UCSF Medical Group Revenue Cycle Advisory Committee

UCSF Medical GroupUCSF Medical Group

Revenue Cycle Advisory Committee

System Improvement IdeasSystem Improvement Ideas

March 6th, 2007

Agenda:Agenda:

Committee Overview

Specific Projects

Next Steps

Committee Scope:Committee Scope:

The primary scope is system changes, enhancements, new applications or products that will improve the pro-fee revenue cycle, either through improved efficiency or improved collections.

GUIDING PRINCIPLES

COMMITTEE COMPOSITION

PROCESS• Ideas• Vendor Presentation• Priority List

Ingenix Claims ManagerIngenix Claims Manager

Ingenix Claims ManagerIngenix Claims Manager

Software Product. Works with TES.

• Reduce denials

• Increase billing accuracy

• Shorten claim turnaround

Ingenix Claims ManagerIngenix Claims Manager

Encounter editor

Comes packaged with:

• LCD (Medicare Local Coverage Determination) part B edits-update as they change

• Annual CPT and ICD-9 revisions

• Medicare CCI (Correct Coding Initiative) edits-updated quarterly

• Commercial and government edit templates for user defined edits

What we feel Ingenix will bring usWhat we feel Ingenix will bring us

Cleaner claims• Efficiency tool • Revenue cycle shorter

Reduce denials• Reduce re-work=efficiency on the backend• Less paper-DRQ

o Reduce opportunity for accounts “falling off radar”o Reduce billing lag

What we feel Ingenix will bring usWhat we feel Ingenix will bring us

More Compliant Billing• New vs. established edits using claim history• Unbundling edits

Increased Patient Satisfaction• Resolution of potential denials prior to billing will

reduce patient inquires

Increase Revenue• Missing charge edits

o Supply billed without serviceo Primary service not billed-add on service billed

ROIROI

COST:• One Time: $90K• Ongoing: $145K to $167K /

Year

RETURN:• Est. $700K Year One

E-Commerce EnhancementE-Commerce Enhancement

Existing IDX Feature

Eligibility Inquiry with Payor

Improve Functionality:• Payors?• Data?• Work Files for Exceptions

Expand User Base

ROIROI

COST:• One Time: $75K

RETURN:• $29K per Year (conservative)

Visit Management EnhancementVisit Management Enhancement

Existing IDX Application

Pre-Arrival and Arrival Alerts• Copy of Insurance Card• NPP/ TACOS• Past Due Balances• Alerts on IDX vs. ONTRAC

ROIROI

COST:• One Time: $75K

RETURN:• Full Extent not Known• DOM Estimate $150K / Year

Rejection SubsystemRejection Subsystem

Existing IDX Module

Improve Functionality:

• Rejections in Workfiles Sooner

• “Action Codes”: FSC Transfer

• Better Reporting

ROIROI

COST:• One Time: $35K

RETURN:• One Time: $348K

EOB ResolveEOB Resolve

Payment Accuracy System

Features• Actual vs. Expected• “Appeals” Letters/ Files• Uses EDI Data• EOB Image• Reporting

ROIROI

COST:• One Time: $10K• Ongoing: $28K / Year

RETURN:• First Year: $592K

Enterprise Task ManagerEnterprise Task Manager (ETM)(ETM)

DescriptionDescription

• ETM is a tool designed to improve workflow in the GE/IDX Centricity products.

• Uses workflow automation and role-based portals to drive revenue management processes through an accelerated and more efficient revenue cycle.

• Provides an interface allowing users to go to the correct place to work

Why ETM?Why ETM?

Decentralized revenue cycle structure with “partially” centralized business office

Access unit, ONTRAC

Focus on front-end

Navigation ease in GE/IDX modules

Eliminate Paper based processes

BenefitsBenefits

Assign tasks to specific users

Increase task completion efficiency

Improve staff production, quality and accuracy

Potential to reduce staff expenses

Minimizes training time

Optimize revenue cycle throughput

Create best practice workflows

Potential to replace ONTRAC

Project PlanProject Plan

Multi Year

Split Financial Responsibility

COST:• Year One: $40K

RETURN:• TBD

Next StepsNext Steps

Board Approval

Coordination with Purchasing

Implementation Planning

General Time Lines

SUMMARYSUMMARY

ProjectProject Funding RequestFunding Request

ONE TIME ONGOING

Ingenix Claims Manager $90K $145 to $167K

Visit Management $75K 0

E-Commerce $75K 0

Rejection Subsystem $35K 0

EOB Resolve $10K $28K

ETM $40K TBD

TOTAL $325K $195K