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1. Creating new opportunities Improving existing
operationsHealth Care Revenue Cycle Expert
2. Expert in health care revenue cycle operations with over 15
years experience in several sectors Payor, provider, and
consultingDeveloped new services and operational turn-around
strategies Proven record of operational performance improvement
Served as the Director of centralized billing offices Managed
projects and complete A/R liquidation engagements with both
on-shore and off-shore staffNegotiated payor / provider contracts
and settlements Executive MBA Graduate, Temple University Jim
Spause 610-256-0088 [email protected]
4. Senior Manager of Product Development, McBee Associates:
Developed and launched 3 new revenue cycle service lines with
annual revenue projections of over $2 million Director of Revenue
Operations, DaVita: Improved collections by an average of $1.2 M
per month within a 9-month period Increased payor appeal wins by
more than $12 M Reduced non-contracted DSO by more than 50-days in
one year Settled several disputes with managed care and commercial
payors totaling $3 million in additional collections Lead
Consultant, McKesson: Performed hospital revenue cycle assessments
leading to $3.8 million of additional software and services sales
Co-published an article examining the use of technology in Patient
Access processes for Aspen Publishings Healthcare Registration
newsletter Engagement Manager, Deloitte Consulting: Managed
outsourcing projects with a total accounts receivable of $150 M
resolved over 97% Corporate Director, Patient Financial Services,
Kennedy Health System: Reduced hospital days in accounts receivable
from 72 to 59 in one year Negotiated settlements with managed care
payors totaling $2 M Directed a multi-departmental effort which
increased net revenue and collections by $1.9 M Network Services
Coordinator, Aetna US Healthcare: Received the prestigious Gold
Service Star Award for service excellence twice in one yearJim
[email protected]
5. Establish stretch goals Develop plan Execute - Repeat
Revenue Cycle DashboardsIndicator Better Practice Hospital Cash
Receipts as % of Net Business Needs100%97.1% Revenue The Hospital
Revenue Cycle Viewed as a System 1. Reduce claim submission
rejections 2. Reduce DNFB A/R Days (Net) 55 Days 50.5 Days 3.
Reduce aged receivables 4. Improve collectionsA/R Over 90 Days 15 -
20% 36.2% 5. Reduce Bad Debt DNFB Gross A/R DaysPatient Admitted5
Days 5.1 Days (includes 4-day bill hold)Point-of-Service
Collections as %Claim coded for initial billing .8% average 2%of
Net Revenue Patient AccessHealth Information Management Patient
Accounting Collect and document all clinical notes Claims scrubbed
for accuracy Billing Backlog Gross A/R Days 1 - 2 Days 1.6
Days(Registration/Admissions) Collect patient demographic / Utilize
patient chart to code diagnoses and compliance Denials as a % of
Gross Revenue1 - 2%6% Claims submitted to insurance insurance
information & procedures Insurance verified & selected /
patient Verify services are medically necessaryBad Debt as a % of
Gross Screen services for medical Paid or Denied3%2.3 % Revenue
Claim follow-up with insurance necessity Collect co-pay /
deductible or patient Status within aged receivables Claim
Demographics GeneratedBetterIndicator Hosp 1Hosp 4 Hosp 2Hosp 3Hosp
5Hosp 6 Practice Clinical Services Provided and Documented DNFB
Gross A/R Days (includes 4-day 5 Days 4.3 Days 5.0 Days5.2 Days 4.8
Days6.8 Days 4.2 Days billhold)IP charts coded per Not Plan to
ImproveDesign & Redesign23-2632 303022.532coder/per dayTracked
Increase pre-registering frequencyProcesses & Services Verify
insurance via EDI OP charts coded per Not 150 23055 30064.322555
coder per/day Tracked POS collections Electronic order entry EMROBS
& AMS charts Not coded per coder/per 36-4050 754564.250
Electronic compliance screening1 Tracked day Clean claims ER charts
coded perOut- Out-Out-Out-Out-180190- 250coder per day
sourcedsourced sourced sourced sourced 1 work Transcription backlog
1 Day1 Day 1 Day1 Day1 Day 1 Day day Not NotNotNot Not % of MPI
duplicates .05%.01 Tracked TrackedTrackedTracked TrackedRecord
Request21-7 days1 day1-7 days 1-7 days1 day14 daysTurnaround
workdays Jim [email protected] 5
6. Be tough on the problem but kind with people Hands-on &
resourceful Brainstorming & Collaboration Mistakes are
forgivable Whats unforgivable is not taking responsibility and
fixing the mistake Do the hard work and analyze - Numbers dont lie
There are always choices and options choose wisely Keep pushing -
You never know how much you can do until you push yourself
Confidence breeds accomplishments (and vice versa) Jim Spause
610-256-0088 [email protected]
7. Contact me at: Jim Spause, MBA, PMPLafayette Hill, PA (H):
610-567-0295 (M): 610-256-0088 [email protected] Spause
610-256-0088 [email protected]