Loyola University of Chicago, Chicago, IL, B.B.A. in Finance, graduated Magna Cum Laude  DePaul University College of Law, Chicago, IL, J.D.

Practicum Overview  Improve current Revenue Cycle Process to decrease:  ACA impact on Reimbursement for Methodist Hospital  Insurance Denials and Write-offs  Under-billing in Cardiology  RAC audits

Practicum Objectives 1.Decrease First Pass Internal Edits by 50% 2.Decrease Write-Offs 3.Decrease Coding/Billing Errors 4.Increase Procedural Documentation Consistency 5.Decrease RAC Audits 6.Increase Operating Margin 7.Increase Net Revenue

Current Status of Practicum COMPLETED...( 212 hours ) Objectives met: 1.Decrease First Pass Internal Edits by 50%- Improved own time management skills and committed 1 hour per day to review workqueues. Proposed new position titled CV Revenue Specialist to decrease initial charging errors 2.Decrease Write-Offs – Attend weekly Revenue Cycle meetings in which rapports are built and relations established with billing personnel. Decreased WQ automation and increased communication regarding accounts. Educated physician office staff to ensure accurate pre-authorization prior to procedure. 3.Decrease Coding/Billing Errors – Educated billing office staff, Cardiology procedural staff responsible for charging, and physician office staff on accuracy and appropriateness of charging, while offering my expertise as a resource.

COMPLETED... Objectives met: 4. Increase Procedural Documentation Consistency – Educated staff and physicians on importance of consistent, thorough documentation and its potential negative impact on reimbursement if performed incorrectly. Continue random chart audits for assurance of compliance. 5.Decrease RAC Audits – Upon investigation, there have been no RAC audits during this 10 week period. However, I cannot confirm the absence of audits is due to this project. 6. Increase Operating Margin – Will continue to monitor and evaluate new processes for positive impact on operating margin. Too soon to tell if any impact has been made thus far. 7.Increase Net Revenue – Will continue to monitor and evaluate new processes for positive impact on operating margin. Too soon to tell if any impact has been made thus far. Awaiting July 2015 financial statements. Current Status of Practicum

Lessons Learned  The faster I can review accounts placed in my workqueue, the faster the accounts can be billed. If I delay, the accounts are delayed and timely reimbursement suffers. I have definitely improved my time management skills, making WQ review a top daily priority.  Make it personal! Meeting the billing and physician office staff, in person, gives a personal touch to the subject of Revenue Cycle, by establishing relationships, rapport, and trust. They are more likely to pick up the phone and ask a question rather than just guessing.  Constant communication and education is the key to success.  Offering my expertise as a resource has been rewarding. This project has helped me see the value I bring to Methodist Hospitals.

Thank you!