UCSF Medical Group UCSF Medical Group Revenue Cycle Advisory Committee System Improvement Ideas System Improvement Ideas March 6 th , 2007
Jan 02, 2016
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