Best Practice Revenue Management Strategies. | 2 | 2 Presented By Christy L. Pehanich, CPC, FHFMA, MHSA, Associate Vice President, Professional Operations.

Best Practice Revenue Management Strategies

| 2| 2

Presented By

Christy L. Pehanich, CPC, FHFMA, MHSA, Associate Vice President, Professional Operations Revenue Management, Geisinger Health System

Lori J. Masters, CPC, Director Accounts Receivable Management, Professional Operations, Revenue Management, Geisinger Health System

| 2

The content of this presentation represents the views of the author and presenters. GE, the GE Monogram, Centricity and Imagination at work are trademarks of General Electric Company

| 3

Agenda

• About Geisinger• Geisinger Revenue Management • Environmental Backdrop• People Process Technology• ETM Case Study• Results

| 4

Geisinger Health SystemAn Integrated Health Service Organization

Physician Practice Group

$948M

Managed Care

Companies

$2,167M

Provider Facilities

$1,924M

| 5

Provider Facilities

$1,924M

Geisinger Medical Center and its Shamokin Hospital Campus

Geisinger Wyoming Valley Medical and its South Wilkes-Barre Campus

Geisinger Community Medical Center Geisinger Bloomsburg Hospital Geisinger Lewistown Hospital Marworth Alcohol and Chemical Dependency

Treatment Center 4 Outpatient Surgery Centers 2 Nursing Homes Home Health and Hospice, services covering 18

counties 86,000 Admissions, Observations and SORUs 1,745 Licensed Inpatient Beds

Geisinger Health SystemAn Integrated Health Service Organization

| 6

Physician Practice Group

$948M

Multispecialty Group 1,110 Physicians 675 Advanced Practitioners 83 Primary and specialty clinic sites 1 Outpatient Surgery Center 2.5 Million outpatient visits 430 Resident and Fellows 335 Medical Students

Geisinger Health SystemAn Integrated Health Service Organization

| 7

Managed Care

Companies

$2,167M

477,000 Members, including 100,000 Medicare Advantage members and 132,000 Medicaid Members

Diversified Products 50,000 Contracted Providers and Facilities 43 Pennsylvania Counties Offered on Public and Private Exchanges Members in 5 states

Geisinger Health SystemAn Integrated Health Service Organization

| 8

Geisinger Revenue Management

Access

Coding and Revenue Capture

Hospital Operations

Professional Operations

Administrative Services

Integrity

Scheduling Call Center

Pre-Visit Clearance

Patient Registration

Financial Counseling

Point of Service Collections

Uninsured Conversion

Coding

RevenueCapture

Concurrent Coding - CDIP

Professional Reimbursement

Physician Education

Third-Party Billing

Clinical Trials

Collections

Cash Management

Revenue Enhancement

Vendor Management

Third-Party Billing

Collections

In-House Patient Collections

Revenue Enhancement

Patient Service Call Center

Physician Credentialing

Systems Support

Quality Assurance

Business Analysis

Training

Charge Master

Budget and Planning

Credit Balances

Charge Capture Audit

Regulatory Compliance and Internal Controls

| 9

Environmental Backdrop

Shrinking Payer Reimbursement

Increased Patient Obligations

Reduce Cost-To-CollectACA, Insurance

Exchange, Medicaid Expansion

| 10

Environmental Backdrop – Shrinking Payer Reimbursement

Provider-Payer Relationships

Underpayment Recovery

Allowance Adjustments

Denial Management

| 11

Environmental Backdrop – Patient Obligations

Propensity to Pay

Pre-Service Collections

HDHP

BAI

TSP

POS Collections

| 12

Environmental Backdrop – Cost to Collect

Demographic & Financial Data

Collection

Coding

AR Management

Claims Processing

| 13

Environmental Backdrop – ACA

CAC Medicaid Expansion

Presumptive Eligibility

Uncompensated Care

| 14

Operational Accountability

Charge Capture

Coding

Reconciliation

Claim Submission

| 15

Planning

• Defined desired outcomes

• Identified each operational step and its components

• Assigned accountability & escalation procedures

• Measured performance daily

• Resolved exceptions

| 16

Desired Outcomes

• Error-Free Processing

• Reduced & Sustained Cycle Time

• Cash Acceleration

• Accurate and Compliant Processing

• Improvement in Cost to Collect & Employee Productivity

| 17

Action Planning

• Created template to measure charges posted vs. budget• Developed acceptable charge capture thresholds

(charge lag)• Electronic charge files vs. manual data entry

• Automated charge transfer – next day

• Manual data entry – 3 days

• Created automated alerts for exceptions & validation • Transactions > $ threshold

• Transactions > # units threshold

• Monthly reconciliation of services to charges entered

| 18

Billing

Daily report on reasons for ‘not yet submitted to payer” • Assigned accountability for resolution

Modified claims generation logic within legacy patient accounting system toward “clean-claim generation”

Measure and trend “Days to Payment” on primary-payer claims

Address unwanted variations

| 19

Third-Party Payment Patterns

• Understand managed care contractual terms and reimbursemento Review Unbilled (TES) reports dailyo Establish outlier threshold (total charge) for

management review and action

• With payer payment schedule, determine last day of the month claims should be submitted to achieve payment within the same period; review and adjust weekly

| 20

Billing – Managing Claim Submission

• Manage exceptions on transmissions with clearing house

• Invest in technology that allows custom edits for error free processing, minimizing the total number of human “touches” to a claim• Use this technology to edit all claims, including claims

submitted hard copy to payers

• Technology should retain audit trail of claim changes to:• Identify opportunities for pre-billing edits• And employee training

| 21

Achieving Results

• Convergence of:

o Peopleo Processo Technology

• Managing key performance metrics to achieve desired results

| 22

People

• Investment in Education

• Career Development

• Providing Career Paths – with longitudinal opportunities

• Employee Engagement

| 23

People

• Financial incentives aligned with desired outcomes• Performance driven reporting delivered

daily – actual vs minimum incentive threshold

• Visibility into operational effectiveness• Motivational tool to achieve highest

level of performance

| 24

People

• Established career paths• Revised job descriptions – aligned with market

competitive compensation• Established incentive compensation plan

• Educated work force on their respective role in achieving desired outcomes

• Communicate forecast of monthly performance daily

• Promoted employee certification (CRCR, CHFP, CPC, ICD-10) in desired field of study

| 25

People

• Defined roles• Delivered tasks• Assigned accountability for performance

outcomes• Line employees – performance/productivity

standards• Management – scope of authority

“Accountability breeds response-ability” – Stephen Covey

| 26

Process

Leverage TechnologyMitigate Opportunities for Human Error

Design a Streamlined Process

| 27

Technology

Must be scalable

Intelligent/Intuitive workflows

Drive processing decisions

Must contribute to cost-efficiency

Return on investment

| 28

Technology Case Study

ETM

| 29

ETM

Enterprise Task Manager (ETM) is a web application that integrates with the Centricity Business Billing & Accounts Receivable (BAR)

ETM supports Geisinger Clinic Revenue Management activities

1st workflow went live on August 25, 2014

Subsequent workflows started to be deployed on

February 9, 2015

| 30

ETM

• Immediate benefits include:• Real time productivity reporting for employee and

supervisor• System generated exception based assignments• Increased accountability and effective identification of

training needs (return feature if work performed failed to resolve the receivable)

| 31

Projected ROI

Annualized Return on Investment:                 414.11%

ROI to be achieved through:

0.5 reduction to Days in AR• 12 month ramp up required for a 0.5 reduction to Days in AR,

additional $55,000 per month in increased collections

Increased cash collections• Year 1 = $4,290,000.00

| 32

Results to Date

• Actual FTE’s Professional Insurance Collections

= 47 pre ETM (Oct 2013)

• Actual FTE’s Professional Insurance Collections

= 38 post ETM (Feb 2015)

• 9 FTE reduction valued at $364,680 annually (salary + benefits)

| 33

Results to Date

• 113% increase in staff productivity

• % Cash in first 30 days

• % Cash in first 60 days

• DRO trending

| 34

Summary

• Create an infrastructure that is transparent with employees and other customers

• Educate stakeholders

• Manage exceptions for error free- processing

• Understand external forces (payer mix, payer behavior and payment patterns)

• Measure and course-correct promptly

• Hold people accountable for results and

• Get out of their way!

| 35

Cost to Collect

| 36

Bending the Curve Impact

2011 2012 2013 2014 2015 YTD Total Projection $-

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$5,757

$8,041 $6,536 $7,190

$3,335

$30,860

Cost Savings (in thousands)

| 37

GE Metrics

TES

GSS Geisinger System Services Comparative Data

  Region: Eastern 

Client Year Qtr Total ChargesMedian

Post Lag Days

Median Extract Lag

Days

Extract Same Day %

Median Post Lag

Days

90th Percentile Post Lag

Days

Median Extract Days

90th Percentile

Extract Days

Median Extract

Same Day %

GSS FY2014 1 $530,502,390 1.0 1.0 30.7 4.0 1.0 0.0 0.0 64.5

GSS FY2014 2 $544,629,922 1.0 1.0 27.0 4.0 1.0 0.0 0.0 70.3

GSS FY2014 3 $536,529,806 1.0 1.0 28.7 4.0 1.0 0.0 0.0 72.8

GSS FY2014 4 $573,141,495 1.0 1.0 29.1 3.0 1.0 0.0 0.0 73.5

Transactional Editing System (TES) Metrics compared to GE peer groups

| 38

BAR

GSS Geisinger System Services Comparative Data

Region: Eastern 

Client Year Qtr Total Charges Total A/RClaim Lag

Days

Days in A/R

Percent A/R > 90

Days

Median Claim Lag

Days

90th Percentile Claim Lag

Median Days in

A/R

90th Percentile Days in

A/R

Median % A/R > 90 Days

GSS FY2014 1 $524,394,945 $169,324,872 3.0 29.7 25.6 7.0 5.2 42.1 32.1 23.4

GSS FY2014 2 $543,208,341 $155,615,973 3.0 26.4 29.4 7.0 5.0 39.7 29.9 24.6

GSS FY2014 3 $538,311,227 $164,953,778 3.0 27.6 27.2 7.0 4.9 42.2 32.7 24.7

GSS FY2014 4 $572,419,043 $159,910,355 3.0 25.4 26.1 6.0 5.0 40.8 30.5 24.7

 Billing & Accounts Receivable (BAR) Metrics compared to GE peer groups

GE Metrics

| 39

Questions?