TITLE HERE Subtitle Date

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Focusing an Organization on Financial Success
2015 Mollie Drake MBA, CPAM Senior Director,
Corporate Access Management
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Todays Agenda

• About Scripps
• Revenue Cycle Functions
• A Focus on Measures
• A Focus on Structure
• A Focus on Training
• Outcomes

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About Scripps

• 5 Hospitals on 4 Campuses located in San Diego
• Not for Profit
• More than 2600 Affiliated Physicians
• Two Level I Trauma Centers
• Extensive Ambulatory Care Network

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Revenue Cycle Functions

• Scheduling / Access Management
• Case Management
• Charge Description Master
• Outpatient Revenue Management
• Health Information Chart Management and Coding
• Billing and Follow Up
• Transactions / EDI
• Self Pay Collections / Customer Service
• Underpayment Audit and Collections

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Whats Measured

• Cash Collections
• POS Collections
• DNFB Bill Edits
• DNFB User Holds
• AR Days
• Credit Balances
• AR Over 90 Days
• Bad Debt Write-offs
• Bad Debt Recoveries
• Charity Write-offs
• Gross Revenue
• Aged Accounts by Payer
• Cash as of Charges
• Charge Errors

• Contractual Adjustments
• Underpayment Collections
• Saved / Avoidable Days
• Medicare / Sr. HMO LOS
• Third Party Liens
• Interest Collections
• Appeals
• Denials
• IME Payments
• Late Charges
• RAC Audits
• One Day Stays
• Pre-admit Percentage
• Unapplied Cash

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The Reports

• Daily
• Cash Collections
• Semi-Weekly
• Cash Collections
• Adjustments
• AR Balances
• AR Days
• Average Daily Cash
• Average Daily Revenue
• Average Daily Adjustments
• Monthly
• Revenue Cycle Summary
• PI Initiatives
• Revenue Management

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The Structure

• Targets Set
• System Goals
• Individual Hospital Goals
• Systemwide Steering Committee
• Meets Weekly
• Reviews Key Measures
• Reports on Current Initiatives
• Policy Review and Approval
• Hospital Committees
• Meet Bi-Weekly
• Review Key Measures
• Report on Current Initiatives
• Identify Obstacles to Discharge
• Accountability established at all levels for all
  goals.

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The Structure
Scripps Health Board of Trustees
CEO
EVP/CFO
VP, Revenue Cycle
Revenue Cycle Steering Committee PFS, Access,
Case Mgt, HIM, Revenue Mgt, Payer Relations,
Contracting, Audit Compliance, Finance,
Accounting, Information Systems
Bi-Weekly Facility Subcommittees
Mercy San Diego Mercy Chula Vista
Encinitas
La Jolla Home Health
Green
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Reality

• The Team
• High School Education
• Trained on the Job
• Role Specific
• Front End/Back End Conflict

• The Plan
• Measures
• Structure
• Goals
• Leaders

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The Gap

• How to bridge the gap?

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The Training

• A three level structured training program
• Over 70 courses
• Front End to Back End
• Consistent Information
• Focused Delivery
• Dedicated Resources
• Advancement Opportunity

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The First Tier

• Level I Core Competencies
• 23 Courses
• All Revenue Cycle Line Staff
• Concepts and Mechanics
• Professional and Technical
• Fundamental Understanding

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Level I Courses

• Patient Registration
• Point of Service Collections
• PPO Plans
• Regulatory Bodies
• Senior HMO Coverage
• Telephone Skills
• Tri-Care and You
• Understanding COB and TPL
• Understanding CMS
• Welcome to Medicare
• Workers Compensation

• Billing Terminology
• Commercial Carriers
• Customer Service
• Effective Communication
• HMO 101
• Hospital Billing Overview
• Insurance Follow Up
• Introduction to Capitation
• Introduction to Medi-Cal
• Patient Accounting
• Patient Confidentiality

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Boot Camp

• 9 day program
• Comprehensive workbook
• Lecture, exercises, role playing
• Hands on system practice
• Secret shopper
• Tour of CBO
• Pre-test

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Core Competency Test

• 203 Questions
• 75 True/False
• 75 Multiple Choice
• 50 Fill-in The Blank
• 3 Insurance Cards
• 16 Subjects
• Passing Score 80
• Failure Loss of Position

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Level II

• Advanced Training
• 25 Courses
• Builds on Core Competencies
• Patient Accounting Certification
• Apply the knowledge
• and get the promotion!

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Level II Courses

• Assigning Liens
• Business Correspondence
• Collection Techniques
• Conducting an Inservice
• Conflict Resolution
• Dealing with Difficult People
• Disproportionate Share
• Effective Communications
• Allscripts Reports
• Follow Up Queues
• Health Information Overview
• Medical Terminology

• Medicare Compliance
• Medicare Cost Report
• Patient Confidentiality
• Payer Contracts
• Risk Pools
• Scheduling System
• Secondary Systems
• Self Pay Negotiations
• System Troubleshooting
• Unbilled Accounts
• Understanding the ChargeMaster
• Utilization Review

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Moving to Level II

• Complete a Project
• Submit the work
• Blinded application
• Peer review
• Follow up review
• Promoted once approved

• Pass the CRCS
• Pay in advance
• Preparation courses
• Reimbursed once passed
• Certificate presented

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Sample Projects

• Break Schedule
• Disaster Preparedness
• Gastric Bypass
• Misdirected Checks
• Procedure Manuals
• Resource Books
• Automating Scheduling

• Correct Posting Codes
• Reimbursement Calculators
• Letter Library
• POS Collections
• Physician Outreach
• Insurance Directory

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Keeping Level II

• One Inservice
• One Teambuilding Exercise
• Less Supervisory Assistance
• Assigned Complex Problems
• Mentor to New Employees

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Level III

• 27 Courses
• Builds Professional Skills
• Develops Computer Skills
• Lead a Performance Improvement Project

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Level III Courses

• Microsoft Excel 1,2,3
• Microsoft PowerPoint 1,2,3
• Microsoft Word 1,2,3
• Motivational Skills
• Patient Confidentiality
• Process Mapping
• Project Management
• Revenue Management
• Technical Writing
• Time Management Skills

• Case Management
• Cost/Benefit Analysis
• Customer Service
• Allscripts Reports II
• Effective Presentations
• Ethics in Business
• Graphing Statistics
• Leading an Effective Meeting
• Medical Terminology
• Medicare Compliance

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Moving to Level III

• Propose a Performance Improvement Project
• Management Team Approves
• Mentor Assigned
• Present Final to Management Team
• Management Team Evaluates
• Promotion upon Approval

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Sample Projects

• Cash Pricing
• Blue Cross Prefixes
• AR over 90
• Boutique Program Guide
• Service Line Standardization
• Medi-Cal Billing Manual
• Interest Calculation and Collection
• Front End Work Queues
• Maternity Collections

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Keeping Level III

• Represent Department on Committees
• Develop / Update Policies and Procedures
• Problem Resolution
• Mentor to Level II

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Outcomes

• Staff Interaction
• Cross Training
• Conflict Replaced with Compassion
• Role Recognition
• Bench Strength
• Joint Commission Compliance

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The Results
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The Results
Reduced monthly average from 74.4 to 70.8 days
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The Results
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The Results
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Last Thoughts

• Knowledge is power. -- Francis Bacon
• Success in business requires training and
  discipline and hard work.
• --David Rockefeller

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Questions
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Fun With Training