2015 Congress Handouts

Prepared for the Foundation of the American College of Healthcare Executives

Session 25AB Bringing Revenue Cycle Into The 21st

Century

Presented by: Michael G. Brokloff, FACHE Caludia E. Crist, RN, FACHE

1

Bringing Revenue Cycle into the 21st Century

Course 25A,B

Mike Brokloff, FACHEClaudia Crist, RN, FACHE

Learning Objectives• Describe the business, cultural and patient cases

supporting the transformation to a shared services organization.

• Discuss the steps necessary to transform your organization to a shared services model: • Service level agreements• Service catalogs• Operating metrics

2

2

Presenter Bios

3

Michael Brokloff, MBA, FACHE joined Sutter Health in February of 2013 as part of the startup of its Shared Services Center in Roseville CA. As the Service and Performance Management Leader he directs the internal operations of the center including: metrics analysis and reporting, process improvement (Lean), business deployment and project management.

After serving in the US Navy, Mike joined GE as a Field Engineer and held positions in operations, sales and marketing leadership until leaving in 2001 for a startup opportunity.In 2004 Mike joined Philips Medical Systems / Dunlee as the Director of Glassware Solutions where he developed and launched a program that quickly grew for account for 1/3 of Dunlee’scommercial revenue. He later Joined DMS Health Group as their VP of Service, then returned to GE as a Director of Service in Northern California. He joined Sutter Shared Services in February of 2013.

Mike has an AS from the University of the State of New York, a BS from Brigham Young University, and an MBA from California State Polytechnic University. He is a Fellow in the American College of Healthcare Executives and on the board of the California Association of Healthcare Leaders.

Presenter Bios

4

Claudia Crist, RN, MHA, FACHE worked for Sutter Health from 2000 until her appointment in January 2015, to Deputy Director of Health Care Delivery Systems with the California Department of Health Care Services. At Sutter Health, she most recently served as Revenue Cycle Process Leader for Sutter Shared Services in Roseville, Sacramento.

Prior to her role in Revenue Cycle, Ms. Crist served as Assistant Administrator at Sutter Medical Center, Sacramento, a 600+ bed acute care hospital (2008-2013). Additional work experience and background include Leadership Training and Development, Internal Audit, Nursing (critical care, emergency, corrections), as well as Physician Assistant (Germany). Ms. Crist also served as lecturer for "U.S. Healthcare Delivery Systems" at the California State University Chico (2013-2014).

Ms. Crist earned her MHA from the University of Southern California, her BS in Health Care Administration from Bellevue University, and her BSN Degree from College of the Canyons. She is an alumna of the Sutter Health Leadership Academy and a Fellow of the American College of Healthcare Executives.

3

Agenda• Shared Services Model

• Change Levers

• Transformation Journey - Business Case

• Governance / Accountability

• Cultural Transformation

• Leadership Lesson Learned

• Q&A

5

A Bit About Sutter Health

6

• 5,000 physicians (physician medical foundation model; plus 4 IPAs); aligned under the Sutter Medical Network

• 24 acute care hospitals

• Approximately 48,000 employees

• $9.6 billion in revenues (2013)

• Home health and hospice services throughout Northern Calif.

• Outpatient surgery and specialty care centers

• Medical research and medical education/training

• 24 fundraising organizations

Serving more than 100 communities with:

6

4

What exactly is a Shared Services Organization?

• Not Centralization

• Not Outsourcing

• Business model that leverages resources across the organization to lower costs and drive standardization while meeting agreed upon Service Level Agreements.

• Integrated service model with:

– Client Governance

– Service Level Agreements

– Charge for services performed

7

Why a Shared Services Organization?

• In Recent Poll of Peeriosity Members, 61% of respondents indicated that cost savings, or productivity improvement was their primary reason for determining if a service should be a shared service

• Their #2 reason was to standardize their processes across their enterprise

8

5

Benefits of Shared Services

• Lower costs through standardization, productivity enhancements and economies of scale

• Standardizing on best practices across the organization

• Common patient / employee / vendor / clinician experience

• Service Level Agreements that clearly define service delivery standards

• Allows leadership to focus on patients and operating priorities because shared services are performed consistently

• Standardized systems and processes allow for meaningful metrics

9

Why Sutter Went With Shared Services

10

“It is our obligation to ensure all costs are the lowest they can be to prevent reduction or

elimination of essential services and programs in our communities.”

Sutter Health Senior Leadership

10

6

Video #1

11

Payment Restraint ACO’s implementationValue Based Purchasing Readmission penalties

Insurance Market Changes More High Deductible Health Plans

Access to Care ACA Health Insurance Exchanges Medicaid expansion

Employer Mandate Defined Employer Contributions

Payment Reform Bundled payments

Shifting Risks – Cost Mandates

2010

2020 +

12

7

Keys to Success

• Understanding that the current model is un-sustainable

• Executive Leadership and Sponsorship

• Well defined stakeholder governance (roles & responsibilities)

• Key Performance Metrics: agreed upon definitions and baseline

• A service mindset: from the back-room to the front-room

• Openness to change: “Not invented here”, embracing best practices

• A commitment to continuous improvement

13

Sutter Shared Services (S3)

14

Revenue Cycle

Human Resources

Supply Chain Finance

Credentials Verification eQuip

Performance Management

8

15

Project TimelineSutter Board approves project

Sutter Announces S3 – RosevilleS3 opens it’s doors

East Bay RCValley Biomed

Alta Bates RC

Sac FinanceValley RC

East Bay / PeninsulaBiomed

Peninsula RC Sutter CVSystem Supply Chain

Various PayrollVarious FinanceVarious HR

Sac RC 1

Sac RC 2

SurgeryCenter Acquisitions

Scheduling 35 New centers

Original Plan Complete

Video 3 r1

9

Video #4

18

10

Change Levers

19

BUSINESS PROCESS RE-ENGINEERING

Reduce, Simplify, Eliminate

SPEND MANAGEMNT

Strategic Sourcing, Facilities Spend

Optimization

ECONOMIES OF SKILL AND SCALE

Centers Of Expertise, Shared Services,

Outsourcing

TECHNOLOGY ENABLEMENT

Automation, IS Infrastructure/Systems Optimization

PERFORMANCE CULTURE

Accountability, Transparency and Measurability

Video 2 r1

11

21

1. Increased effectiveness/efficiency, reduced workforce

2. Different work force structure, elimination of duplicate efforts, favorable labor arbitrage, revised union contracts

3. Increase in “managed spend”, consolidated vendor contracts, reduced category options

4. Consolidated IT infrastructure, rationalized application portfolio, retired systems

5. Clear accountability, performance based rewards, control over services vs. workforce, no opt out solutions

Results from Using Performance Levers

21

Revenue CycleScheduling

Verification/Authorization

Financial Counseling/

POS Collection

Revenue Capture

Case Management

Coding

Health Information

Management

Billing/Follow Up

DenialsPre-

Admission

Customer Service

22

12

Revenue Cycle Business Case

23

Opportunity Types

Cost reduction

Net revenue improvement

One-time cash improvement

Business Case - Patient Access Services

24

Project

Annual Net Benefit

($M) Description of Business CaseAvoidable Write-off Improvement

$ 48 Reduce preventable insurance write-offs to improve net revenue capture.

Patient Liability Collection

$ 42 Increased patient liability collections / reduced bad debt

13

Shared Services Patient Access Center (Pre-Service)

Point of Service(at or near service)

Financial Clearance

Financial Counseling

Scheduled Services

Current State Future StateKey Gaps

One-stop registration for patients

Streamlined registration and validation processes

service / time of Varying pre-service / time of service patient experiences across entities

Limited self-service options for scheduling, pre-service processing, and check-in

Duplicate requests for patient data within and across entities

Workflow not always automated

Limited up front patient liability estimation, communication and collection

Multiple entry / exit points with some intake areas not reporting directly to Patient Access

Sac Sierra

Regional Contact Center

Patient Access Initiative

Multiple Access Points

PCR CVR

East Bay West Bay

Regional Contact Center

Entity-based Financial Clearance

Entity-based Financial Clearance

Multiple Access Points

Multiple Access Points

Entity-based Financial Clearance

Multiple Access Points

Multiple Access Points

25

Operating Model Patient Access Center

26

Sutter Health – Patient Access Center

Financial ClearancePrimarily outbound callsAccount level management

Functions Include:

Financial ClearancePrimarily outbound callsAccount level management

Functions Include:

Pre-registration Completion Insurance Verification ABN / Medical Necessity Pre-certification / Authorization (initial)

Referral Management Patient Liability Estimation /

Notification / Collection Initiate Assessment of Financial

Counseling

Worklist and referral-driven work

Patient Access Center

Functions Included: Evaluation of assistance eligibility Assistance Applications /

Insurance Enrollment Self Pay Collections Payment Plan Options Low Interest Loans

On-site Financial

Counselors

Affiliate-based

services

Rea

l Tim

e R

efer

ral

Financial Counseling

Revenue Management Data Warehouse and Decision Support

Customer Excellence

Financial Clearance Worklist•Scheduled Accounts

• Unscheduled Admissions

Standardized P&P Standardized Technology Enablers Standardized QA and Training Standardized Metrics

Patient Access Clinical Resource

Assist with Medical Necessity, Authorizations and Level of Care Pre-Service, Liaison with Physician Office

Worklist-driven; exception-based work

26

14

Business Case - Charge Capture / Charge Description Master

27

Project Benefit Type

Annual Net Benefit

($M) Charge Capture Net Revenue

Improvement$ 17

Description of Business CaseAccuracy of charges captured and/or reimbursement associated with charges through enterprise-wide approach to coordinate, deploy and audit charge capture & reconciliation activities and CDM management.

Charge Capture and Charge Description Master Management

Current State

Enterprise level CDM with inconsistent regional charge master management

Future StateKey Gaps

• Multiple CDM items with same CPT Code

• Inconsistent data and charging

• Lack of standardization in charge master management across regions and affiliates

• Significant percentage of manual charge entry

• Potential for errors or missed charges

• High volume of paper orders from external providers

• Lack of specialized skills / knowledge Enterprise level CDM with standardized

charge master management

Charge capture accountability widely distributed and managed

inconsistently, driving compliance riskShared services support of charge

capture with joint accountability between department / practice and enterprise

Dedicated resources with appropriate skill level to support departments with

consistent and compliant CDM and charge capture activities

Charge Capture/CDM Initiative - Operating Model Migration

28

15

Operating Model - Charge Capture/CDMSutter Health Enterprise Standards

Charge Capture / CDM Shared Services

Level 2 –Shared responsibility to confirm accurate and complete charge capture for each encounter

Level 3 – High level monitoring of daily revenue to identify and manage anomalies

Provider Documentation

Charges

Codes

Charge Capture Audit Charge Capture Recovery (in

coordination with Disputed Claims/PFS)

Regulatory and Compliance Readiness

Local / Department / Practice

CDM Standardization

Charge Master Management

Item Master and CDM linkage

Regulatory and Compliance Readiness

Bil

lin

g S

yste

m

CDM Management

Ch

arg

e R

eco

nci

liati

on

an

d

Mo

nit

ori

ng

CDM Change Request

Level 1 – reconciling encounters to schedule

Local / Department / Practice

Exc

epti

on

-Bas

ed P

roce

ssin

gCharge Capture Audit

and Compliance

Provider Documentation/ Electronic Charge Capture

Real-time charge capture edits

Charge EditsHIM / Coding

feedback loop (documentation / charge discrepancies)

Reimbursement

Corporate Compliance

29

Business Case - Health Information Management

30

ProjectBenefit Type

AnnualNet

Benefit ($M) Description of Business Case

Hospital ProjectsCoding Performance Support

Cost Reduction

$ 1 Reduction in coding operating costs

HIM Operations Cost Reduction

$ 3 Reductions driven by leading practice productivity standards enabled by the consolidated enterprise model.

16

HIM (Coding and HIM Operations / Support)

Current State Future StateKey Gaps

training Inconsistent HIM training and QA processes

Wide variation in coding and documentation practices across entities

Multiple workarounds due to hybrid systems

Lack of standardization of processes leading to incomplete documentation

Lack of workload balancing

Regional and/or site-specific HIM coding and operations – managed

separately on hybrid systems

Enterprise HIM operations and coding – centrally managed with standardized processes, procedures and systems

Enterprise Shared Services HIM

HIM/Coding Initiative - Operating Model Migration

Record Completion Coding & Abstracting EMPI Support Release of Information Documentation / EHR

Support Health Information Access

& Monitoring

Sac Sierra

RegionalHIM

PCR CVR

East Bay West Bay

RegionalHIM

RegionalHIM

Regional HIM

Entity-based HIM

Site-based Functions• Medical Staff & Customer Support (ROI)• Administrative Support

Site-based Functions• Medical Staff & Customer Support (ROI)• Administrative Support

31

HIM Shared service workload management approach – single pool of resources cross-

trained to work across sites / regions Enable virtual / remote deployment of staff with centralized management Implementation of Computer Assisted Coding and Direct-to-Bill

Clinical Key clinical documentation required for coding and other functions available real-

time or within a standard defined service level agreement Clinical Documentation Improvement – integration between documentation and

coding

Department / Practices Structure and processes to continuously improve record completion processes

and timeliness; includes coordination and feedback loop among Coding, HIM Operations, medical staff leadership, Clinical Documentation Improvement (CDI), Quality, Risk and Case Management

HIM/Coding Initiative - Operating Model Migration

32

17

HIM Shared Service Center

Operating Model – Health Information Management

Central oversight of remote and on-site codersWorkload managed across sites / regions

Coding Support Functions

Quality Assurance / Audits Coding Support (clerical / non-coding) Coding Audit Response

Pro

vid

er

Do

cu

me

nta

tio

n

Deficiency Analysis (Document Completion)

Suspension Process Dictation / Transcription Document Imaging

Master Patient IndexSupport

Release of Information (ROI)

Workload Balancing Regulatory and Compliance Readiness Documentation / EHR Support Management functions (vendors, budgets)

Medical Staff and Customer Support (includes onsite ROI) Administrative Support (e.g. administrative committees) Medical Staff and Customer Support (includes onsite ROI) Administrative Support (e.g. administrative committees)

Local Support (Site-based)*

On

go

ing

Op

erat

ion

s &

Re

co

rd

Man

agem

ent

Remote and On-site Coders

Coding Abstracting Pre-Bill Edits (DNFC)

Coding

HIM Management

Record Completion

33

Business Case - Central Billing Office

34

Project Benefit Type

AnnualNet

Benefit($M) Description of Business Case

Avoidable Write-Off Improvement

Revenue Improvement

$ 48 Reduce preventable insurance write-offs to improve net revenue capture..

AR Reduction Cash Flow $242 Net cash impact of reduction in AR days.

CBO Consolidation

Cost Reduction

$ 19 Reduction in operating

18

Current State Future StateKey Gaps

CBO (Patient Financial Services) - Operating Model Migration

35

PFS Shared Services Center Hospital

Single CBO

Patient Financial Service Functions

CBOPFS

East Bay Region

Cornel FPO

~100% cash Posting

Central Valley Region

Peninsula Coastal Region

CBO PFS

West Bay Region

Sacramento Sierra Region Billing

CBOPFS

CBOPFS

CBOPFS

CBOPFS

Not leveraging economies of skill, scale and technology

Denial rates of 1-4% leaves significant uncollected $$

Too many manual processes and unnecessary rework

Inconsistent and confusing patient experience (billing & customer service)

Lack of consistent, standard policies and procedures across Regions to achieve best practice

Data / performance metrics and reporting not standardized across Region or enterprise

Use of different vendors across all entities with limited SLAs in place

Not leveraging economies of skill, scale and technology

Denial rates of 1-4% leaves significant uncollected $$

Too many manual processes and unnecessary rework

Inconsistent and confusing patient experience (billing & customer service)

Lack of consistent, standard policies and procedures across Regions to achieve best practice

Data / performance metrics and reporting not standardized across Region or enterprise

Use of different vendors across all entities with limited SLAs in place

Follow-up

Cash Posting

Denial Mgmt.

Core Support

Consolidate and standardize around an integrated best practice. Accelerate cash flow, reduce cost and write-offs

Clearly defined metrics and service level agreements to support expected outcomes

CustomerService

3535

Sutter Health – Patient Financial Shared Services

36

Standardized P&P Standardized Technology Enablers Standardized QA and Training Standardized Metrics

Revenue Management Data Warehouse and Decision Support

Customer Excellence

Claim Submission Resolution of pre-bill and payer claim edits Claim submission to re-engineered payer

relationship

Disputed Claims Resolution Direct denials to appropriate area for resolution Monitor resolution and accountability Track denial management and prevention efforts

Cash & Remittance Processing Electronic posting of third party payments Review of exception reports for manual posting Refund processing

Vendor Management Ensure accounts are transferred timely to vendors

for follow-up Generate and review KPI and dashboard reports

Follow-up Claims queued by payer, patient type Follow-up of unpaid claims that are not denied Analysis for over / under payment

Customer Service Respond to inbound customer inquiries Make outbound patient calls where necessary Review and process refund request

Sutter Health CBO Single CBO

CBO Consolidation Operating Model

36

19

Participants Responsibilities

Single Cross-Functional Committee:• Key Regional & Business

Executives• Key Corporate Function

Executives (HR, FI, etc)• SSS Executives/SVP

Strategic:• Formulate Shared Services strategic direction• Review Shared Services performance• Determine scope expansion (i.e. new functions)• Promote environment of joint commitment• Resolve strategic issues• Shared Services priorities

Multiple Single-FunctionCommittees:• Business Operational

Leads• SSS Executives

Tactical:• Respond to items from Super Users • Review performance and manage costs • Manage service expectations and SLAs• Monitor scope/ change requests • Resolve escalated issues (e.g. performance,

process design)

Multiple Single Sub-Functional Groups:• Business Process Users

(Super-Users)• Process Owners• Functional Managers

Operational:• Super User Committees provide functionally

specific feedback and serve as process champions

• Day to day queries regarding service delivery• Service performance issues• Resolve operational issues• First level of issue escalation

37

SSS

Steering

Committee

SSS Client Advisory Committees

SSS Functional

Super Users

Strategic Direction Setting

Issue Escalation

Performance

Governance / Accountability

37

Governance Impact

38

Enabling benefits beyond centralization

CENTRALIZATION SHARED SERVICES

ConsolidationRe-organization and de-layering

Resource Strategy

Re-engineeringSimplified, standardized system/process

SLAsClear 2-way services

agreed by clients

Performance Mgmt.Metrics, Targets,

Scorecards

Service/Cost Transparency

Global End-to-End Process

Visibility, Governance

Lack of Clarity Services, Costs

Corp. CultureTenure, wages, back-

office mentality

Exceptions Increase

Shadow Cost Increase

Benefits of centralization shrink due to lack of shared accountability for performance and increase in shadow cost over time

RA

NG

E O

F B

EN

EF

ITS

Transition from Centralization to Full Value of Shared Services

Many organizations stop here leaving value behind and decreasing the likelihood of sustainability and scalability

38

20

Approved by Support Function Transformation Steering Committee November 27th, 2012

Service: 3.5 Record Completion

Service Description:

This service addresses all inquiries for assembling and analyzing and completion of patient records.

Key Activities/Responsibilities:

ActivityResponsibility

S3 Client Other

Identification of chart / encounterdeficiency

X X

Processing of deficiency X

Completion of records X

Deficiency notification and suspension X

Service Measures:

Service Level Agreements:• 98% of deficiency analysis

validation completed within 24 hours

Operating Level Agreements:• < 5% delinquent (as defined by

state requirements -14 days) records for the system on a daily basis

How You Can Help:

Clients:Resolve identified deficiencies.

Clients:

Client & Customer: Operations

Chargeback Details:

Enter description of the chargeback model for this services.

Key Cost Drivers:

Enter key cost driver variables.

Sample Service Catalog Page

3939

Service Level Agreements

1. Output: Deficiency Analysis Completed2. Metric: Within 24 Hours3. Target: 98%

Clearly Defined Up FrontCost vs BenefitBest PracticeApproved by Client Advisory

Group and Steering Committee

40

21

Operating Level Agreements

1. Clearly define customer dependencies needed to meet SLA commitments

2. Measured and reported with SLAs

41

SLA Scorecard - How are we performing?

42

22

Cultural TransformationEveryone is Important• Everyone Contributes

• Performance trumps position

We Believe we Can Achieve • Change because we want to

• Proud to say “Not Invented Here”

43

Customer #1 Team #2 Me #3• Share everything

• Colaborate for greater success

Do What You Say You Will Do• Own it

• Don’t pass the buck

Paperless – Technology EnabledOpen – Shared & Collaborative Performance / Metrics Driven

Cultural Transformation

44

23

Cultural Transformation

45

• Develop your shared values and cultural statements before your start the first employee.

• Provide a fair and defendable process to transition impacted staff.

• Use limited term resources for all transitional work and strictly enforce PCD discipline.

• Invest in a strong New Employee Orientation. Everyone participates in the process - No exceptions.

• Set expectations: startup, still evolving, ask for help, do teambuilding

• Invest in communication: over-communicate, be clear and consistent, share the good the bad and the ugly.

Cultural Transformation

46

• Don’t hold out for a “best practice”. Start with strong, agreed upon work flows and process improve as you learn and grow.

• Design in LEAN or another process improvement methodology

• Must be perceived as fair to affected employees. Consider using a “salary place holder” for year 1st for negatively impacted salaries.

• Do all you can reasonably do to avoid lay-offs but ensure positions are eliminated from legacy organizations per business case.

• Listen to your employees so you understand their issues and perspectives BUT leadership decides priorities.

• Train, Train, Train: new processes, new technologies, new structure, new culture

24

Video #5

To Wrap Up

• Shared Services is an organizational transformation• Shared Services drive cost reduction through

Standardization, Best Practices, Automation, Consistent Patient Experience

• Consultants can help: Experience, Proven Change Models, Speed of Change but leadership must Own and Sponsor the transformation

• Change because you want to or be changed because you have to

48

25

Video #6

Q&A

50

26

Presenter Contact Information• Michael Brokloff, Service and Performance Leader

Sutter Shared Services

• [email protected]

• (916) 297-9735

• Claudia Crist

• Revenue Cycle Operations Leader

• [email protected]

• (916) 297 8000

51

BibliographyPeeriosity for Shared Services

Industry peer group for Shared Services Operations

www.peeriosity.com

Johns Hopkins University & Medicine Shared Services

Multi-Functional Shared Services Portal

http://ssc.jhmi.edu/

Barbara Quinn, Robert S. Cooke, Andrew Kris

Shared Services: Mining for Corporate Gold

Financial Times Prentice Hall, 2000

Donniel S. Schulman, Martin J. Harmer, John R. Dunleavy,

James S. Lusk

Shared Services: Adding Value to the Business Units

John Wiley & Sons 1999

Daniel C. Melchior Jr.

Shared Services: A Manager's Journey

John Wiley & Sons 2008

Kyle A. Schumacher, Ed.D.

Viewing The Impact of Shared Services Through The

Four Frames of Bolman and Deal

Department of Leadership, Educational Psychology and Foundations

Northern Illinois University, 2011

Mark Wnorowski

Simulation- Based Patient-Centered Shared Service Resource

Planning and Staffing

Binghamton University 2011

52

American College of Healthcare Executives

Disclosure of Relevant Financial Relationships

By Faculty and Planners of Continuing Education Activities

It is the policy of the American College of Healthcare Executives (ACHE) to ensure balance, independence, objectivity

and scientific rigor in all of its directly sponsored or jointly sponsored Continuing Education (CE) activities. The

intention of this policy is to identify potential conflicts of interest, facilitate resolution according to protocols, and ensure

that disclosure is provided to participants prior to the beginning of the activity so that learners may formulate their own

judgments as to the objectivity of the activity. Failure to disclose is grounds for dismissal as a faculty member or planner.

All individuals in a position to influence and/or control the content of ACHE directly and jointly sponsored CE activities

must disclose to ACHE and subsequently to learners that the individual has either no relevant financial relationships or

the nature of the financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of

commercial services discussed in the CE activities.

Conflict of Interest: Circumstances create a conflict of interest when an individual has received financial benefits in any

amount from a commercial interest within the past 12 months and that individual is in a position to affect the content of

CE regarding products or services of commercial interest.

Commercial Interest: A commercial interest is considered any entity producing, marketing, re-selling, or distributing

goods or services.

Financial Relationships: A financial interest is established by payments for various activities to the individual, the

individual’s spouse or partner by proprietary companies related to the content of a CE program. Examples of payments

that constitute financial interests include grants or research support, employment, consultation, speaking or teaching

activities, or royalties for companies. Financial interest also includes owning stock or options in any amount in these

types of companies.

Michael G. Brokloff, FACHEName:

Event Title: 2015 Congress on Healthcare Leadership

Program Title: Bringing Revenue Cycle Into The 21st Century (25A and 25B)

Relationship: Faculty

Do you or any immediate family member have a financial relationship or interest (currently or within the past 12 months)

with a proprietary entity? No

If Yes, please indicate the individual, organization and he nature of the financial relationship below.

Do you intend to discuss an unapproved/investigative use of a commercial product/device? If yes, please

disclosure such references to the learner in the educational activity. No

I will adhere to the ACHE policy on Conflict of Interest Disclosure. I will uphold the ACHE standard to insure

that balance, independence, objectivity and scientific rigor are maintained in the planning and presentation of

this CE activity.

Michael Brokloff October 03, 2014

DateSignature

American College of Healthcare Executives

Disclosure of Relevant Financial Relationships

By Faculty and Planners of Continuing Education Activities

It is the policy of the American College of Healthcare Executives (ACHE) to ensure balance, independence, objectivity

and scientific rigor in all of its directly sponsored or jointly sponsored Continuing Education (CE) activities. The

intention of this policy is to identify potential conflicts of interest, facilitate resolution according to protocols, and ensure

that disclosure is provided to participants prior to the beginning of the activity so that learners may formulate their own

judgments as to the objectivity of the activity. Failure to disclose is grounds for dismissal as a faculty member or planner.

All individuals in a position to influence and/or control the content of ACHE directly and jointly sponsored CE activities

must disclose to ACHE and subsequently to learners that the individual has either no relevant financial relationships or

the nature of the financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of

commercial services discussed in the CE activities.

Conflict of Interest: Circumstances create a conflict of interest when an individual has received financial benefits in any

amount from a commercial interest within the past 12 months and that individual is in a position to affect the content of

CE regarding products or services of commercial interest.

Commercial Interest: A commercial interest is considered any entity producing, marketing, re-selling, or distributing

goods or services.

Financial Relationships: A financial interest is established by payments for various activities to the individual, the

individual’s spouse or partner by proprietary companies related to the content of a CE program. Examples of payments

that constitute financial interests include grants or research support, employment, consultation, speaking or teaching

activities, or royalties for companies. Financial interest also includes owning stock or options in any amount in these

types of companies.

Claudia E. Crist, RN, FACHEName:

Event Title: 2015 Congress on Healthcare Leadership

Program Title: Bringing Revenue Cycle Into The 21st Century (25A and 25B)

Relationship: Faculty

Do you or any immediate family member have a financial relationship or interest (currently or within the past 12 months)

with a proprietary entity? No

If Yes, please indicate the individual, organization and he nature of the financial relationship below.

Do you intend to discuss an unapproved/investigative use of a commercial product/device? If yes, please

disclosure such references to the learner in the educational activity. No

I will adhere to the ACHE policy on Conflict of Interest Disclosure. I will uphold the ACHE standard to insure

that balance, independence, objectivity and scientific rigor are maintained in the planning and presentation of

this CE activity.

Claudia Crist September 30, 2014

DateSignature