1. 1. Creating new opportunities Improving existing operationsHealth Care Revenue Cycle Expert
2. 2. Expert in health care revenue cycle operations with over 15 years experience in several sectors Payor, provider, and consultingDeveloped new services and operational turn-around strategies Proven record of operational performance improvement Served as the Director of centralized billing offices Managed projects and complete A/R liquidation engagements with both on-shore and off-shore staffNegotiated payor / provider contracts and settlements Executive MBA Graduate, Temple University Jim Spause 610-256-0088 jspause@comcast.net2
3. 3. Companies and clients that I have served Jim Spause610-256-0088jspause@comcast.net 3
4. 4. Senior Manager of Product Development, McBee Associates: Developed and launched 3 new revenue cycle service lines with annual revenue projections of over $2 million Director of Revenue Operations, DaVita: Improved collections by an average of $1.2 M per month within a 9-month period Increased payor appeal wins by more than $12 M Reduced non-contracted DSO by more than 50-days in one year Settled several disputes with managed care and commercial payors totaling $3 million in additional collections Lead Consultant, McKesson: Performed hospital revenue cycle assessments leading to $3.8 million of additional software and services sales Co-published an article examining the use of technology in Patient Access processes for Aspen Publishings Healthcare Registration newsletter Engagement Manager, Deloitte Consulting: Managed outsourcing projects with a total accounts receivable of $150 M resolved over 97% Corporate Director, Patient Financial Services, Kennedy Health System: Reduced hospital days in accounts receivable from 72 to 59 in one year Negotiated settlements with managed care payors totaling $2 M Directed a multi-departmental effort which increased net revenue and collections by $1.9 M Network Services Coordinator, Aetna US Healthcare: Received the prestigious Gold Service Star Award for service excellence twice in one yearJim Spause610-256-0088jspause@comcast.net4
5. 5. Establish stretch goals Develop plan Execute - Repeat Revenue Cycle DashboardsIndicator Better Practice Hospital Cash Receipts as % of Net Business Needs100%97.1% Revenue The Hospital Revenue Cycle Viewed as a System 1. Reduce claim submission rejections 2. Reduce DNFB A/R Days (Net) 55 Days 50.5 Days 3. Reduce aged receivables 4. Improve collectionsA/R Over 90 Days 15 - 20% 36.2% 5. Reduce Bad Debt DNFB Gross A/R DaysPatient Admitted5 Days 5.1 Days (includes 4-day bill hold)Point-of-Service Collections as %Claim coded for initial billing .8% average 2%of Net Revenue Patient AccessHealth Information Management Patient Accounting Collect and document all clinical notes Claims scrubbed for accuracy Billing Backlog Gross A/R Days 1 - 2 Days 1.6 Days(Registration/Admissions) Collect patient demographic / Utilize patient chart to code diagnoses and compliance Denials as a % of Gross Revenue1 - 2%6% Claims submitted to insurance insurance information & procedures Insurance verified & selected / patient Verify services are medically necessaryBad Debt as a % of Gross Screen services for medical Paid or Denied3%2.3 % Revenue Claim follow-up with insurance necessity Collect co-pay / deductible or patient Status within aged receivables Claim Demographics GeneratedBetterIndicator Hosp 1Hosp 4 Hosp 2Hosp 3Hosp 5Hosp 6 Practice Clinical Services Provided and Documented DNFB Gross A/R Days (includes 4-day 5 Days 4.3 Days 5.0 Days5.2 Days 4.8 Days6.8 Days 4.2 Days billhold)IP charts coded per Not Plan to ImproveDesign & Redesign23-2632 303022.532coder/per dayTracked Increase pre-registering frequencyProcesses & Services Verify insurance via EDI OP charts coded per Not 150 23055 30064.322555 coder per/day Tracked POS collections Electronic order entry EMROBS & AMS charts Not coded per coder/per 36-4050 754564.250 Electronic compliance screening1 Tracked day Clean claims ER charts coded perOut- Out-Out-Out-Out-180190- 250coder per day sourcedsourced sourced sourced sourced 1 work Transcription backlog 1 Day1 Day 1 Day1 Day1 Day 1 Day day Not NotNotNot Not % of MPI duplicates .05%.01 Tracked TrackedTrackedTracked TrackedRecord Request21-7 days1 day1-7 days 1-7 days1 day14 daysTurnaround workdays Jim Spause610-256-0088jspause@comcast.net 5
6. 6. Be tough on the problem but kind with people Hands-on & resourceful Brainstorming & Collaboration Mistakes are forgivable Whats unforgivable is not taking responsibility and fixing the mistake Do the hard work and analyze - Numbers dont lie There are always choices and options choose wisely Keep pushing - You never know how much you can do until you push yourself Confidence breeds accomplishments (and vice versa) Jim Spause 610-256-0088 jspause@comcast.net6
7. 7. Contact me at: Jim Spause, MBA, PMPLafayette Hill, PA (H): 610-567-0295 (M): 610-256-0088 jspause@comcast.netJim Spause 610-256-0088 jspause@comcast.net7