Transcript TITLE HERE Subtitle Date

Focusing an Organization on
Financial Success
2015
Mollie Drake MBA, CPAM
Senior Director, Corporate Access Management
Today’s 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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What’s Measured
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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
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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
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Cash Collections
 Semi-Weekly
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Cash Collections
Adjustments
AR Balances
AR Days
Average Daily Cash
Average Daily Revenue
Average Daily Adjustments
 Monthly
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Revenue Cycle Summary
PI Initiatives
Revenue Management
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The Structure
 Targets Set
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System Goals
Individual Hospital Goals
 Systemwide Steering Committee
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Meets Weekly
Reviews Key Measures
Reports on Current Initiatives
Policy Review and Approval
 Hospital Committees
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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
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
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
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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
 Correct Posting Codes
 Resource Books
 Reimbursement
 Automating Scheduling
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
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
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
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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
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