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ACHIEVING HEALTHCARE’S TRUE RETURN

Introducing Patient Access Partnership


Apollo Health Street partners with

hospitals and healthcare

organizations across the country to

achieve healthcare’s True Return –

the financial strength you need to

offer excellent patient care today

and tomorrow.

Achieving Healthcare’s True Return

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Ready to partner with your team to create a process-focused solution that is fast, accurate and designed to achieve your financial goals

Will tackle your challenges on any scale – a targeted troubleshoot spot or a full-scale, sustainable platform for managing the entire process

Bring first-hand, specialized knowledge of the hospital revenue cycle, delivering the results our customers need

Industry Leader

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Conshohocken, PA

Bloomfield, NJ

New York, NY

Boston, MA

Springfield, IL

Americus, GA

Atlanta, GA

Sunrise, FL

Los Angeles, CA

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Corporate Office

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321

Leveraging People, Process and Technology

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Full Revenue Cycle Outsourcing

Focused Outsourcing Solutions

Third Party Solutions

Denial Management

Zero Balance Recovery

Private Pay Solutions

Medicaid and Patient Advocacy

Patient Access Partnership

EMS Billing and A/R Management

Transaction Service Solutions

• Pre-registration

• Medicaid eligibility and patient advocacy

• Financial counseling

• Charge integrity

• Complete billing services

• Cash posting and EOB processing

• Third party follow-up

• Denial management

• Customer service

• Accounts receivable management

• Self pay collections

• Management reporting

Comprehensive Suite of Revenue Cycle Management Solutions

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This program is designed to audit and correct 100% of patient

accounts. It offers a unique blend of automation and people

power to make corrections prior to bill drop, thus increasing the

rate of cash collections, decreasing the cost to collect and

providing timely root cause analysis to improve overall quality.

The Patient Access Partnership

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Patient Access Recap:

• Review of 100% of accounts is labor intensive

• Multiple data entry points increase the likelihood of errors

• High turnover of staff

• Patients don’t always provide accurate and/or updated information

• Complex IS systems make training never ending

Inherent Problems

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Excessive errors often lead to the following:

• Lost and/or significantly slowed revenue due to administrative denials

• Increase in days in A/R

• Increased cost to collect

• Friction between patient access and patient accounting

• Poor patient satisfaction

The Adverse Impact

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Hospitals often have some means of reviewing patient accounts, yet the following often occurs:

• Errors are identified, but not always corrected prior to bill drop

• Many errors are missed due to lack of resources available to thoroughly audit 100% of accounts

• Ongoing issues and common mistakes take longer to identify and trend

• Data reporting requires lengthy manual preparation

Limitations to Traditional Approach

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Technology is available in the marketplace to audit accounts and provide feedback regarding errors. Such tools are helpful, yet still have the following limitations:

•Hospital staff still has to correct errors

•Information is often not validated against external sources

•Automation alone cannot reach 100% accuracy because they do not:

– Compare diagnosis to service

– Determine WC/NF on follow up visits

– Correct DOB mismatches

– Carefully review accounts returned from automated eligibility as not eligible or not found to determine if coverage exists

– Understand the subtle differences between plan codes in the providers information system

Limitations to Automated-only Approach

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Apollo utilizes a blend of automation and human intervention to provide 100% account review:

• Validation of patient insurance and demographics

• Corrections are made live on the hospital system prior to bill drop

• Robust reporting provided which will assist in identifying root cause as well as detailed, individual registrar scorecards

• Physicians will be able to contact us via our toll free telephone number to obtain updated insurance information

The Apollo Approach

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By partnering with Apollo and implementing Patient Access Partnership, the following results can be expected:

•Increase rate of cash collections

•Reduce the cost to collect

•Improve system data integrity

•Enhance quality assurance process, continuous monitoring and adjustments

•Rapid staff feedback

•Ability to provide focused training based on QA results

•Robust reporting system

•“Ghost Effect”- People perform better if they know someone is watching; build instant accountability

The Apollo Results

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Registration performedRegistration performed

Eligibility processed through Automated

Eligibility Processing

Eligibility processed through Automated

Eligibility Processing

Eligible no discrepancies


Eligible with discrepancies


Discrepancies displayed to

registrar

Discrepancies displayed to

registrar

Accept changes & post

back to HIS

Accept changes & post

back to HIS

If time allows, check by phone

call

If time allows, check by phone

call

Not available through Electronic Eligibility

Processing

Not available through Electronic Eligibility

Processing

If time does not allow, no check

performed

If time does not allow, no check

performed

EndEnd

EndEnd

Do not accept changes

Do not accept changes

Not eligibleNot eligible Not foundNot found

Change to self pay

Change to self pay

Best Practice Process Flow without Patient Access Partnership

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Registration performed, then transferred to Apollo Health Street

Registration performed, then transferred to Apollo Health Street

Eligibility and demographic reviewEligibility and demographic review





Discrepancies reviewed

Discrepancies reviewed

Changes made directly to

provider HIS

Changes made directly to

provider HIS

Not available through Electronic Eligibility Processing

Not available through Electronic Eligibility Processing

EndEnd

EndEnd

Not eligibleNot eligible Not foundNot found

Manual Eligibility look up performed including: 1) review of insurance co. web sites; 2) review

of other websites; 3) phone call to carrier

Manual Eligibility look up performed including: 1) review of insurance co. web sites; 2) review

of other websites; 3) phone call to carrier

Phone call made to carrier to determine

eligibility

Phone call made to carrier to determine

eligibility

Eligibility discovered changes made to

provider HIS

Eligibility discovered changes made to

provider HIS

No eligibility found

No eligibility found

Transfer to supervisor for

review

Transfer to supervisor for

review

No eligibility to change to self

pay

No eligibility to change to self

pay

Results reviewed by a live agentResults reviewed by a live agent

Process Flow with Patient Access Partnership

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New Island HospitalChallenge • Reduce delays in collections due to incorrect insurance

information collected at scheduling/registration

• Lack of consistency in entry of information

• Higher cost to collect due to business office re-work

• Improve registrar accuracy and establish accountability

Decision • Evaluated several internal initiatives, process redesigns, staff augmentation and outsourcing

Results > > > • 31% increase in cash collected in 0-30 days • $5,000 per month in reduced business office re-

working costs• Increase from 93% to 98% in average departmental

accuracy• Unmatched impact of a better trained staff and a

stronger patient experience

Patient Access Partnership Case Study

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• Mid-sized suburban facility• 100,000+ outpatient visits per year

$-

$1,000,000.00

$2,000,000.00

$3,000,000.00

$4,000,000.00

$5,000,000.00

$6,000,000.00

$7,000,000.00

$8,000,000.00

$9,000,000.00

$10,000,000.00

$11,000,000.00

0-30 31-60 61-90

2008 Total Dollars

2009 Total Dollars

Comparison Period: January to June

Project Goal: Increase the Speed of Cash Collections

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Project Goal: Reduce the Cost of Collections

Number of Annual

Registrations 5% Error Rate 10% Error Rate

Cost to Rework a Rejected Claim

Cost at 5% Error Rate

Cost at 10% Error Rate

100,000 5,000 10,000 $25 $125,000 $250,000

250,000 12,500 25,000 $25 $312,500 $625,000

500,000 25,000 50,000 $25 $625,000 $1,250,000

750,000 37,500 75,000 $25 $937,500 $1,875,000

1,000,000 50,000 100,000 $25 $1,250,000 $2,500,000

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Project Goal: Enhance Quality Assurance Process

Enhanced quality assurance

• Consistent objective data

• 100% review

• Flexible audit parameters

• Experienced patient access team to assist in analysis

• Robust on-line reporting system

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Project Goal: Improve Registrar Accuracy

Continuous learning environment including focused re-training based on QA data

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Sample A: Error Log

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Sample B: Error Ranking by Occurrence Report

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Sample C: Average Score by Registrar

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Contact Information

Michael S. Friedberg, FACHE, CHAM

Associate Vice President, Patient Access Services

[email protected]

Office 973.233.7644

Mobile 732.809.0260

Learn more at www.apollohealthstreet.com

introducing patient access partnership generic 3 18 10

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