Transcript UCSF Medical Group Revenue Cycle Advisory Committee
UCSF Medical Group
Revenue Cycle Advisory Committee System Improvement Ideas
March 6 th , 2007
Agenda:
Committee Overview Specific Projects Next Steps
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 Manager
Ingenix Claims Manager
Software Product. Works with TES.
• Reduce denials • Increase billing accuracy • Shorten claim turnaround
Ingenix 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 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 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 service o Primary service not billed-add on service billed
ROI
COST:
• One Time: $90K • Ongoing: $145K to $167K / Year
RETURN:
• Est. $700K Year One
E-Commerce Enhancement
Existing IDX Feature
Eligibility Inquiry with Payor
Improve Functionality:
• • • Payors?
Data?
Work Files for Exceptions
Expand User Base
ROI
COST:
• One Time: $75K
RETURN:
• $29K per Year (conservative)
Visit Management Enhancement
Existing IDX Application
Pre-Arrival and Arrival Alerts
• • • • Copy of Insurance Card NPP/ TACOS Past Due Balances Alerts on IDX vs. ONTRAC
ROI
COST:
• One Time: $75K
RETURN:
• • Full Extent not Known DOM Estimate $150K / Year
Rejection Subsystem
Existing IDX Module
Improve Functionality:
• Rejections in Workfiles Sooner • “Action Codes”: FSC Transfer • Better Reporting
ROI
COST:
• One Time: $35K
RETURN:
• One Time: $348K
EOB Resolve
Payment Accuracy System
Features
• • • • • Actual vs. Expected “Appeals” Letters/ Files Uses EDI Data EOB Image Reporting
ROI
COST:
• One Time: $10K • Ongoing: $28K / Year
RETURN:
• First Year: $592K
Enterprise Task Manager (ETM)
Description
• 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?
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
Benefits
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 Plan
Multi Year Split Financial Responsibility
• COST: Year One: $40K • RETURN: TBD
Next Steps
Board Approval Coordination with Purchasing Implementation Planning General Time Lines
Project
SUMMARY
Ingenix Claims Manager
Funding Request
ONE TIME ONGOING
$90K $145 to $167K Visit Management E-Commerce $75K $75K 0 0 Rejection Subsystem EOB Resolve ETM $35K $10K $40K 0 $28K TBD
TOTAL $325K $195K