A Case Study with Orlando Health: Driving new levels of business performance with revenue cycle efficiencies

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A Case Study with Orlando Health: Driving new levels of business performance with revenue cycle efficiencies



Driving new levels of business performance with revenue cycle efficiencies

Driving new levels of business performance with revenue cycle efficiencies



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A Case Study with Orlando Health: Driving new levels of business performance with revenue cycle efficiencies Presentation Transcript

  • 1. subtitleSession Title: A Case Study with Orlando Health:  Driving new levels of business performance with revenue cycle efficiencies 
  • 2.  About us A/R team structure The need for information How did we get here Monthly reconciliation overview ETM/reports
  • 3. 64,1445,82610,00020,00030,00040,00050,00060,00070,000 200702200705200708200711200802200805200808200811200902200905200908200911201002201005201008201011201102201105201108201111201202CLAIM INVOICESPhysician & Professional Services
  • 4. 82102030405060708090 200702200705200708200711200802200805200808200811200902200905200908200911201002201005201008201011201102201105201108201111201202DivisionsPhysician & Professional Services
  • 5. 510100200300400500600ProvidersPhysician & Professional Services
  • 6.  team member training review notes, assess workload, summarize issues allocation of staffing resources payer mix, payer trends, workload distribution monthly payer reconciliations validation of information categorization of issues
  • 7.  Monthly payer reconciliation Cigna East/West, Humana, Careplus, AvMed, Citrus, Freedom, Prestige, PUP, Sunshine, Wellcare On going projects & claim events Aetna, United, Florida Blue (BCBS), Multiplan/Beechstreet
  • 8. Day 3CompileviewDay 12FinalizescrubbingDay 15Submit topayerDay 20-25Receive frompayerDay 25-30Review withpayerARRepsphone follow Upreview  coding denialsmedical recs/docreview fee schedulesreview provider set upupdate infofile appealspayer portal follow upaccess sub systems
  • 9.  Categories – payer status
  • 10.  Categories – payer status
  • 11.  Categories – payer status
  • 12. OrlandoHealthInsurance
  • 13.  See what’s out there
  • 14.  Compile recon view on the 3rd of each month
  • 15.  Work each invoice and clearly document the reason why we believe the claim was processed incorrectlyupdate payer statusupdate status
  • 16.  Review status field ie: “02eval” – previous month’s carry over
  • 17.  Sort by Balance to review high/low or Division to review patterns
  • 18.  Sort by Corr (charge correction flag) –> Y or Note? –> Y
  • 19.  Scripting of payer notes Response to our report Capturing most recent note from both Orlando health and insurance Going through our secxond round of calls with the insurance directly from therecon view Benefits Review only invoices outstanding Changes are real time We are in control
  • 20.  Minimized excel spreadsheets Reduced  days of workflow to xx daysJose to update 
  • 21.  BAR ETM InformaticsNeed to update with full list of CB modules used at Orlando
  • 22. Centricity BusinessNext-generationrevenue cycle
  • 23. ©2012 General Electric Company – All rights reserved.This does not constitute a representation or warranty or documentation regardingthe product or service featured. All illustrations are provided as fictional examplesonly. Your product features and configuration may be different than those shown.Information contained herein is proprietary to GE. No part of this publication may bereproduced for any purpose without written permission of GE.DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION,ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE ACOMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITYREMAIN AT GE’S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLEREGULATORY CLEARANCE.* GE, the GE Monogram, Centricity and imagination at work are trademarks ofGeneral Electric Company.General Electric Company, by and through its GE Healthcare division.
  • 24. Centricity Business overviewGE Healthcare
  • 25. Centricity Business Revised Positioningand DifferentiatorsA proven, next generationhealthcare revenue cyclemanagementsolution that supportstraditional andaccountable carereimbursement models forgreater profitability,efficiency and enhancedquality of care.InteroperableHigh performanceEnterprise ready
  • 26. • Integrated inpatient and ambulatoryrevenue cycle management across multiplelocations for improved transparency andefficiency• Support for multiple reimbursement modelsincluding: fee for service, capitation, payfor performance and shared savings foraccurate reimbursements and higherprofitability• Versatile, scalable revenue cycle tools andworkflows to support operationalexcellence across the continuum of careCentricity BusinessEnterprise Ready
  • 27. Centricity BusinessHigh Performance• Automated, exception based workflowsthat provide faster, cleaner claims andaccelerated revenue collection• Ability to manage increasing patientresponsibility with integrated tools tomanage patient access and revenuecycle processes• Proven financial performance• 8 of the top 10 Top Performers in Faculty PracticeSolutions Center Billing Office Survey1• 13 of the 17 Best hospitals in2011-12 honor roll21)UHC & AAMC, FY10 Faculty Practice Solutions Center Billing Office Survey, June 20112)US News and World Report, Best Hospitals 2011-12: the Honor Roll, July 2011
  • 28. Centricity BusinessInteroperable• Revenue cycle management with clinicalworkflow integration to virtually any EMR• Standards based connectivity enablesfreedom to choose your clinical system,while lowering total cost of ownership.• Connect the enterprise and provideinsights across clinicals and financials todrive improved care coordination andstreamlined reimbursements
  • 29. Centricity Business resources• Stop by the GE Healthcare Booth #343/345• Read more about Orlando Health on our website• www.gehealthcare.com/centricitybusiness• Follow @GEHealthcareIT on Twitter and use #gecb to jointhe Centricity Business conversation