CENTRALIZING PRE-ARRIVALIDEAS FOR BUILDING A WINNING TEAMMarch 20, 2015

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ContinuousRevenue CycleImprovement

Import and Build Capabilities• HealthRise revenue

cycle expertise• Enhance leader

capability

Develop Clear Metrics• Benchmark-able

reporting and evaluation• Individual and

departmental accountability

Optimize Technologies• Refinement of

existing platforms• Integration and

supplementation as necessary

Implement Best Practices• Leverage actionable

knowledge• Meet and exceed

industry standards

WHAT WE DOA STRATEGIC APPROACH TO PERMANENT REVENUE ENHANCEMENT

OUR APPROACH

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Process Re-engineering Technology Optimization Performance Management

THREE KEY AREAS SUPPORTED BY SOPHISTICATED ANALYTICS AND RELATIONSHIPS DRIVE OUR IMPACT

We help our partners achieve targets by improving their departmental

processes to industry best practice levels with our proven, customized

approach

We bring a deep knowledge of industry technology that enables effective

collaboration with partner IT departments to improve operational

processes and financial outcomes

We assist our partners in creating a culture of accountability and high

performance standards that can achieve sustained results

ANALYTICS

RELATIONSHIPS

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Payor Yield Self Pay Reduction Patient Cash Yield

Opportunity:Reduce payment loss from insurers

utilizing proven processes from registration through adjudication that

ensure accurate and timely billing

REVENUE CYCLE LEVERSTHESE LEVERS DRIVE UP TO 4% NET REVENUE IMPROVEMENT

Potential Impact:

0.5 – 1.0%Potential Impact:

0.5 – 1.5%Potential Impact:

1.0 – 1.5%

Challenge:New billing systems are significantly

more complicated and the development of automated processes to maximize reimbursement has not

kept pace with change

Opportunity:Reduce uncompensated care by

securing best possible paying coverage for uninsured patients from available

sources

Challenge:Hospitals have been challenged to

handle the number of self pay patients and the changing rules for coverage

Opportunity:Reduce payment loss from patients utilizing advanced patient education

and collection strategies that maximize likelihood of full and timely payment

Challenge:Patient out of pocket costs have risen

exponentially in the last five years, while hospitals have struggled to implement strategies to collect

effectively

LEVER1

LEVER3

LEVER2

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• Pre-Arrival Defined……………………………………………………………………………………Slide 6

• Significance of the Pre-Arrival function.…………………………………………………….Slide 7

• Changing landscape of patient financial responsibility.….............................Slide 8

• Pre-Arrival structures…………………………………………………………………...............Slide 9

• Pro’s & Con’s of centralized vs. decentralized.……………………………………..……Slide 10

• Work flow design within a Pre-Arrival department……………………………………Slide 11

• Manager & staff feedback………..……..……………………………………………………....Slides 12-13

• Final thoughts/conclusions.………….…………………………………………………………..Slide 14

• Contact info.……………………………………………………………………………………………..Slide 15

• Questions/comments…….………………………………………………………………………….Slide 16

AGENDA

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PRE-ARRIVAL DEFINED

A department within a hospital’s revenue cycle responsible for onboarding patients for scheduled services. This department is responsible for, but not limited to, the following functions

WHAT IS A PRE-ARRIVAL DEPARTMENT? (AKA as Financial Clearance and/or Insurance Verification)

Patient Scheduling & Pre-Registration

Insurance Verification

Obtaining Authorization

Patient Balance

EducationCollection

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SIGNIFICANCE OF THE PRE-ARRIVAL FUNCTION

• Scheduled services are both high in volume and cost; Pre-Arrival is directly responsible for ensuring these populations are “cleared” prior to services being rendered

• Pre-Arrival teams assist patients in the following ways:• Ensure accurate demographic information is obtained• Ensure patient coverage is active and the proper benefits to cover the visit are in place • Educate patients on their estimated out-of-pocket costs for their upcoming visit • Educate patients on any outstanding balances from past visits by substantiating the balance and offering payment

options to help facilitate payment

WHAT IS THE PURPOSE OF A PRE-ARRIVAL DEPARTMENT WITHIN THE REVENUE CYCLE?

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THE CHANGING LANDSCAPE OF PATIENT FINANCIAL RESPONSIBILITY

• Consumer insurance plans 20 years ago• Low premium/no out-of-pocket costs

• Consumer insurance plans 10 years ago• The shift starts to begin – slightly higher premiums & out-of-

pocket costs

• Consumer insurance plans <5 years old• Post ACA – much higher out-of-pocket costs for patients on

an ACA plan• Employer offered plans have their highest premiums and out-

of-pocket costs to date

MORE THAN EVER FINANCIAL RESPONSIBILITY IS SHIFTING FROM THE EMPLOYER TO THE PATIENT

May want to think about doing another slideHere that talks about the future and exchangeDeductibles. Check out the link below…http://avalere.com/expertise/managed-care/insights/avalere-analysis-consumers-should-look-at-maximum-out-of-pocket-limits-dedu

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PRE-ARRIVAL STRUCTURESCENTRALIZED VS. DECENTRALIZED

Centralized Decentralized

Pre-Arrival functions are primarily structured two ways within an organization• Both models are structured in their own unique ways, though there are some overlapping similarities

Title Title

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PRO’S & CON’S OF CENTRALIZED VS. DECENTRALIZED

There are both pro’s & con’s of each model, with the centralized model having different variations on how it can be structured within an organization

EACH MODEL HAS ITS BENEFITS AS WELL AS CHALLENGES

• Pro’s• Centralized, standard processes• Consistent messaging and expectations set

for patients• Uniform implementation of performance

management strategies across all staff

• Con’s• Non-patient facing• Not closely linked to specific site activities

and clinical staff

• Pro’s• Close relationship with clinical staff• Direct patient contact and counseling

• Con’s• Variation in processes and expectations• Sharing of best practices among staff

limited to site• Mixed messages given to patients

Centralized Decentralized

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WORK FLOW DESIGN WITHIN A PRE-ARRIVAL DEPARTMENTTWO COMMON APPROACHES TO PRE-ARRIVAL WORK FLOWS

Assembly-Line ApproachSpecialization of Functions

Working Accounts Beginning – End

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APPLYING A NEW CONCEPT TO YOUR FACILITY

• Redesigning a centralized Pre-Arrival department • Previous structure of the department• Issues with the previous design

• Adoption of the new assembly line approach• Way the team is now structured

• Key Metrics• Before and after the redesign• Incorporating staff feedback

• Keeping the team engaged

PRE-ARRIVAL MANAGER FEEDBACK

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STAFF FEEDBACK STAFF COMMENTS AFTER ADAPTING A CENTRALIZED ASSEMBLY LINE APPROACH

“I expect that we will meet and exceed our days out goal in a very short time!”

– Nurse feedback within a month of new process implementation

“We are able to contact and educate patients further in advance of their service instead of only the

day before” – Pre-Arrival Representative

“I enjoy the updated workflow, much easier to track and follow-up

on accounts” – Pre-Arrival Representative

“It’s so nice to focus on the function of the job I truly enjoy doing the

best, and that I am the best at doing!” – Pre-Arrival Representative

“We love this new breakout, we had actually wished it would have happened sooner” – Pre-Arrival

Representative

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FINAL THOUGHTS

• Know your patient demographic and choose which model best suites your environment

• Define what success looks like in your department – including what metrics you’re managing

• Make a list of the challenges you face and determine the model or process that could bring resolution to these pain points

• Communication is key – inform and include all affected areas in any changes made to your processes

CONCLUSIONS & RECOMMENDATIONS

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CONTACT US

• Terri LombardiBotsford Pre-Arrival Managertlombardi@botsford.org248-987-1712

• Norman HartmanHealthRise Revenue Cycle OperationsNHartman@healthrise.com586-524-0504

• Ashley DiLucchioHealthRise Revenue Cycle OperationsADiLucchio@healthrise.com 248-207-7504

HEALTHRISE SOLUTIONS & BOTSFORD CONTACT INFORMATION

WWW.HEALTHRISE.COM

WWW.BOTSFORD.ORG

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QUESTIONS AND COMMENTSTHANK YOU!