1. Creating a Physician Shared Services Strategy (B06) Kevin McAndrews and Roy Axelson St. Vincent Health, Indianapolis, Indiana October 30, 2012 Partnering to Achieve Revenue Cycle Excellence Partnering to Achieve Revenue Cycle Excellence

2. Ascension Health Revenue Cycle 1. Who we are 2. SVH Revenue Cycle Structure 4. Process Integration 3. Shared Service Model 5. Results Agenda 2

3. Ascension Health Revenue Cycle Who We Are Ascension Health: Largest not-for-profit health system in the country 81 Hospitals (in 21 states and D.C.) and 1,400 health facilities 4,000 Employed Providers 30,000 Affiliated Providers $16B Annual Net Revenue St. Vincent Health: One of 37 Ministries within Ascension Health 20 Hospitals 1,000 Employed Providers $3B Annual Net Revenue Kevin McAndrews: System Executive Director, Revenue Cycle Operations at SVH Roy Axelson: System Director, Physician Revenue Cycle Operations and I.T. Support at SVH 3

4. Ascension Health Revenue Cycle Ascension Health 4

5. Revenue Cycle St. Vincent Health 5 St. Mary’s Warrick Hospital St. Mary’s Medical Center

6. Ascension Health Revenue Cycle SVH Revenue Cycle Strategic Partnership 6 Exceptional Compliance Excellent PeopleRevenue EnhancementCost-to-CollectPerformanceVendor Management & Technology Strategy Patient Experience

7. Ascension Health Revenue Cycle SVH Mission Statement St. Vincent Health Physician Revenue Cycle is committed to transforming the business of healthcare by generating significant, sustainable results. Our strength is our people who are relationship-centered and outcomes-focused. We are dedicated to optimizing our ministry partners’ operating income while improving patient, physician and associate satisfaction. 7

8. Ascension Health Revenue Cycle SVH Vision Statement 8 St. Vincent Health Physician Revenue Cycle will apply our collective expertise and scale to provide unprecedented value for our ministry partners. We offer a comprehensive suite of capabilities addressing all aspects of the revenue cycle in a unique, customizable service offering. We are committed to: –Healing our patients financially as well as clinically –Respect, trust and supporting each other –Operating with honesty, integrity and fairness –Passionately pursuing innovative and practical solutions

9. Ascension Health Revenue Cycle SVH Revenue Cycle Structure People Single Shared Services Center located in Indianapolis with 1,100 FTEs Seasoned senior leadership with proven success in varied and dynamic revenue cycle settings Technology Siemens, Invision and Soarian reference site for hospital GE Centricity Business Practice Management reference site for clinic Hospital EMR Eclipsys (now AllScripts) Clinic EMR AllScripts SVH Key Performance Indicators Net Days = 40 AR > 90 days 14% Hospital cost to collect < 4% Clinic cost to collect < 6% 9

10. Ascension Health Revenue Cycle Guiding Principles and Outcomes Mission & Values: Keep our mission and values at the forefront of all decisions and actions Local Ministry Respect & Transparency: Open communication throughout the design and implementation process Service: Optimize customer service by simplifying processes and minimizing handoffs Stewardship: Optimize resources by increasing revenue and reducing the cost of doing business Adaptability & Scalability: Future state structure should be adaptable to accommodate future growth, strategy and innovation Efficiency: Breakdown silos and streamline structures and processes to enable timely and actionable business practices in a cost effective manner Compliance: Increase compliance; anticipate and mitigate risk Standardization: Structure for consistency in order to enable cost reduction and risk mitigation 10 Mission & Values Adaptability & Scalability Local Ministry Respect & Transparency Stewardship Compliance Service Efficiency Standardization St. Vincent Health RCO

11. Ascension Health Revenue Cycle Hospital & Physician Shared Service Model 11 Commingled Collocated  Customer Service  Uncompensated Care (i.e., Bad Debt vs. Charity Determination  Financial Counseling  Common Statement Format and Vendor  Managed Care Contracting  Education & Process Improvement  Scheduling & Pre-Registration  Financial Clearance  Coding/Charge Entry  Billing & A/R Follow-Up  Payment Posting  Information System Support

12. Ascension Health Revenue Cycle The Traditional Revenue Cycle Model The Traditional Revenue Cycle model places a strong emphasis on “Post-Service” processing. 12 Post-Service Day of Service Pre-Service Scheduling Comprehensive registration Limited Financial Counseling Charge capture Charge reconciliation Medical Records completion Claim scrubbing edit resolution and claim submission Follow-up, transaction posting

13. Ascension Health Revenue Cycle The Progressive Revenue Cycle Model The Progressive Revenue Cycle model focuses on up-front activities, pre-service activities to secure accounts and move to a more transactional post-service environment. 13 Scheduling Demographic, financial and clinical data capture Insurance eligibility/benefit verification Authorization & referral management Patient financial education and counseling Patient liability management Arrival account activation Coding Charge entry edits Charge capture Billing Transaction posting Pre-Service Day of Service Post-Service

14. Ascension Health Revenue Cycle SVH Physician Business Services 180,000 encounters 120,000 arrived appointments $50M in charges; $20M in payments 90,000 statements Billing for over 1000 providers 1500+ active users (800+ simultaneous) 250% increase in original claims/FTE since conversion to GE Centricity Business 14 Monthly Volumes

15. Ascension Health Revenue Cycle Process Integration Practice Liaisons Main point of contact Every practice or department has an assigned Liaison Responsible for implementation and ongoing support Process Improvement Edit review Financial Analysis Pre-Bill Edits Demographic Insurance Coding including integrated Ingenix Claims Manager Edits are worked by the appropriate area 15

16. Ascension Health Revenue Cycle Process Integration (continued) Consolidated eligibility verification Pre-Appointment Charge Entry Automation of corrections (working only exceptions) Enterprise Task Manager Real time work lists to the appropriate staff members Productivity tracking Ability to send tasks and track outcomes electronically Best Practice Workflows 16

17. Ascension Health Revenue Cycle Monthly Original Claims per FTE including Business Office and Application Support 17

18. Ascension Health Revenue Cycle Physician Business Services Cost to Collect 18

19. Ascension Health Revenue Cycle Gross Days in A/R 19

20. Ascension Health Revenue Cycle Questions & Discussion Thank you! 20