Webinar: Turning Insight Into Action: Analytics & Effective Denials Management

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http://www.modernhealthcare.com/article/20140514/SPONSORED/305149926/webinar-turning-insight-into-action-analytics-effective-denials

Join us to learn how leaders at Middlesex Hospital turned insight into action by leveraging analytics to drive financial performance. This presentation will showcase how Middlesex streamlined its Denials Management process by using analytics to identify trends and opportunities for improvement, as well as for departmental managers to monitor operational aspects of the business.

By attending this webinar, you will learn:

- How post-denial write-off analytics provide immediate feedback for targeting payers, service type, denial type and/or high-dollar areas
- The impact near-real-time data can have on the feedback loops working with clinical departments
- The financial benefit of investing in a dedicated a Denials Management team

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Webinar: Turning Insight Into Action: Analytics & Effective Denials Management

  1. 1. Analytics & Effective Denials Management June 10, 2014
  2. 2. Introductions Andy LeBlanc Supervisor, Revenue Cycle Employed at Middlesex Hospital for the past 25 years. Director of Patient Financial Services overseeing patient accounting, patient access, and payer contracting. Active on Ct. Hospital Association committees, and a member of HMFA and AAHAM. Currently using GE Centricity Business for revenue cycle and partner with GE on focus groups, enhancement requests and the hospital user group. Prior employment was with a Connecticut Bank managing two branch offices. Employed with Middlesex Hospital a total of 6 years. Responsible for implementing, designing and providing support for business and administrative analytics within all revenue cycle functional areas. Works to find revenue opportunities related to cost reductions and/or charging efficiency. Focused on architecture of business intelligence tools that assist in decision support activities. Holds a PMP certification & is an active member of HFMA & PMI communities. 1 Michael Mast Global Director, GE Healthcare IT Michael Mast is a global director at GE Healthcare IT. Michael manages go-to-market strategy for GEHC’s Integrated Care and Financial Management solutions. Michael has over 10 years of healthcare IT experience. You can follow Michael on Twitter at @mjmast Pat Neisser Director, Patient Financial Services
  3. 3. About Us 2
  4. 4. Background ● 2009 - Denials were approx $3m annually ● Hired a Denial Specialist to better handle analytics & reporting ● Leveraged Analytics to identify, by Payor and/or Service Line areas of opportunity ● High-level analytics coupled with drill-down capabilities provided direction & actionable information direct to department leads 3
  5. 5. Denial Write-Offs Appeals Tracking Denials Team Progression... 2014 2013 2010 4
  6. 6. Denial Write-Offs (2010) ● Analytics o Categorization of Write-Offs, by Payer, Service & Type of Denial o Dashboard, single-source of truth ● Workflow/Process Controls o Formation of Clinical Compliance teams o Feedback loops direct to departments & physician practices o Ability to focus on specific targeted denials, as-needed ● Measurable Outcomes o Service Line dollars written-off, by type o Time-based trending with goals, overall + departmental Analytics Workflow Outcomes 5
  7. 7. Denial Write-Offs Analytics Workflow Outcomes ● Categorization of Write-Offs, by Payer, Service & Type of Denial ● Dashboard, single-source of truth 6
  8. 8. Denial Write-Offs Analytics Workflow Outcomes 7
  9. 9. Denial Write-Offs Analytics Workflow Outcomes ● Formation of Clinical Compliance teams ● Feedback loops direct to departments & physician practices ● Ability to focus on specific targeted denials, as-needed 8
  10. 10. Denial Write-Offs Analytics Workflow Outcomes ● Service Line dollars written-off, by type ● Time-based trending with goals, overall + departments Lab Radiology 9
  11. 11. Appeals Tracking (2013) ● Analytics o Visibility into Payers, Appeal Type, Time to Resolution ● Workflow/Process Controls o Date/Time stamps o Support for redistribution of work ● Measurable Outcomes o Win %, by Payer, by Appeal Type for both volume & dollars o Benchmark resolution times comparing payers o Negotiating leverage with payers Analytics Workflow Outcomes 10
  12. 12. Appeals Tracking Analytics Workflow Outcomes ● Visibility into Payers, Appeal Type, Time to Resolution *subset of total *subset of total 11
  13. 13. Poll Question What financial outcomes is your organization most focused on improving? a. Reduced A/R days b. Improved net collections ratio c. Improved point of service collections d. Greater understanding of activity costs e. Improved cash flow 12
  14. 14. Appeals Tracking Analytics Workflow Outcomes ● Date/Time stamps ● Support for redistribution of work 13
  15. 15. Appeals Tracking Analytics Workflow Outcomes ● Win %, by Payer, by Appeal Type for both volume & dollars ● Benchmark resolution times comparing payers ● Negotiating leverage with payers *subset of total *subset of total 14
  16. 16. Denial Team (2014) ● What is it? ● Why is it needed? ● How was it staffed? Analytics Workflow Outcomes 15
  17. 17. Denial Team Analytics Workflow Outcomes ● Categorization of Rejections, by Payer, Service & Type of Denial ● Crosstab, time-based tracking tools 16
  18. 18. Denial Team Analytics Workflow Outcomes ● Reorganized 2 FTE’s to focus on rejection functional area, by payer (Medicare 1st LOB tackled) ● More focus on consolidation & specialized work for greater overall visibility to source of denials, yielding greater results 17
  19. 19. Denial Team Analytics Workflow Outcomes ● FTE savings ● Cash flow improvement ● Reduction in volume of rejections, by Payer & Type 18
  20. 20. Next Steps
  21. 21. Imagination at work. Michael Mast, Global Director at GE Healthcare IT Financial Management
  22. 22. ©2014 General Electric Company – All rights reserved. The results expressed in this document may not be applicable to a particular site or installation and individual results may vary. This document and its contents are provided to you for informational purposes only and do not constitute a representation, warranty or performance guarantee. GE disclaims liability for any loss, which may arise from reliance on or use of information, contained in this document. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may be reproduced 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 A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GE’S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE. Omnyx products are for in vitro diagnostic use for specific clinical applications, and are intended for research use only on other applications. Predix™ is GE’s software platform for the Industrial Internet. Predix enables asset and operations optimization by providing a standard way to run industrial-scale analytics and connect machines, data, and people. Whether your solutions are deployed on machines, on-premise or in the cloud, Predix provides an integrated stack of technologies for distributed computing and big data analytics, asset management, machine-to-machine communication and mobility, meeting your needs for scalability, extensibility, customizability, and security. GE, the GE Monogram, Centricity, Predix, and imagination at work are trademarks of General Electric Company. Caradigm is a registered trademark of Caradigm USA LLC. Omnyx is a trademark of Omnyx, LLC. All other product names and logos are trademarks or registered trademarks of their respective companies. General Electric Company, by and through its GE Healthcare division. 22
  23. 23. A fundamental transformation of healthcare 23 Healthcare IT is at the helm of driving a productivity transformation across the industry Patients seek… Providers need… • More face time • Care that revolves around them • More active role in care decisions • More consistent, higher quality outcomes • Configurable tools to match their workflow • Integration with existing systems • View of patient across care pathway • More consistent, higher quality outcomes
  24. 24. The rapid rise of value-driven healthcare 24 Increased government policies and financial pressures… …which require software- enabled solutions to deliver on cost and quality …drive shift to more integrated and value- based care models…
  25. 25. 25 Poll Question What are the biggest challenges that your organization faces in managing risk? a.The complexity of contracting b.Defining attributable costs c. Managing populations d.Taking the first step e.We do not plan to engage in risk-based contracting
  26. 26. Our joint opportunity Healthcare IT transformation to help drive better outcomes 26 From treating illness to managing health Enable patients with more informed and proactive healthcare experience Give providers tools to help deliver better outcomesAccelerating workflows, streamlining processes, improving analytics capabilities… Liberate and create new value from data
  27. 27. Key ingredients to deliver successful outcomes 27 All three elements required to improve healthcare delivery Software & Analytics Workflow & Domain Expertise Strong Ecosystem
  28. 28. Financial Management 28 Customer Challenges GE Solutions Customer Outcomes 1 Baystate Health in Massachusetts: reduced billing lag time by 69% - Source: Baystate Health in Massachusetts Case Study, 2012 2 University of Missouri Health: decreased days in A/R by 58% - Source: University of Missouri Health Case Study, 2012 3 Saint Francis Health System: increased up-front collections by $2M to $12M. Source: Optimizing Revenue Cycle Management: A Case Study of Centricity Business at Saint Francis Health System, IDC Health Insight, August 2012 “How can we take on risk and still deliver solid patient outcomes?” Financial Risk Management Solutions Reduced billing lag time by 69%1 Decreased A/R days by 58%2 “What type of healthcare reform model is right for my practice?” Contract Modeling & Management Helped reduce cost to collect to less than 4%3 “Which metrics should I focus on to drive maximum profitability?” Revenue Cycle Management Activity-Based Costing Increased up-front collections by $2M to $12M3 “How do I connect my IT systems to ensure accuracy and great outcomes in reporting?” EDI & Claims Processing
  29. 29. Enterprise Revenue Cycle: Centricity Business Core Tenets Reform ready. Now. • Whether implementing full capitation or taking your first steps in managing risk, Centricity Business is your foundation for success. Enterprise-wide visibility & control • Improve financial performance with a consolidated approach to managing both acute care hospital billing and ambulatory billing Comprehensive Task Management • Flexible enterprise task management enables you to control every aspect of your accounts receivable; every payer, every edit, every rejection. 29
  30. 30. Questions for Our Speakers? Andy LeBlanc Supervisor, Revenue Cycle Michael Mast Global Director, GE Healthcare IT Pat Neisser Director, Patient Financial Services

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