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2. UC Irvine and Centricity™ Business Eligibility Optimization Going at risk to share in the gain!

3. ©2015 General Electric Company – All rights reserved. The results expressed in this document may not be applicable to a particular site or installation and individual results may vary. This document and its contents are provided to you for informational purposes only and do not constitute a representation, warranty or performance guarantee. GE disclaims liability for any loss, which may arise from reliance on or use of information, contained in this document. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE. DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GE’S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE. GE, the GE Monogram, Centricity, and imagination at work are trademarks of General Electric Company. All other product names and logos are trademarks or registered trademarks of their respective companies. General Electric Company, by and through its GE Healthcare division. 3

4. Introductions Elizabeth Burrows IT Director, Physicians Billing Group, UC Irvine Health Jamie Stallwood Systems Registration & Support Supervisor, UC Irvine Health Simone Arms Optimization Solutions Consulting Manager, Centricity Business 4

5. What is there to Gain? 5

6. Key Performance Indicators for Eligibility Optimization 6

7. Opportunity December 2013 – 3 month average Utilization – 42%Target 85% Verification – 62%Target 85% Automation – 0%Target 85%Active Response Automation – 0%Target 50%Enterprise Denials $$ - 3%Target 1% Denials by count – 3.5%Target 1% 7

8. The UC Irvine Perspective 8

9. About UC Irvine Health UC Irvine Medical Center has ranked among the nation’s best hospitals for the past 14 years and is home to more than 800 specialty and primary care physicians. We have 1 of only 41 nationally designated comprehensive cancer centers, a level I trauma center and a level II pediatric trauma center. We have about 45 various outpatient clinics 9

10. Physicians Billing Group (PBG) Bills for 90% of UCI physician services CB v5.1, 28 active BAR groups (3 non-PBG) AVM, TES, BAR, ETM, Reporter, Informatics Medical Center uses Allscripts on front end ADT interface GE plans kept in sync with Allscripts 10

11. Centralized Registration Unit 8 FT representatives Hold Bills, TES edits, BAR claim edits across groups, across visits Eligibility related hold bills Approx 2000 open items on daily basis Manual registration for outside facilities Part-way thru project PBG took on 2 large departments, no increase in staff 11

12. Key Business Drivers GE eligibility not up to date Desire to improve what and how we were checking eligibility PBG taking on additional business with no increase in Reg staff needed better workflow needed visibility into what/how users were working Enterprise-wide goal of reducing front end-related denials 12

13. Project Outline 13

14. Project Team GE Optimization Team: Functional Resources/Project Management - 2 Engineering Resources – 2 UC Irvine Team: Leadership – Elizabeth and Jamie Billing Analysts – 3 Members of the Registration team IT Staff – 2 Analysts 14

15. Project Plan and Timeline May – Kick-off Call, KPI Review to set our baseline June - On-site – Week long Overview, Design, Build June / July – Testing August – Phase I / Phase II – Live events September onward – Tweaking and ongoing KPI reviews 15

16. Technology and Workflow Changes Increase Electronic Payer Mix Specific results screens by Payer Automation – Auto file Active results and FSC/Plan follow up Needs Review Logic – to support work by exception Hold Bills/VM Alerts – to help manage the Eligibility Work TES Edit Integration – Complete work before billing Self Pay screening – Active Medicaid? New ETM Workflows to manage eligibility and hold bills Claim logic changes and claim edits 16

17. Increasing Electronic Utilization – Electronic Payer Mix 17 Utilization Rate: Measure of the % of visits could have an electronic eligibility check because an electronic connection is available. June 2014 – CIRV Utilization Rate 42% 50,214 visits - 21,150 had FSC’s with an electronic connection. December 2014 CIRV Utilization Rate 85% 50,016 Visits - 42,573 had FSC’s with an electronic connection.

18. Needs Review – Work by exception Needs Review Evaluates result data to identify exception situations Notifies the user and provides specific messaging around scenario Payer reports other primary payer review and adjust FSC’s accordingly Medicare Part A only Medicare Part B only Conflict with subscriber reported – verify name, DOB, relationship with data on file Unworked NR can trigger alert, Hold Bill, TES or claim edit 18

19. Results Screen: Medicare, Medicaid, Commercial Info on left is from registration/IMS, right from the payer

20. Automation Automatically file variant information into Eligibility Variance FSC Follow up questions to allow for use of that information on claims: You send “Smith, Joseph” - Payer sends “Smith, Joseph Michael” Variant name auto files to be used on claims and future eligibility requests, but demographic name stays as supplied by the patient. No human intervention required – no need to work these responses even with variance Automatically manage Mixed Responses Rules defined on data to look for when Mixed is received, what situations do you want to show something Besides “Active”, otherwise seen as Active and Auto Filed. 20

21. TES Integration Edits delivered to hold Charges with Eligibility Unworked, NR Unworked, Eligibility Hold Bills on the Visit, Self pay with an Active Eligibility Response DBMS GERD’s - Queries to scan incoming charges without an Eligibility Request and then Process the request, Self pay Scan for Active Eligibility, Charges without Visit attached 21

22. Managing the Work- To positively affect eligibility denials Needs Review tracks the Exceptions Hold Bills/Alerts – Worklists to work NR, Inactive, Rejected –Hold Bill Work-list –Alerts Manager –ETM Worklists TES Edits – stops what hasn’t been worked before charge is released Claim edits – last stop to capture released unworked charges before they are submitted 22

23. Workflow and Process Improvement Gains Actually using GE eligibility checking as opposed to website Immediate gains in terms of what was being checked without intervention Uniform process and instructions for users on how to work ETM workflows provide increased visibility into what the user is doing, how much they are doing Exception-based workflow, more specific logic 23

24. Challenges and Lessons Learned Main challenge was volume – increase in FSC’s being checked resulted in huge increase in hold bills/edits 2000 vs 20,000 (plans 1, 2 and 3) Business Growth – now responsible for additional departments Needs Review - must define what really needs to be reviewed as opposed to what would be nice to review TES edits based on Hold Bills – impacted charge lag days 24

25. Challenges and Lessons Learned continued Working Hold Bills – started with Alerts Manager, moved to ETM Volume testing in test environment – visits, charges Change in overall approach – team struggled 25

26. Recognizing The Gains 26

27. Before and After 27 Baseline - 2013 Utilization – 42% Verification – 62% Automation (Active) – 0% Automation (Enterprise) – 0% Denials $$ - 3% Denials Count – 3.5% Current State - 2015 Utilization – 85% Verification – 98% Automation (Active) – 71% Automation (Enterprise) – 63% Denials $$ - 2.79% Denials Count – 3.7%

28. Time Recovery Opportunity due to Automation 28 June – 16,217 requests Needed to work them all. December 51, 453 requests 13,145 that need to work – 38,308 Active /Auto Processing almost 3 X the volume with same FTE count – would not be possible without automation.

29. Denials Analysis 29

30. Denials Analysis Tools to review what staff is working and how - Manage the change! Monthly we review all KPI’s including Denials Scenario (denial codes), division & Billing Area, payer and scenario Determine where based on highest volume we want to focus Start looking at individual invoices that have particular scenario etc. Focused denial workouts get to root cause to reduce future denials 30

31. Contact information Optimization Solutions: Centricity.Business@ge.com Simone Arms: simone.arms@ge.com 31

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