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Sentry Data Systems Revenue Cycle BI application
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Sentry Data Systems Revenue Cycle BI application

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Sentry Data Systems revenue cycle management BI applicaion

Sentry Data Systems revenue cycle management BI applicaion

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Sentry Data Systems Revenue Cycle BI application Presentation Transcript

  • 1. Good Samaritan Hospital
    William D. Kirsh DO, MPH
    Chief Medical Officer
    Sentry Data Systems, Inc.
    1
  • 2. Sentinel RCM Application
    Value
    Financial Exposure
    • Provides linkage between divergent hospital data silos without additional IT FTE support.
    • 3. Data is longitudinally compiled and warehoused in a proprietary, SAAS cloud with rigorous security controls and levels.
    • 4. No impact to hospital’s data storage requirements, data processing capacity or data security risks.
    • 5. Effective analytic tools without interfering with normal operational functions.
    • 6. Claims Guardian, an application running in the background of Sentinel RCM , provides financial benchmarking, out-patient/ in-patient volume management, technology to up date and maintain charge master coding, provides billing and denial management analysis. .
    • 7. All reports provide a track & trend option associated with a directed alert engine
    • 8. BI solution that is non-intrusive, comprehensive, flexible and fast priced extremely completive
    No added fees
    No added costs
    No added costs
    No added consulting fees
    No added consulting fees
    Value driven pricing
  • 9. Three regulatory changes, over next 24 months, that substantiallyalter hospitals profit and cash flow?(requiring change to systems of improving patient outcome and cost controls)
    Cap on medical cost of insurance premiums(will change contracting shifting insurance administrative cost to medical costs)
    ICD 10 coding(mapping engines will not work, will greatly affect cash flow)
    Contracted performance measures(global contracting linked to outcomes will affect short term hospital payments and alter out-patient utilization)
    To Adapt to the AboveHospitals must have an effective software application (BI) to aggregate & analyze high volume, divergent data (EMRs not developed for this application)
    3
  • 10. Current Regulatory Changes Producing a “Cash Flow” Crisis in 24 months for Hospitals
    Hospitals need a mechanism focusing on and understanding small variations of costsof services.
    Hospital’s medical management will need applications to understand details of whichthird party payors contracts need specific utilizationcontrols to maximize profit.
    Hospitals must be able to understand variations in care by controlling their physician network.
    Improving administrative efficiency “not by cost cutting” but through continuous background analytics and alert engines that drive data supported administrative decisions.
    Using data to support evolving information to provide a basis for actuarial sound contractingto hospital providers, vendors & third party payors.
    4
  • 11. Hospital Administrators Must Have Data Analytic Capacity to Make CLINICAL and FINANCIAL decisions WITHINA FISCAL QUARTER
    Sentry’s
    Must Have Solutions
    Sentinel RCM™ Claims Guardian
    HealthBIT® Business Intelligence
    Together provide a
    Revenue Cycle Management
    BI Application
    5
  • 12. Sentry’s Revenue Cycle Management BI Application’s Immediate Value
    Key Performance Indicators
    Reduction in Days in A/R
    Pharmacy cost reduction
    Reduction in medication-related errors, lost billing opportunity
    Third party payers, contract management
    Value Drivers
    Revenue enhancement
    Cost avoidance, labor productivity
    Quality of Care, patient safety, cost avoidance
    Revenue enhancement, information for improved contract negotiations
    6
  • 13. To Meet New Payment/Billing VariationsHospitals Must Integrate Healthcare Information…
    Performance Indicators
    Stricter regulations & billing requirements
    Speed of collections
    Reduced contractual allowances
    Lower bad debt
    Understanding underpayments
    Controlling pre-authorization and pre-certification
    Claims denial management
    Identifying overpayments
    Sentry’s RCM BIApplication
    Recognition of meeting regulatory requirements
    Tracks, monitors, alerts variation
    Provides a picture into contract application verse group
    Tool to help identify “at risk” population
    Tool to identify high risk devises
    Information on appeals
    Tool to ID risk for audits.
    7
  • 14. Sentry’s Revenue Cycle Management BIApplication Allows Hospitals to Evaluate Contract Reimbursement
    Contract Terms
    Claim submission timeframes
    Authorization / referral processes
    Payment Terms
    Prompt-pay / payment timeframes
    Explanation of payment / benefits
    Governing Regulations
    HIPAA, CMS (HCFA), NCQA, JCAHO, ERISA, State laws
    Analyze & Profile Contract Specifics
    Trends by payor, trends by employer group, claims in A/R, Global fee payments
    Track Disputed Claims
    Use information to improve payor’s contract language, i.e. pre-negotiate claim denial rate
    8
  • 15. Sentry’s Revenue Cycle Management BI Application Provides Real Time Information to Focus on Front End Claims Management & Clinical Performance Measures
    Analytics and Data Validation
    Demographics
    Insurance
    Patient’s financial responsibility
    Set performance standards
    Maximize the amount of patient revenue
    9
  • 16. Why Do Hospitals Need Sentry’s Revenue Cycle Management BI Application?To assure proper reimbursement in the shortest time at the lowest administrative cost
    Hospital’s Requirements
    Understand & manage costs and cash flow
    Decrease write offs
    Assure services rendered are billed
    Link costs to specific contracts
    Evaluate financial information timely
    BI Output
    Monitors electronic claims submission
    Tracks claim outliers
    Alerts when services are not billed
    Allows for specific contract analysis
    Provides high level and drill down for A/R
    10
  • 17. Examples of Critical Information Evaluated By Sentry’s Revenue Cycle BIApplication
    Hospital Charge Master Codes
    • Links charge master to revenue codes
    • 18. Provides a tracking system that alerts missing charge master to revenue codes
    • 19. Example: A service with no charge and consequently not linked to revenue code.
    Link Revenue Code to a Claim
    • Assures that all the revenue codes are linked to a claim
    • 20. No volume or time limitation for alert system
    Explanation of Payment (EOP)
    • Links 837 claim to reimbursement form 835
    • 21. No volume or time limitation for alert system
    Provides A Way To Analyze The Service Preformed
    • Eg. CPT, HCPC, J Code
    • 22. Links patient and physician and location of service to the ICD-9 codes , Charge master and revenue codes associated with hospital’s intervention
    • 23. Clinical aspect: Performed service, captured the service, billed for service, reimbursed for service, link to physician that performed service, link to patient that received the service and the diagnostic codes.
    • 24. All of the key components are reflected in both physician and patient databases
    11
  • 25. Examples of Critical Information Evaluated By Sentry’s Revenue Cycle BI Application
    Provides Linkage of Diagnostic Codes with Patient Event
    • The system captures both the primary and all secondary diagnosis codes (ICD-9 and ICD 10) which will allow institutes to better bill secondary insures
    Recognition of Utilization Patterns
    • Links specific revenue codes/charges/procedures to a specific third party payor (BCBS plan 123, with employer group 8910)
    Flags (Alerting) Change in Patient Clinical Severity
    • e.g.. Transfer from Med/Surg bed to an ICU bed.
    • 26. e.g.. How does system recognize death events.
    8. Utilization
    Key linkage utilization of services other than pharmacy to location, physician, patient, and third party payor?
    12
  • 27. Sentry’s RCM BIApplication Addresses Information Regarding Variation in Financial Risk
    Traditional Hospital Financial Risks
    Hospital’s Future Financial Risks
    Capitation for specialists (PMPM)
    Moving PCPs to “Fee for Service” away from capitation
    Carve outs for Disease Management Providers (global fees)
    Intense medical management at insurance plan
    - Daily hospital utilization review (nurse on site)
    - Preauthorization for out patient services
    Aggressive “Fee for Service” hospital contracting
    Global Fee contracting with all health care providers
    Detailed medical coding (ICD-10) to define global fee contracting
    Significant reduction or complete elimination of medical management by insurance plan with shift to hospitals
    Investmentin “Pay for Performance Models” (Care Targets)
    Data converted to timely informationfor action within the fiscal quarter
    13
  • 28. Hospitals Must Manage “Bundled Payments” (integrated & connected)
    Must have health information technology that fits within the organization’s financial limitations and operational structure to assist in capturing data and converting it to informationto meet evolving “performance measures” & reimbursement requirements.
    Must have SAAS technology systems allowing seamless integration for exchange and flexibility in capturing data to allow variations in software applicationsto manage the immediate future of radical variations in third party reimbursement.
    14
  • 29. Sentry Data Systems Key Values
    A non-intrusive Web basedaddition that integrates with any technology platform.
    Operates in a cloud computing environment coupled with propriety aggregation engines to allow rapid development and implementation, both retrospectively and prospectively, of unique applications empowering the management team to make critical decision within a financial quarter.
    Software flexibility to aggregate and link all financial and healthcare data into individual longitudinal patient and physician records which then can be reassembled with focused applications on medication utilization/purchases, charge Master entries, quality initiatives, clinical/ financial protocols, third party contracting and risk management without a tether to a technical team.
    Sentry’s platform will import divergent elements, store, aggregate, integrate vendors and export data to generate informationto effect financial and quality drivers, which if altered,  improves a institution’s bottom line.
    15
  • 30. William D. Kirsh DO, MPH
    Chief Medical Officer
    Sentry Data Systems, Inc.
    800-411-4566 ext 2403 office
    16