Welcome to Trace Days!
Dave StriddeChief Operating OfficerThe White Stone Group
Account Management TeamJo Norris – VP of Account ManagementNichole Harmon – Indianapolis, INDebra Holman – Nashville, TNAl...
Sales TeamKen Cassell – Senior Vice President of SalesBlair Wright – Knoxville, TNJerry Thomas – Oviedo, FLWalt Bearden – ...
Our Team - Here to Serve YouTim Hoskins | Director of Enterprise Architecture & SecurityMatt Jernigan | Director of Produc...
Our Lofty GoalTo be the very best support organization in thehealthcare software industry.• High value on genuine relation...
Thanks for joining us!
Jeff PetersPresident and CEOThe White Stone Group, Inc.
Key StatsThe White Stone Grouphas 64 employees –48 at our corporateoffice in Knoxville andanother 16 employeesacross the c...
Continuity of KnowledgeThe average tenure of a TWSG employee is over6 years.
05101520253099 00 01 02 03 04 05 06 07 08 09 10 11 12TransactionsinMillionsTrace Usage
Where does the growth come from?VoiceFaxElectronic
We love to hear from our customers!We have received over 700 inputs from Tell Us!
Thank You!
Workshop 1:Is Your Revenue Cycle STILL Sufferingfrom Communication Chaos?Rebecca Black, FHFMA, CPAVice President of Revenu...
IS YOUR REVENUECYCLE STILL SUFFERINGFROM COMMUNICATIONCHAOS?Rebecca T. Black, FHFMA, CPA | Vice President of RevenueCycleS...
Learning ObjectivesWhat are the signs that you still havecommunication gaps in your Revenue Cycle?What are your key feedba...
The Cost of Communication ChaosHospitals waste $12 billion a year due to poorcommunication, approximately 2 percent of nat...
Why Do We Still Have CHAOS inthe Revenue Cycle? Very complex Many processes and players Broad spectrum of activities D...
How to Know if You Still Suffer from CHAOS Delayed accounts receivables Initial denial rate Net days in A/Rec – benchma...
How to Know if You Still Suffer from CHAOS Frustrated customers Complaint volume HCAHPS scores Cancelled procedures L...
Key Revenue Cycle Feedback Sources• Who owns these functions:• Scheduling• Pre Access• Point of Service• Case Management f...
Missing Pieces to Your Bottom Line Denials “falling through the cracks” Reliance on “homegrown” databases andmanual spre...
Denials: Not Going Away20% of claims are delayed or denied7% of claims are never paidInsurance companies return claims an ...
Initial Denials: % of Outstanding AR50%19%31%0% - 5%6% - 10%>10%31% of hospitals have initial denials greater than 10%Sour...
Initial Denials: Sources of ErrorsNearly 3/4 of errors traced back to the front endSource: Financial Leadership Council 20...
Denied Claims0.0%0.2%0.4%0.6%0.8%1.0%1.2%1.4%1.6%National Average Top 25% Benchmark1.5%0.6%Source: Healthcare Business Ins...
Denial Write-Offs0.0%0.5%1.0%1.5%2.0%2.5%3.0%3.5%4.0%High PerformanceQuartileMedian Low PerformanceQuartile0.4%1.1%3.9%Sou...
Making Sense of the NumbersHospital A Gross revenue = $1B Net revenue (30%) = $300M Net operating margin of 3% = $9M 1...
Are You Protecting Your Dollars Today…AND TOMORROW?• Recoupment reasons:• Coverage at time of care• Type of service provid...
How Are You Doing in These Areas? Denial Prevention Authorizations (phone, web or fax) Verification that no pre cert wa...
Face-to-FaceConversationsPrinterScannerMemoryNote PadFileCabinetCD-ROMDVDTapeRecorderComputer
Bringing Clarity to ChaosCentralRecordStorageWebTrackingSystemIndex andArchiveDate-and-Time StampSystem-WideAccessEasyRetr...
Saint Joseph’s Hospital of Atlanta410-bedacute-carefacility servingmetro Atlanta& surroundingareasOne ofSoutheast’stop spe...
Areas of Technology Application Precertification Preregistration process Payment estimates POS collections Verificati...
Voice Recording ProcessIncoming CallsOutgoing CallsOutgoing VoicemailsVoice solutioncaptures, indexes, and stores theconve...
Real-Life ScenarioIdentified large volume of denials for “lack ofpre-certification/notification” from a particularpayer re...
DetailsPatient received 3 CT scans on samedate of service – chest, abdomen, andpelvis.All 3 scans were fully authorized.A ...
Review of Payer’s ResearchRecorded conversation between facility & Contracting Manager from PayerPayer saysthat only oneof...
Transcript Emailed Immediately toContracting ManagerThis is the transcript header; it contained the patient’s name, accoun...
Transcript Continued…This is from the body of the transcript where the authorization takesplace; it clearly shows that all...
A Week Later, Payer Calls Back…Payer finally acknowledges that they have a core issue between their third-party radiology ...
Results of Project Implementation Implemented Dec. 1, 2009 Results as of Mar. 31, 2012 “Cash in the door” = $458,816 1...
Results – Improved SatisfactionStaff Members• Listening torecorded callshelps staffmembers learnfrom mistakesand find ways...
Lessons LearnedFor SJHA, documentation was invaluable to provingcompliance with prescribed precertification protocols.With...
Calculating ROI: Scheduling, Orders Prevent one cancelled surgery = ___ Retain one physician = ___ Reassign one FTE fro...
Calculating ROI: Patient Experience Retain one additional patient = ___ Collect one additional payment atPoint of Servic...
Calculating ROI: Revenue At-Risk Prevent one denial per month = ___ Overturn one denial per month = ___ Reduce cost to ...
Calculating ROI: Coordination of Care Prevent one readmission = ___ Prevent one medical necessity denial = ___ Prevent ...
ConclusionsRevenue cycle communications are many and varied and far fromperfect.Misleading and inaccurate information is a...
Questions?Thank You!
Which area represents the best opportunityfor growth with Trace at your organization?1 2 3 454%5%24%16%1. Revenue-at-Risk2...
Welcome to Trace Days!
Workshops 2 & 5Session 1: What’s New In TraceJo Norris, VP of Account ManagementDerek Morgan, Trace Product OwnerMarcia Pa...
Tracker Work Lists: Done!
HL7 Indexing
My Hospital…A. Already has an HL7/ADT feed with TraceB. Does not have HL7 with Trace, but we plan to get itC. Does not hav...
Unassigned Manual
Unassigned
Reconciling
Annotation
Signatures
Annotation…A. Is great and we will/do use it a lotB. Is not very useful for usC. Doesn’t do enough, it needs more workD. N...
Downloads
Import
Import
Coversheet Notes
Quick Print/ Custom Button
Notification Favorites
Notification Favorites
List Actions
Batch Actions
User Preferences
User Preferences
PixCert XPS…………It’s fast!
Reports!A. We need more & better reports ASAP!B. The reports we already have are good enoughC. We love the existing report...
Face to Face Recording/ Photo Capture
Questions?
Welcome to Trace Days!
Workshop 2 & 5Trace Best Practices & User Stories
HL7 Integration & IndexingWhat is HL7 integration? It is an interface or communication between yourhospitals patient mana...
Downloads Tab This feature gives you the ability to “upload and save”files saved in your documents library or documentsst...
Front-End ProcessesPatient Access, Central Scheduling,Registration, Etc.Nichole Harmon & Lynda Clay
Inbound Faxing• Physician Order Management• Indexing, manual or HL7 integration• Custom Fields• Reserve Faxes
New Inbox Faxes Display
Front End Processes• Notifications• Fax/Image Annotation• Fax Back Invalid Orders or Confirmations• Standard Cover Sheet N...
Front End Processes
Inbound Faxing – Best Practice• Physician Orders• Pharmacy• Bed Status Change• Surgery• Case Management
Front End Processes• Value- Prevents lost orders- Audit Trail- Ability to track invalid orders- Eliminate Paper- Accessibl...
Trace Voice• Why Record Conversations?– Big BrotherOR– Capture Prior Authorizations– Validate Scripting– Eliminate “he sai...
Trace Voice4 Voice Recording Options -Choice depends on:• Volume• Purpose• Call Type
Trace Voice• Auto Record– Seamless– No end user intervention– IndiscriminateBest Practice Scenario – Call Centers to suppo...
Trace Voice• On Demand– Requires hardware– User controlled– DiscriminateBest Practice Scenario – Collection areas calling ...
Trace Voice• Anywhere– Flexible– User controlled– DiscriminateBest Practice Scenario – Case Managers for billingdisputes, ...
Trace Voice• Face-to-Face– In-person– User controlled– DiscriminateBest Practice Scenario – Financial Counselorsreviewing ...
Mid-Cycle ProcessesCase Management, Concurrent Review, Etc.La Teshia Jones & Lauren Bento
Case Management Processes• Centralized number for incoming faxes• Case Managers officed all over the hospital• Paper docum...
Fax Management with FaxCert• Inbound and outbound• Alternative to scanning documents• HL7 integration for efficient and ac...
Fax Management with FaxCert• Value– Centralized, electronic storage of faxes– Improve workflow efficiency– Enhanced depart...
PixCert• Capture clinical documentation and fax• Capture departmental forms and notify or fax• HL7 integration for efficie...
PixCert
PixCert• Value– Increased workflow efficiency– Accessibility– Electronic audit trail
Downloads Tab• Insurance specific forms• Internal documents– Authorization changes– Schedules– Concurrent appeal letters
Downloads Tab for Mid Cycle Process
Downloads Tab• Value– Centralized location for frequently used forms anddocuments– Capture and store document without havi...
Trace Voice for Readmissions Reductions Programs Patient Protection and Affordable Care Act (P-PACA) Quality indicator v...
Back-End ProcessesBusiness Office, Denial Management,Appeals, Etc.Debbie Holman & Michael Mouton
Back-End Processes Denial, Appeal Management Worklists Downloads Tab, Tools Tab Import Tiff and PDF Feature Outbound ...
Managing Trace Communication EventsHow do I use my Worklists? Customize Column data to match your workflow Organizes dat...
Worklist
Download DocumentsDo you have a standard form that you can“edit”? Upload to your downloads Tab and completewith new patie...
Downloads
How do you resubmit your denials & appeals?Answer # 1 - By FaxAnswer # 2 - Print and MailAnswer # 3 - Phone Call and plead...
Tools and Utilities for Back EndImport Tiff or PDF documents Electronic Medical Records Insurance Forms Release of Info...
Tools Tab
Outbound Faxing Why Fax Outbound your appeals and claim process?Benefits Easy to locate faxed transactions anddocuments...
With TraceYour Hospital is on theroad to recovery!!
Welcome to Trace Days!
Workshop 3Trace – New & Coming AttractionsMatt Jernigan, Director of Product ManagementDebra Holman, Trace Account Manager...
Topics• Trace Integration Options• Auto Notification of Admission• Trace Quality & Coaching• Discharge Instructions
Trace IntegrationTrace Integration includes two options…Image Export&Image Import
Do you currently print and scan documentsfor the sole purpose of entering into anothersystem?1 2 3 4 531%0% 0%63%6%1. No, ...
Image ExportAutomatically transfers images in Trace tovirtually any EMR or imaging system.trace EMR
Image ExportSome typical benefits…• Reduced printing costs• Instant access to documents in other systems• Documents backed...
Image ImportHighly versatile and provides automatic faxingindexing and notifications.traceEMRFaxIndexNotify
Image ImportSome typical uses…• Auto faxing of test results such as radiology ormammography results• Consolidate CPOE and ...
Image Import
Trace IntegrationRequirements• Trace standard HL7 interface• Technical service call / project plan• Priced per sending/rec...
• Trace Integration Options• Auto notification of admission• Trace Quality & Coaching• Discharge InstructionsNext Up
Notification of AdmissionProblem• Payers often require notification of inpatientadmission within 24 hours.• If missed, the...
Notification of AdmissionSolutionAutomatically fax a notification to the payer oninpatient admissions and status changes.t...
Notification of Admissiontrace PayerRegistrationHL7 Fax*Notification
Notification of Admission
Notification of AdmissionAdvantages• Trace automates the notification.• Within Tracker the notifications can becompared to...
Would this feature be valuable at yourhospital?1 2 3 457%0%14%29%1. Yes, this would beawesome!2. Interesting, it might beh...
• Trace Integration Options• Auto notification of admission• Trace Quality & Coaching• Discharge InstructionsNext Up
Voice – Quality & Coaching• 70% of hospitals rank patient experience asone of their top three priorities.*• The patient’s ...
Voice – Quality & CoachingRevenue Cycle Impact• Pre-Service communications set the tone forthe entire stay.• Post-Service ...
Voice – Quality & CoachingRevenue Cycle ImpactSatisfied withbilling experience93% Satisfied withClinicalUnsatisfied withbi...
Voice – Quality & CoachingVoice – Quality and Coaching will be an add-onmodule allowing managers to grade recordingsso tha...
Voice – Quality & CoachingDemo
Voice – Quality & CoachingAdvantages• Create a quality and coaching program.• Grade recordings based on your criteria.• Id...
Would this feature be valuable at yourhospital?1 2 3 443%3%26%29%1. Yes, this is the coolestthing since Trace Days!2. Inte...
• Trace Integration Options• Auto Notification of Admission• Trace Quality & Coaching• Discharge InstructionsNext Up
Discharge Instructions• The Affordable Care Act established the HospitalReadmission Reduction Program.• Requires CMS to re...
Discharge InstructionsTrace• Utilize Trace Voice Face-to-Face to capture.• Evaluate quality with Trace Quality & Coachingt...
Would this feature be valuable at yourhospital?1 2 3 424%9%32%35%1. Yes, I think it would begreat!2. Interesting, it might...
Questions?
Welcome to Trace Days!
Workshop 4Q&A with Trace ChampionsStephen HovanVice President, Revenue CycleUniversity of Tennessee Medical CenterKnoxvill...
Stephen HovanVice President, Revenue CycleUniversity of Tennessee Medical CenterKnoxville, TN
About UHS• University Health Systems, Inc., Knoxville, TN• The region’s only academic medical center• Licensed for 581 bed...
The Past Facts for UHS• Over $16 million in denials consisting of 8.7million in fatal denials• Over 35,000 denials• 2.2% o...
Our Plan of Attack• Define denials• Measure & monitor• Establish denials champion• Tools of the trade
Our Tools of The Trade• Reporting• Workflow• Documentation• Communication
Our Revenue Cycle IndicatorsJanuary 2007 to March 2012• Aged Accounts greater than 90: 31% to 19%• 23% increase in Cash Co...
Trace Voice at UHS• Scheduling• Insurance Authorization• Financial Counseling• Customer Service• Business Office
FaxCert at UHS• Order management• Medical record requests• Itemized charges for patients• Information requests from physic...
PixCert at UHSDocumented proof of important onlineprocesses that protects revenue such as:Verification of Benefits and El...
Our Results• Overturning and preventing denials• Improved revenue cycle productivity• Renewed staff confidence to fight a ...
Our Fatal Denials Reduction$4,000,000.00$5,000,000.00$6,000,000.00$7,000,000.00$8,000,000.00$9,000,000.002007 2008 2009 20...
Our Future State• Continue to streamline workflow• Expansion of user defined work-lists• Integration with optical imaging ...
Questions
How effective are you in using Trace toaddress denials?1 2 3 49%21%15%56%1. We’re doing great!2. We’re doingokay, but coul...
Workshop 4Q&A with Trace ChampionsLynn Arrington, CHAMManager of Insurance Verification,Patient Access Intake CenterTexas ...
About THR
Q&A
What is your level of interest in usingface-to-face recording at your hospital?1 2 3 443%10%3%43%1. OMG! I wish I had itye...
7th Inning Stretch
Workshop 4Q&A with Trace ChampionsStuart SchiffmanVice President of Revenue ManagementCatholic Health ServicesLauderdale L...
2013TRACE DAYS CONFERENCEStuart Schiffman
CATHOLIC HEALTH SERVICES Faith Based Organization Mission: “To provide health care and services to those in need;To mini...
CATHOLIC HEALTH SERVICES Nursing Homes (Skilled Nursing & Long Term Care) 633 Beds (4 locations) Rehabilitation Hospita...
CATHOLIC HEALTH SERVICES 8 Service Lines 30 Facilities 2,700 Employees Total Revenue - $160 Million
Revenue Cycle Management Centralized Business Office Billing Collections System Management & Oversight (Net Solutions)...
Revenue Cycle Management PAYER MIX Medicare – 40% Medicaid – 35% Managed Care/Commercial – 18% Private Pay – 7%
Regulatory Environment Medicaid State Reform Program Mandatory Medicaid Long Term Care Enrollment (Managed Care) Contr...
REVENUE CYCLE PROCESS
Accounts Receivable Management Denials Management Authorization (Extended Stays) Level of Care Disputes Assertive Appr...
ACCOUNTABILITY Monitoring Performance Reports Cash Collections Days In A/R Bad Debt Census Payer P & L Utilization...
REVENUE CYCLE TOOLS Net Solutions RAM (ADT & Billing) Clinical (Interfacing) SSI Electronic Billing (Edits; Transmiss...
REVENUE CYCLE TOOLS Verification/Eligibility Process Passport Availity Web Sites Medicaid Web Portal Medicare DDE F...
OVERALL PERFORMANCE Days In A/R (Reduced from 45 to 33) Cash Collections (Over Budget by $1.9M & $1.5M) Increased Reven...
Trace Implementation – KeyComponents Senior Management Support ROI Analysis References Facility Leadership Support Ke...
Trace Implementation – KeyComponents (cont’d.) Project Management Trace Oversight Project Charter Ongoing Communicatio...
Trace Implementation – KeyComponents (cont’d.) Project Management CHS Approach Departmental Process Reviews (Admissions...
Have you been able to quantify the benefitTrace has brought to your organization?1 2 3 423%20%33%23%1. Yes, through increa...
Workshop 4Q&A with Trace ChampionsJeanette McDowell R.N.C./MSNManager of Central Intake and AssessmentPhoebe Putney Memori...
Q&A
What is your interest in using Trace in yourTransfer Center?1 2 3 418%11%39%32%1. Very interested! It’s a bigproblem for u...
Welcome to Trace Days!
What movie/TV show best describes yourevening last night?1 2 3 4 59%41%38%3%9%1. The Hangover2. Good Times3. Lost4. Alien5...
Chance to Win $50 Right Now!Like UsFacebook.com/TracebyTWSGorUse #tracedays in a TweetTwitter.com/TracebyTWSG
Workshop 6Making the Most of TraceLori Forbess, Vice President of Enterprise AccountsJo Norris, Vice President of Account ...
Is Trace underutilized in your facility?1 2 3 40%27%42%30%1. I think it’s used to itsmaximum potential.2. There are a few ...
OptimizationThe act, process, or methodologyof making something (as adesign, system, or decision) as fullyfunctional or ef...
Optimization Process
Enterprise Tools – Usage Matrix
Optimization Process
Trace Administrator• Leadership• Planning• Configuration• Preparation• Compliance• Follow up
Lunch and Learn
Trace Assessment Purpose1. Identify current work flow issues2. Make recommendations for optimizing use of Trace3. Identify...
General Workflow Overview1. What is your department responsible for?2. How is your work divided?3. How many physical sites...
Department AssessmentPATIENT ACCESS / PFS / SCHEDULING:1. Who handles benefits and eligibility processing?2. How do you do...
Assessment Summary• DEPARTMENT: CASE MANAGEMENT – WHITE STONE HOSPITAL• Contacts:• Department Contact:• Trace Administrato...
Enterprise Tools – Strategic Plan
RoadmapQ2 2012 Q3 2012 Q4 2012Discovery Test/Trainingenvironment Redundancy/DisasterRecovery Prioritize additionalfacil...
Optimization Process
Project Charter• Purpose– Identify Key Stakeholders– Outline Requirements– Authorize Resources• Contents– Strategic Object...
Project Charter
Project Management Plan• Scope Management Plano Project charter• Time Management Plano Implementation Scheduleo Project Pl...
Stakeholder RegisterName Primary Role/Designation Title Influence Communications/Strategy wkly call notes risk register up...
Risk RegisterRisk # Date RequestorRiskDescriptionOverallImpact(H-M-L)Probability (%)ScheduleImpact(H-M-L)Mitigation Risk O...
Continuing Improvement
Questions?
Welcome to Trace Days!
Workshop 7H. A. & Enterprise SupportTim Hoskins, Director of Enterprise Architecture
What Is H.A. And Why Do I Want It?• Load / Capacity• Availability &Resiliency• Continuity
What does your day look like if you havedowntime with Trace?1 2 366%19%16%1. Running around withmy hair on fire.2. I hear ...
Do you use Trace in patient contact or clinicalsettings?1 2 3 428%22%34%16%1. Patient Contact (e.g.Registration, Financial...
How Trace Looks Today“I’m theDatabase!”“I’m theTraceStorageSystem”“I’m theFaxCertServer”“I’m theTracker WebServer”“I’m the...
How Trace Enterprise Solutions Look“I’m theFaxCertServer”“I’m theFaxCertServer”“I’m theDatabaseServer”“I’m theStorageServe...
The Trace Enterprise Solution• Capacity gain with multiple Trace servers• The ability to scale as Trace grows• Minimize an...
Questions?
Workshop 7Support ServicesBen O’Brien, Director of Support Services
Support Services:How Can We Help You?
Who Is Support ServicesTrace Support Services is comprised ofAccount Specialists, Product Specialistsand Technical Special...
Our GoalTo be the very best support organization in thehealthcare software industry.• High value on genuine relationships ...
Contacting Customer Support8 AM-8 PM EDT(Mon-Fri)Available 24x7x365Phone:877-864-2378Email:Support@twsg.comTellUs!(Right f...
Support ProcessAccount Specialist Product SpecialistTechnical SpecialistImplementation andSupport EngineeringYouAccount Sp...
2012• We closed over 19,000 Cases,80% of which were closed in less than 1 hour.• The average wait time for a Trace support...
2013• Close 90% of cases in less than 1 hour• Continuous improvement of server monitoring• Cut down average queue wait tim...
Today’s Customer Portal
Today’s Customer Portal• Download help documents• Request training• Submit a support case• Submit new users
A Note About Self ServiceOur goal is to provide you as many opportunitiesas possible to get the information, access andsup...
Self ServiceWhat features would you like to see in 2013?
Would you like the ability to manage yourcases online?1. Interested2. Not Interested
Would You Like the Ability to Have RemoteSupport from Tracker?1. Interested2. Not Interested
Would You Like to Be Able to Chat With TraceSupport?1. Interested2. Not Interested
How Interested Are You in “Ideas”?1. Interested2. Not Interested
How Interested Are You in Improvementsto User Submission?1. Interested2. Not Interested
Questions?
Thank You!I want to hear your ideason how we can continueto improve your supportexperience. Email me atben.obrien@twsg.com...
Final Wrap-Up• Surveys• Boxed Lunches• Rides to Airport• Rides to Corporate Office• Room Key is Parking Pass
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
Trace Days 2013 | Knoxville, TN
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  • Worked at TWSG for over 12 yearsStarted out as a developer Managed the Technical team Now I manage the Architecture and the Infrastructure Team
  • “I’ll help you understand H.A. by talking about Truck Tires” Why does the semi truck have so many tires? - Load - Resiliency (a tire goes flat, blows out) - Continuity (the other tires pick up the slack)
  • “Let’s take that analogy and extend that to Trace”
  • At the beginning you might have PFS and Scheduling as part of your Charter for Trace and all is well. Over time OR Scheduling, ED, Bed Control, Case Management, Customer Service, Radiology….Q: How many of you have gone through a Trace server replacement? Over time the Trace “sprawl” can overwhelm the resources that Trace started with
  • Who has ever met the “Database Administrator” Who has ever met the Virtualization guy or gal? Who has ever met the someone on the “Storage Team” (Arrays)
  • Worked at TWSG for over 12 yearsStarted out as a developer Managed the Technical team Now I manage the Architecture and the Infrastructure Team
  • Trace Days 2013 | Knoxville, TN

    1. 1. Welcome to Trace Days!
    2. 2. Dave StriddeChief Operating OfficerThe White Stone Group
    3. 3. Account Management TeamJo Norris – VP of Account ManagementNichole Harmon – Indianapolis, INDebra Holman – Nashville, TNAljeana Howard – Atlanta, GALa Teshia Jones – Houston, TXDebbie Lloyd – Dallas, TXMichael Mouton – Dallas, TXMarcia Patterson – Cincinnati, OHDeborah Todd – Memphis, TNLynda Clay – Nashua, NHLauren Bento – Port St. Lucie, FL
    4. 4. Sales TeamKen Cassell – Senior Vice President of SalesBlair Wright – Knoxville, TNJerry Thomas – Oviedo, FLWalt Bearden – Knoxville, TNLori Forbess – Beaverton, ORWindell Yancy – Dallas, TXPhillip McClure – Fort Worth, TX
    5. 5. Our Team - Here to Serve YouTim Hoskins | Director of Enterprise Architecture & SecurityMatt Jernigan | Director of Product ManagementErin McCarty | Director of MarketingBill Milam | Director of Software DevelopmentDerek Morgan | Trace Product OwnerBen O’Brien | Director of Support ServicesNicole Shanklin | Director of Implementation & Training
    6. 6. Our Lofty GoalTo be the very best support organization in thehealthcare software industry.• High value on genuine relationships with our customers• High value on responsiveness• High value on ROI - ensuring that our products bring realvalue to your organization• High value on trustworthiness - we want to be acompany that you can trust to do the right thing
    7. 7. Thanks for joining us!
    8. 8. Jeff PetersPresident and CEOThe White Stone Group, Inc.
    9. 9. Key StatsThe White Stone Grouphas 64 employees –48 at our corporateoffice in Knoxville andanother 16 employeesacross the country.
    10. 10. Continuity of KnowledgeThe average tenure of a TWSG employee is over6 years.
    11. 11. 05101520253099 00 01 02 03 04 05 06 07 08 09 10 11 12TransactionsinMillionsTrace Usage
    12. 12. Where does the growth come from?VoiceFaxElectronic
    13. 13. We love to hear from our customers!We have received over 700 inputs from Tell Us!
    14. 14. Thank You!
    15. 15. Workshop 1:Is Your Revenue Cycle STILL Sufferingfrom Communication Chaos?Rebecca Black, FHFMA, CPAVice President of Revenue CycleSouthern Regional Medical CenterRiverdale, GA
    16. 16. IS YOUR REVENUECYCLE STILL SUFFERINGFROM COMMUNICATIONCHAOS?Rebecca T. Black, FHFMA, CPA | Vice President of RevenueCycleSouthern Regional Medical Center | Riverdale, GA
    17. 17. Learning ObjectivesWhat are the signs that you still havecommunication gaps in your Revenue Cycle?What are your key feedback loops?How did one hospital use Trace to reducecommunication chaos?How can you track and demonstrate return oninvestment (ROI)?
    18. 18. The Cost of Communication ChaosHospitals waste $12 billion a year due to poorcommunication, approximately 2 percent of nationalhospital revenues and more than half the averagehospital margin of 3.6 percent.Source: Amednews.com. Communication failures over diagnostic tests prompting more lawsuits. 2011.
    19. 19. Why Do We Still Have CHAOS inthe Revenue Cycle? Very complex Many processes and players Broad spectrum of activities Departments don’t align under the same area ofoversightSource: Protiviti. Healthcare Revenue Integrity Strategies: Using High Value Revenue Cycle Assessments to Protectand Improve the Bottom Line. 2012.“A provider is at risk every day of losing revenue atmany points in the cycle, especially in routineareas of operations where inefficiency and a lackof communication between departments arecommon.”
    20. 20. How to Know if You Still Suffer from CHAOS Delayed accounts receivables Initial denial rate Net days in A/Rec – benchmark to standards/best practice Collections compared to Net Patient Service Revenue (avg100%) Denied claims Technical (administrative) or clinical rate Overturn rate Data by payer/line of business Rework First pass clean claim rate Volume of required claim edits Volume of manual adjustments Wasted staff time Productivity Cost to collect
    21. 21. How to Know if You Still Suffer from CHAOS Frustrated customers Complaint volume HCAHPS scores Cancelled procedures Last minute scheduling changes By procedural area/payer contract Wasted materials/resources High cost radio therapeutic drugs/chemo agents Gaps in schedules (Open rooms in procedural areas) Physician dissatisfaction Complaints to Administration Loss of volume/downward trends Patient steerage
    22. 22. Key Revenue Cycle Feedback Sources• Who owns these functions:• Scheduling• Pre Access• Point of Service• Case Management functions• Notification of Admission• Status Determination• Concurrent Reviews• Denials Management• Trending• Tracking• Root cause analysisCommunicationis critical tosolving denialsand harnessinginformation todrive revenuecycleperformance
    23. 23. Missing Pieces to Your Bottom Line Denials “falling through the cracks” Reliance on “homegrown” databases andmanual spreadsheets to track performance Not prioritizing denied accounts for resolution Inconsistent follow-up activity on accounts Lack of understanding of root causes ofdenials Inability to speed account resolution withpayers Poor communication among departments andrevenue cycle functions
    24. 24. Denials: Not Going Away20% of claims are delayed or denied7% of claims are never paidInsurance companies return claims an average of two timesto get the information they require to process the claimSource: PNC. Automated Billing/Payment Process Can Reduce US Health Care Costs Without Sacrificing Patient Care. 2007.
    25. 25. Initial Denials: % of Outstanding AR50%19%31%0% - 5%6% - 10%>10%31% of hospitals have initial denials greater than 10%Source: Financial Leadership Council 2011 Revenue Cycle Survey. The Advisory Board Company. 2011.
    26. 26. Initial Denials: Sources of ErrorsNearly 3/4 of errors traced back to the front endSource: Financial Leadership Council 2011 Revenue Cycle Survey. The Advisory Board Company. 2011.27%16%30%27%Medical NecessityAuthorizationsDemographic InformationEligibility
    27. 27. Denied Claims0.0%0.2%0.4%0.6%0.8%1.0%1.2%1.4%1.6%National Average Top 25% Benchmark1.5%0.6%Source: Healthcare Business Insights. Solution Provider Academy. 2013
    28. 28. Denial Write-Offs0.0%0.5%1.0%1.5%2.0%2.5%3.0%3.5%4.0%High PerformanceQuartileMedian Low PerformanceQuartile0.4%1.1%3.9%Source: Financial Leadership Council 2011 Revenue Cycle Survey. The Advisory Board Company. 2011.Percentage of Net Patient Revenue
    29. 29. Making Sense of the NumbersHospital A Gross revenue = $1B Net revenue (30%) = $300M Net operating margin of 3% = $9M 1.5% lost to denials = $4.5M left on the table Losing 50% of margin Every year!
    30. 30. Are You Protecting Your Dollars Today…AND TOMORROW?• Recoupment reasons:• Coverage at time of care• Type of service provided• Existence ofauthorizations• Retro reviews wherestatus is changedRetrodenialsarecostinghospitalsmillions
    31. 31. How Are You Doing in These Areas? Denial Prevention Authorizations (phone, web or fax) Verification that no pre cert was required POS Collections/Back-end Follow-up & Collections OOP estimates, ABNs for Medicare Promises to pay/claim tracking Patient Satisfaction/Quality Assurance Consistent use of scripting, record of encounter Document consistent adherence to Policy/Procedure Behavior Modification Staff training/retraining And much more…
    32. 32. Face-to-FaceConversationsPrinterScannerMemoryNote PadFileCabinetCD-ROMDVDTapeRecorderComputer
    33. 33. Bringing Clarity to ChaosCentralRecordStorageWebTrackingSystemIndex andArchiveDate-and-Time StampSystem-WideAccessEasyRetrievaland RoutingCentral Repository
    34. 34. Saint Joseph’s Hospital of Atlanta410-bedacute-carefacility servingmetro Atlanta& surroundingareasOne ofSoutheast’stop specialty-referralhospitalsChallengingmargins dueto highMedicareutilization &tight marginson managedcareObjective tosupportrevenue cyclebest practices& achievetotal denialrate of < 1%gross
    35. 35. Areas of Technology Application Precertification Preregistration process Payment estimates POS collections Verification of claim receipt & promise to pay Denial & appeal management Contract review/payment accuracy Staff education & training
    36. 36. Voice Recording ProcessIncoming CallsOutgoing CallsOutgoing VoicemailsVoice solutioncaptures, indexes, and stores theconversation ormessageStaff access thetranscription of thecall or voicemailHospital then usesthe transcripts toresolve disputeswith insurancecompanies
    37. 37. Real-Life ScenarioIdentified large volume of denials for “lack ofpre-certification/notification” from a particularpayer related to outpatient radiology scans(CT, MRI, PET).Almost every denied claim appeared to bepre-certified and had a pre-certificationnumber.The payer’s Contracting Department wascontacted and several examples were sentfor “investigation” as to why the claims weredenied.
    38. 38. DetailsPatient received 3 CT scans on samedate of service – chest, abdomen, andpelvis.All 3 scans were fully authorized.A recorded conversation clearly indicatedthat SJHA obtained the pre-certification andhad explicitly inquired whether a differentprecert number was needed for each scan.
    39. 39. Review of Payer’s ResearchRecorded conversation between facility & Contracting Manager from PayerPayer saysthat only oneof the 3 CTscans wasauthorized.
    40. 40. Transcript Emailed Immediately toContracting ManagerThis is the transcript header; it contained the patient’s name, accountnumber, and time stamps
    41. 41. Transcript Continued…This is from the body of the transcript where the authorization takesplace; it clearly shows that all three scans were authorized.
    42. 42. A Week Later, Payer Calls Back…Payer finally acknowledges that they have a core issue between their third-party radiology vendor and their claims processing system.
    43. 43. Results of Project Implementation Implemented Dec. 1, 2009 Results as of Mar. 31, 2012 “Cash in the door” = $458,816 161 accounts, average recoup = $2,849 Average accounts overturned per month = 6.4 Prevented denials
    44. 44. Results – Improved SatisfactionStaff Members• Listening torecorded callshelps staffmembers learnfrom mistakesand find ways tokeep improvingcustomer service• Staff membersknow they havedocumentedproof tosubstantiatePatients• Increased front-end staff trainingleads to moresatisfied patients• Front-end staffhave moreaccountabilityand resources attheir disposal toprovide greatservice topatientsPhysicians• Improvedrelations betweendifferentdepartments• Less oftenassume an erroris the result ofpatient accessnegligence
    45. 45. Lessons LearnedFor SJHA, documentation was invaluable to provingcompliance with prescribed precertification protocols.Without it, inappropriate denials and cash paymentdelays would have continued.Documentation used to assure mutually agreeableprocesses with managed care payers and lessenadministrative burdens for both payer and provider.
    46. 46. Calculating ROI: Scheduling, Orders Prevent one cancelled surgery = ___ Retain one physician = ___ Reassign one FTE from scanning, filing, etc. = ___ Prevent one HIPAA violation = ___ Save one hour per day in managing orders = ___ Save one hour per day in document scanning = ___ Eliminate fax machines = ___ TOTAL savings per month = ___
    47. 47. Calculating ROI: Patient Experience Retain one additional patient = ___ Collect one additional payment atPoint of Service = ___ Prevent one patient identity theft = ___ TOTAL savings per month = ___
    48. 48. Calculating ROI: Revenue At-Risk Prevent one denial per month = ___ Overturn one denial per month = ___ Reduce cost to collect = ___ Reduce number of net days in AR = ___ TOTAL savings per month = ___
    49. 49. Calculating ROI: Coordination of Care Prevent one readmission = ___ Prevent one medical necessity denial = ___ Prevent one notification denial = ___ Prevent one EMTALA violation = ___ Reassign one FTE from faxing for dischargeplacement = ___ TOTAL savings per month = ___
    50. 50. ConclusionsRevenue cycle communications are many and varied and far fromperfect.Misleading and inaccurate information is a significant barrier toachieving revenue cycle best practices.Providers can leverage technology to bring clarity to the chaos andgain valuable ground toward achieving best practices.Providers need to increase their knowledge and understanding ofwhat “value” systems such as Trace provide and endeavor to findadditional ROI opportunities.
    51. 51. Questions?Thank You!
    52. 52. Which area represents the best opportunityfor growth with Trace at your organization?1 2 3 454%5%24%16%1. Revenue-at-Risk2. Physician Orders3. Care Coordination4. Patient Experience
    53. 53. Welcome to Trace Days!
    54. 54. Workshops 2 & 5Session 1: What’s New In TraceJo Norris, VP of Account ManagementDerek Morgan, Trace Product OwnerMarcia PattersonDeborah ToddAljeana HowardDebbie Lloyd
    55. 55. Tracker Work Lists: Done!
    56. 56. HL7 Indexing
    57. 57. My Hospital…A. Already has an HL7/ADT feed with TraceB. Does not have HL7 with Trace, but we plan to get itC. Does not have HL7 with Trace & we don’t really think we need itD. Thinks it would be awesome if we only had the $$
    58. 58. Unassigned Manual
    59. 59. Unassigned
    60. 60. Reconciling
    61. 61. Annotation
    62. 62. Signatures
    63. 63. Annotation…A. Is great and we will/do use it a lotB. Is not very useful for usC. Doesn’t do enough, it needs more workD. Not sure yet
    64. 64. Downloads
    65. 65. Import
    66. 66. Import
    67. 67. Coversheet Notes
    68. 68. Quick Print/ Custom Button
    69. 69. Notification Favorites
    70. 70. Notification Favorites
    71. 71. List Actions
    72. 72. Batch Actions
    73. 73. User Preferences
    74. 74. User Preferences
    75. 75. PixCert XPS…………It’s fast!
    76. 76. Reports!A. We need more & better reports ASAP!B. The reports we already have are good enoughC. We love the existing reportsD. We hate the existing reports with a burning hateE. We don’t care about reportsF. Reports? I didn’t know there were reports….
    77. 77. Face to Face Recording/ Photo Capture
    78. 78. Questions?
    79. 79. Welcome to Trace Days!
    80. 80. Workshop 2 & 5Trace Best Practices & User Stories
    81. 81. HL7 Integration & IndexingWhat is HL7 integration? It is an interface or communication between yourhospitals patient management system and Trace.It sends the Patient’s Registration, PreRegistration, Admission, Discharge or Transfer data toTrace.How do you index with the HL7 interface? Simply search in Trace by the patient’sdemographics. Then select the correct patientrecord from the HL7 results shown.
    82. 82. Downloads Tab This feature gives you the ability to “upload and save”files saved in your documents library or documentsstore in other applications on your desktop. Once saved, you can choose to PixCert & Fax, Notifyor Print your documents.
    83. 83. Front-End ProcessesPatient Access, Central Scheduling,Registration, Etc.Nichole Harmon & Lynda Clay
    84. 84. Inbound Faxing• Physician Order Management• Indexing, manual or HL7 integration• Custom Fields• Reserve Faxes
    85. 85. New Inbox Faxes Display
    86. 86. Front End Processes• Notifications• Fax/Image Annotation• Fax Back Invalid Orders or Confirmations• Standard Cover Sheet Notes• Image Export
    87. 87. Front End Processes
    88. 88. Inbound Faxing – Best Practice• Physician Orders• Pharmacy• Bed Status Change• Surgery• Case Management
    89. 89. Front End Processes• Value- Prevents lost orders- Audit Trail- Ability to track invalid orders- Eliminate Paper- Accessible to other departments to view
    90. 90. Trace Voice• Why Record Conversations?– Big BrotherOR– Capture Prior Authorizations– Validate Scripting– Eliminate “he said....she said”– VOB/VOE– Quality Insurance– Scripting
    91. 91. Trace Voice4 Voice Recording Options -Choice depends on:• Volume• Purpose• Call Type
    92. 92. Trace Voice• Auto Record– Seamless– No end user intervention– IndiscriminateBest Practice Scenario – Call Centers to support VOBand/or VOE, scripting, pre-registration information
    93. 93. Trace Voice• On Demand– Requires hardware– User controlled– DiscriminateBest Practice Scenario – Collection areas calling onclaim status for multiple claims/patients
    94. 94. Trace Voice• Anywhere– Flexible– User controlled– DiscriminateBest Practice Scenario – Case Managers for billingdisputes, SNF placement conversations, transfers.
    95. 95. Trace Voice• Face-to-Face– In-person– User controlled– DiscriminateBest Practice Scenario – Financial Counselorsreviewing patient financial responsibility andpayment plans.
    96. 96. Mid-Cycle ProcessesCase Management, Concurrent Review, Etc.La Teshia Jones & Lauren Bento
    97. 97. Case Management Processes• Centralized number for incoming faxes• Case Managers officed all over the hospital• Paper documentation filed in individual deskdrawers• Paper shuffling
    98. 98. Fax Management with FaxCert• Inbound and outbound• Alternative to scanning documents• HL7 integration for efficient and accurateindexing• Departmental notifications
    99. 99. Fax Management with FaxCert• Value– Centralized, electronic storage of faxes– Improve workflow efficiency– Enhanced departmental communication– Paper savings
    100. 100. PixCert• Capture clinical documentation and fax• Capture departmental forms and notify or fax• HL7 integration for efficient and accurateindexing
    101. 101. PixCert
    102. 102. PixCert• Value– Increased workflow efficiency– Accessibility– Electronic audit trail
    103. 103. Downloads Tab• Insurance specific forms• Internal documents– Authorization changes– Schedules– Concurrent appeal letters
    104. 104. Downloads Tab for Mid Cycle Process
    105. 105. Downloads Tab• Value– Centralized location for frequently used forms anddocuments– Capture and store document without having tosave to PC– Electronic faxing and combining of documents
    106. 106. Trace Voice for Readmissions Reductions Programs Patient Protection and Affordable Care Act (P-PACA) Quality indicator versus reimbursement denial Record discharge instructions Non compliance versus neglect to inform
    107. 107. Back-End ProcessesBusiness Office, Denial Management,Appeals, Etc.Debbie Holman & Michael Mouton
    108. 108. Back-End Processes Denial, Appeal Management Worklists Downloads Tab, Tools Tab Import Tiff and PDF Feature Outbound Faxing
    109. 109. Managing Trace Communication EventsHow do I use my Worklists? Customize Column data to match your workflow Organizes data in an easy to read format whenperforming searches on patient transactions Quickly access transactions forprinting, faxing, emailing transactions Perform batch operations
    110. 110. Worklist
    111. 111. Download DocumentsDo you have a standard form that you can“edit”? Upload to your downloads Tab and completewith new patient information.
    112. 112. Downloads
    113. 113. How do you resubmit your denials & appeals?Answer # 1 - By FaxAnswer # 2 - Print and MailAnswer # 3 - Phone Call and pleading case
    114. 114. Tools and Utilities for Back EndImport Tiff or PDF documents Electronic Medical Records Insurance Forms Release of Information or Disclosure FormsBenefits Retrieve and complete on any patient Index form/document and save in Tracker Fax outbound completed documents for denialsmanagement and appeals
    115. 115. Tools Tab
    116. 116. Outbound Faxing Why Fax Outbound your appeals and claim process?Benefits Easy to locate faxed transactions anddocuments Merge records and documents into a singleTrace transaction to fax Date & Time Stamped - proof that you met thedeadline date Fast and easy process to “Resend” faxes Saves time- no more running to and from faxmachine
    117. 117. With TraceYour Hospital is on theroad to recovery!!
    118. 118. Welcome to Trace Days!
    119. 119. Workshop 3Trace – New & Coming AttractionsMatt Jernigan, Director of Product ManagementDebra Holman, Trace Account ManagerLa Teshia Jones, Trace Account Manager
    120. 120. Topics• Trace Integration Options• Auto Notification of Admission• Trace Quality & Coaching• Discharge Instructions
    121. 121. Trace IntegrationTrace Integration includes two options…Image Export&Image Import
    122. 122. Do you currently print and scan documentsfor the sole purpose of entering into anothersystem?1 2 3 4 531%0% 0%63%6%1. No, not in my area.2. I don’t know.3. I think so.4. Yes.5. No, that’s whatinterns are for!
    123. 123. Image ExportAutomatically transfers images in Trace tovirtually any EMR or imaging system.trace EMR
    124. 124. Image ExportSome typical benefits…• Reduced printing costs• Instant access to documents in other systems• Documents backed up within Tracker• Increased workflow efficiency
    125. 125. Image ImportHighly versatile and provides automatic faxingindexing and notifications.traceEMRFaxIndexNotify
    126. 126. Image ImportSome typical uses…• Auto faxing of test results such as radiology ormammography results• Consolidate CPOE and faxed physician ordersinto a single system for workflowimprovement
    127. 127. Image Import
    128. 128. Trace IntegrationRequirements• Trace standard HL7 interface• Technical service call / project plan• Priced per sending/receiving system
    129. 129. • Trace Integration Options• Auto notification of admission• Trace Quality & Coaching• Discharge InstructionsNext Up
    130. 130. Notification of AdmissionProblem• Payers often require notification of inpatientadmission within 24 hours.• If missed, the claim will be denied for everyday late.• Adds pressure on access staff, particularly onweekends and holidays, to notify payers.
    131. 131. Notification of AdmissionSolutionAutomatically fax a notification to the payer oninpatient admissions and status changes.trace Payer
    132. 132. Notification of Admissiontrace PayerRegistrationHL7 Fax*Notification
    133. 133. Notification of Admission
    134. 134. Notification of AdmissionAdvantages• Trace automates the notification.• Within Tracker the notifications can becompared to the patient census.• In the event of a denial, proof of thetransaction is in Trace.
    135. 135. Would this feature be valuable at yourhospital?1 2 3 457%0%14%29%1. Yes, this would beawesome!2. Interesting, it might behelpful.3. I’m not the rightperson to ask but I’dlike to tell someone atmy hospital about it.4. No, I don’t think this isuseful.
    136. 136. • Trace Integration Options• Auto notification of admission• Trace Quality & Coaching• Discharge InstructionsNext Up
    137. 137. Voice – Quality & Coaching• 70% of hospitals rank patient experience asone of their top three priorities.*• The patient’s experience is affected by everyhospital interaction including those withinthe revenue cycle.*“State of the Patient Experience,” The Beryl Institute © 2013.
    138. 138. Voice – Quality & CoachingRevenue Cycle Impact• Pre-Service communications set the tone forthe entire stay.• Post-Service communication may be the lastimpression made with the patient.
    139. 139. Voice – Quality & CoachingRevenue Cycle ImpactSatisfied withbilling experience93% Satisfied withClinicalUnsatisfied withbilling experience63% Satisfied withClinical“Study shows link between patient satisfaction with Billing Experience and ClinicalSatisfaction”, Executive Insight © 2011.
    140. 140. Voice – Quality & CoachingVoice – Quality and Coaching will be an add-onmodule allowing managers to grade recordingsso that can staff can be coached, qualityimproved…and ultimately the patient experience improved.
    141. 141. Voice – Quality & CoachingDemo
    142. 142. Voice – Quality & CoachingAdvantages• Create a quality and coaching program.• Grade recordings based on your criteria.• Identify top performers to use for training.• Compare team members to identify coachingopportunities.• Track quality scores over time.
    143. 143. Would this feature be valuable at yourhospital?1 2 3 443%3%26%29%1. Yes, this is the coolestthing since Trace Days!2. Interesting, it might behelpful.3. I’m not the right person toask but I’d like to tellsomeone at my hospitalabout it.4. No, I don’t think this isuseful.
    144. 144. • Trace Integration Options• Auto Notification of Admission• Trace Quality & Coaching• Discharge InstructionsNext Up
    145. 145. Discharge Instructions• The Affordable Care Act established the HospitalReadmission Reduction Program.• Requires CMS to reduce payments to hospitalswith excessive readmissions.• Common drivers of readmission– Lack of a standard discharge process– Lack of engagement by patients and families– Patients did not understand/correctly takemedications
    146. 146. Discharge InstructionsTrace• Utilize Trace Voice Face-to-Face to capture.• Evaluate quality with Trace Quality & Coachingtool.• Review instructions prior to patient follow-up.• Provide patients with access to recordeddischarge instructions.
    147. 147. Would this feature be valuable at yourhospital?1 2 3 424%9%32%35%1. Yes, I think it would begreat!2. Interesting, it might behelpful.3. I’m not the right person toask but I’d like to tellsomeone at my hospitalabout it.4. No, I don’t think this isuseful.
    148. 148. Questions?
    149. 149. Welcome to Trace Days!
    150. 150. Workshop 4Q&A with Trace ChampionsStephen HovanVice President, Revenue CycleUniversity of Tennessee Medical CenterKnoxville, TN
    151. 151. Stephen HovanVice President, Revenue CycleUniversity of Tennessee Medical CenterKnoxville, TN
    152. 152. About UHS• University Health Systems, Inc., Knoxville, TN• The region’s only academic medical center• Licensed for 581 beds• Delivery of care model, Centers of Excellence:– Brain and Spine Institute– Cancer Institute– Center for Women’s and Children’s Health– Emergency and Trauma Services– Heart Lung Vascular Institute
    153. 153. The Past Facts for UHS• Over $16 million in denials consisting of 8.7million in fatal denials• Over 35,000 denials• 2.2% of hospital net revenue lost to deniedclaims• 96% cash to net patient service revenue• Overturn rate less than 35%• Less than 20% of all denied claims appealed
    154. 154. Our Plan of Attack• Define denials• Measure & monitor• Establish denials champion• Tools of the trade
    155. 155. Our Tools of The Trade• Reporting• Workflow• Documentation• Communication
    156. 156. Our Revenue Cycle IndicatorsJanuary 2007 to March 2012• Aged Accounts greater than 90: 31% to 19%• 23% increase in Cash Collections• 99.5% Cash as % of NPSR• 56% decrease in denials from $16M to $9M(Jan 2007 – Mar 2010)• 51% decrease in fatal denials from $8.7M to $4.3M• 71% success in overturning denials!!!!• 90% of all denials are reviewed for determination
    157. 157. Trace Voice at UHS• Scheduling• Insurance Authorization• Financial Counseling• Customer Service• Business Office
    158. 158. FaxCert at UHS• Order management• Medical record requests• Itemized charges for patients• Information requests from physicians• Insurance benefit information• Notification of admission• Discharge planning & notification
    159. 159. PixCert at UHSDocumented proof of important onlineprocesses that protects revenue such as:Verification of Benefits and EligibilityClaim StatusPrior AuthorizationAppeals
    160. 160. Our Results• Overturning and preventing denials• Improved revenue cycle productivity• Renewed staff confidence to fight a battle and win• Courtesy and customer focus among staff• Real, live training examples for management team• Improved relationships within revenue cycle team,other hospital departments, physician offices,patients and even with insurance companies
    161. 161. Our Fatal Denials Reduction$4,000,000.00$5,000,000.00$6,000,000.00$7,000,000.00$8,000,000.00$9,000,000.002007 2008 2009 2010YearYTD Fatal Denials ProgressTot Charges Fatal Denials
    162. 162. Our Future State• Continue to streamline workflow• Expansion of user defined work-lists• Integration with optical imaging product• Implementation of face-to-face recording• Physician order management
    163. 163. Questions
    164. 164. How effective are you in using Trace toaddress denials?1 2 3 49%21%15%56%1. We’re doing great!2. We’re doingokay, but could bebetter.3. We’ve got a longway to go.4. We’re in denialabout our denialproblem.
    165. 165. Workshop 4Q&A with Trace ChampionsLynn Arrington, CHAMManager of Insurance Verification,Patient Access Intake CenterTexas Health ResourcesArlington, TX
    166. 166. About THR
    167. 167. Q&A
    168. 168. What is your level of interest in usingface-to-face recording at your hospital?1 2 3 443%10%3%43%1. OMG! I wish I had ityesterday!2. It’s sounds cool, but Ihave some concerns.3. Sounds too much likeBig Brother. I can’timagine ever doing that.4. I’d like to use it to recordthings my boss says!
    169. 169. 7th Inning Stretch
    170. 170. Workshop 4Q&A with Trace ChampionsStuart SchiffmanVice President of Revenue ManagementCatholic Health ServicesLauderdale Lakes, FL
    171. 171. 2013TRACE DAYS CONFERENCEStuart Schiffman
    172. 172. CATHOLIC HEALTH SERVICES Faith Based Organization Mission: “To provide health care and services to those in need;To minimize human suffering; To assist people to wholeness;To nurture an awareness of their relationship with God.” Vision includes innovative and proactive approaches to: Managing care and providing services Facilitating transitions across levels of care Community partnerships and collaboration Advocacy efforts
    173. 173. CATHOLIC HEALTH SERVICES Nursing Homes (Skilled Nursing & Long Term Care) 633 Beds (4 locations) Rehabilitation Hospitals (Inpatient & Outpatient Services) 88 Beds (3 locations) Assisted Living Services 2 locations Home Health Services 2 locations Catholic Hospice Home Services Inpatient Services Cemeteries Elderly Housing (15 locations; 2200 units) Early Education
    174. 174. CATHOLIC HEALTH SERVICES 8 Service Lines 30 Facilities 2,700 Employees Total Revenue - $160 Million
    175. 175. Revenue Cycle Management Centralized Business Office Billing Collections System Management & Oversight (Net Solutions) Technical Support Charge Entry Cash Posting Customer Service Policies & Procedures Training & Development Managed Care Contracting
    176. 176. Revenue Cycle Management PAYER MIX Medicare – 40% Medicaid – 35% Managed Care/Commercial – 18% Private Pay – 7%
    177. 177. Regulatory Environment Medicaid State Reform Program Mandatory Medicaid Long Term Care Enrollment (Managed Care) Contracting (Letters of Intent; Negotiations) Staff Education Resident & Family Education Insurance Industry Managed Care Payers Individual Requirements Payment Issues Denials
    178. 178. REVENUE CYCLE PROCESS
    179. 179. Accounts Receivable Management Denials Management Authorization (Extended Stays) Level of Care Disputes Assertive Approach 62% Success Rate Appeals Process (Labor Intensive; Cash Delays)
    180. 180. ACCOUNTABILITY Monitoring Performance Reports Cash Collections Days In A/R Bad Debt Census Payer P & L Utilization Individual patient service costs (i.e., Physical Therapy;Pharmacy; etc.)
    181. 181. REVENUE CYCLE TOOLS Net Solutions RAM (ADT & Billing) Clinical (Interfacing) SSI Electronic Billing (Edits; Transmissions; Confirmation) Tract Manager Contract Management Authorization Process NS Plan Authorization Report eQ Health (Medicaid)
    182. 182. REVENUE CYCLE TOOLS Verification/Eligibility Process Passport Availity Web Sites Medicaid Web Portal Medicare DDE Financial Screening – Charity Care Program Search America/Experian Trace *** Denials Reduction Accountability Payers Staff
    183. 183. OVERALL PERFORMANCE Days In A/R (Reduced from 45 to 33) Cash Collections (Over Budget by $1.9M & $1.5M) Increased Revenue via Managed Care Contracting Reduced Bad Debt
    184. 184. Trace Implementation – KeyComponents Senior Management Support ROI Analysis References Facility Leadership Support Key Users’ “Buy – In”
    185. 185. Trace Implementation – KeyComponents (cont’d.) Project Management Trace Oversight Project Charter Ongoing Communication Accountability & Accessibility User Perspective Experience
    186. 186. Trace Implementation – KeyComponents (cont’d.) Project Management CHS Approach Departmental Process Reviews (Admissions; CaseManagement; Business Office; CBO) Enhancement vs. “More work” Pilot Roll – Out Assessment/Feedback Improvements Full Roll- Out Assessment/More Feedback ROI
    187. 187. Have you been able to quantify the benefitTrace has brought to your organization?1 2 3 423%20%33%23%1. Yes, through increasedproductivity.2. Yes, through increasedrevenue.3. Yes, but don’t have themetrics to show it.4. No, haven’t been able toquantify the benefit.
    188. 188. Workshop 4Q&A with Trace ChampionsJeanette McDowell R.N.C./MSNManager of Central Intake and AssessmentPhoebe Putney Memorial HospitalAlbany, GA
    189. 189. Q&A
    190. 190. What is your interest in using Trace in yourTransfer Center?1 2 3 418%11%39%32%1. Very interested! It’s a bigproblem for us.2. It sounds great, but it’snot my area.3. We don’t have a TransferCenter.4. I’d like to share this witha colleague, but I don’tthink I can say “PhoebePutney” without giggling.
    191. 191. Welcome to Trace Days!
    192. 192. What movie/TV show best describes yourevening last night?1 2 3 4 59%41%38%3%9%1. The Hangover2. Good Times3. Lost4. Alien5. Home Alone
    193. 193. Chance to Win $50 Right Now!Like UsFacebook.com/TracebyTWSGorUse #tracedays in a TweetTwitter.com/TracebyTWSG
    194. 194. Workshop 6Making the Most of TraceLori Forbess, Vice President of Enterprise AccountsJo Norris, Vice President of Account ManagementNicole Shanklin, Director of Implementation & Training
    195. 195. Is Trace underutilized in your facility?1 2 3 40%27%42%30%1. I think it’s used to itsmaximum potential.2. There are a few otherareas in which I’d like tosee it used.3. There are many otherareas in which it shouldbe used.4. Don’t get me started!
    196. 196. OptimizationThe act, process, or methodologyof making something (as adesign, system, or decision) as fullyfunctional or effective as possible.
    197. 197. Optimization Process
    198. 198. Enterprise Tools – Usage Matrix
    199. 199. Optimization Process
    200. 200. Trace Administrator• Leadership• Planning• Configuration• Preparation• Compliance• Follow up
    201. 201. Lunch and Learn
    202. 202. Trace Assessment Purpose1. Identify current work flow issues2. Make recommendations for optimizing use of Trace3. Identify ongoing training and implementation needs4. Identify opportunities to streamline efficiencies5. Build and maintain a positive customer relationship
    203. 203. General Workflow Overview1. What is your department responsible for?2. How is your work divided?3. How many physical sites does your department have?4. What is your biggest source of pain in your workflow?5. What do you like most in your workflow?6. How do you communicate internally?7. How do you document authorization information?8. What EMR system is in place?
    204. 204. Department AssessmentPATIENT ACCESS / PFS / SCHEDULING:1. Who handles benefits and eligibility processing?2. How do you document information from insurancecompany websites?3. Does your department schedule appointments?4. How does your department receive physician orders?5. How do you register patients?6. Do you do upfront collections?7. Who handles denials?8. What is your denial rate?
    205. 205. Assessment Summary• DEPARTMENT: CASE MANAGEMENT – WHITE STONE HOSPITAL• Contacts:• Department Contact:• Trace Administrator:• Account Manager: Jo Norris• Reason for request:• Currently uses Trace – wants to optimize Trace with consistent process and workflow Improve consistent usage and workflow Determine how to optimally print labels from exported Indexed info Assess need for F to F recording and Voice Recording•• Recommended Solution:• Training for employees w/shortcuts (done)• Label workflow reviewed, recommendations made & implemented (Search Tracker, Export List to csv instead of xls and manipulatedata as desired before merging with label function in MS)• All Call Solution when White Stone Hospital adopts it as a whole (approximately 10 users)• Considers Trace implementation for Outbound faxing if / when applicable• For Rx’s – evaluate Trace Export feature to Prescription system•• Costs: $0 Maintenance:$0• No additional fax volume – already in use. All Call – 10 Seats (when proposal actually done, revisit number of seats in case there has been achange)• Metrics:• Time Savings: Improve Inbound fax processing; Export names to excel for labels• Save Money: Paper, Time Value associated with time savings• Increased Efficiency: Consistent workflow process, Increase automation• Compliance: Audit trails of transactions and workflow, Labels on all documents
    206. 206. Enterprise Tools – Strategic Plan
    207. 207. RoadmapQ2 2012 Q3 2012 Q4 2012Discovery Test/Trainingenvironment Redundancy/DisasterRecovery Prioritize additionalfacilitiesImplementation TBD – somedepartments based onprioritized listDiscovery Gap AnalysisImplementation Training Environment Redundancy/ DisasterRecoveryDiscovery Awaiting onprioritized list ofdepartmentsImplementation Outpatient Pharmacy HIM TBD – somedepartments based onprioritized list
    208. 208. Optimization Process
    209. 209. Project Charter• Purpose– Identify Key Stakeholders– Outline Requirements– Authorize Resources• Contents– Strategic Objectives– Keys to Success– Risk Factors– Partnership Team Acknowledgment
    210. 210. Project Charter
    211. 211. Project Management Plan• Scope Management Plano Project charter• Time Management Plano Implementation Scheduleo Project Plan• Communications Plano Stakeholder Registero Communication methods & frequency• Risk Management Plano Change control processo Risk Register
    212. 212. Stakeholder RegisterName Primary Role/Designation Title Influence Communications/Strategy wkly call notes risk register updates monthly dashboardex. Vicki Moore Project SponsorVP ofOperationsStrategy /Prioritization/ResourceApprovalRegular briefing, solutions,progress dashboard / Meetingreports , emails N Y YConsiderations:• Peer-to-Peer (Trace to Enterprise) mapping for each stakeholder• Re-occurring optimization team status meetings
    213. 213. Risk RegisterRisk # Date RequestorRiskDescriptionOverallImpact(H-M-L)Probability (%)ScheduleImpact(H-M-L)Mitigation Risk Owner Notes1 7/23/2012TWSGHospitalCurrent enterpriseHIS implementationis delayed. Technicalteam resources mustcomplete HIS projectprior to engagementwith TraceOptimizationM 70%HTeam anticipates 3 week delayif impact is realized. Hospitaland Trace will begin non-technical / implementationsteps: workflow assessments,needs analysis, etc. whileproject waits for technicalresources to be released.Hospital PM Lead / IT DirectorTeam will reconvene weekly to assess probability of impact and will adjustmitigation steps if necessary.
    214. 214. Continuing Improvement
    215. 215. Questions?
    216. 216. Welcome to Trace Days!
    217. 217. Workshop 7H. A. & Enterprise SupportTim Hoskins, Director of Enterprise Architecture
    218. 218. What Is H.A. And Why Do I Want It?• Load / Capacity• Availability &Resiliency• Continuity
    219. 219. What does your day look like if you havedowntime with Trace?1 2 366%19%16%1. Running around withmy hair on fire.2. I hear about it, but itdoesn’t impact me.3. Business as usual.
    220. 220. Do you use Trace in patient contact or clinicalsettings?1 2 3 428%22%34%16%1. Patient Contact (e.g.Registration, FinancialCounseling, etc.)2. Clinical Setting (e.g.Physician Orders, PatientDischarge/Follow-up, etc.)3. Both4. Neither
    221. 221. How Trace Looks Today“I’m theDatabase!”“I’m theTraceStorageSystem”“I’m theFaxCertServer”“I’m theTracker WebServer”“I’m the PixCertServer”“I’m theTrace Auto-RecordServer”“I’m theTrace VoiceAnywhereServer”“I’malso the....”
    222. 222. How Trace Enterprise Solutions Look“I’m theFaxCertServer”“I’m theFaxCertServer”“I’m theDatabaseServer”“I’m theStorageServer“I’m the WebServices VirtualMachine” “Uh Oh – I just010011’dmyself, somebody get me atowel!”“I’mgood!”
    223. 223. The Trace Enterprise Solution• Capacity gain with multiple Trace servers• The ability to scale as Trace grows• Minimize and potentially eliminateunscheduled downtime for all Traceapplications• Maximize performance by utilizing existingtechnology investments• Enable future cloud based redundancy options
    224. 224. Questions?
    225. 225. Workshop 7Support ServicesBen O’Brien, Director of Support Services
    226. 226. Support Services:How Can We Help You?
    227. 227. Who Is Support ServicesTrace Support Services is comprised ofAccount Specialists, Product Specialistsand Technical Specialists withexpertise in all Trace products andknowledge of your specificenvironment and needs.
    228. 228. Our GoalTo be the very best support organization in thehealthcare software industry.• High value on genuine relationships with ourcustomers.• High value on responsiveness.• High value on ROI – ensuring our products bringreal value to your organization.• High value on trustworthiness – we want to be acompany that you can trust to do the right thing.
    229. 229. Contacting Customer Support8 AM-8 PM EDT(Mon-Fri)Available 24x7x365Phone:877-864-2378Email:Support@twsg.comTellUs!(Right from trace)
    230. 230. Support ProcessAccount Specialist Product SpecialistTechnical SpecialistImplementation andSupport EngineeringYouAccount Specialist – Your first contact for any issuesProduct Specialist – Cross functional team to manage your needsTechnical Specialist – Your technical server teamImplementation and Support Engineering – Dedicated to setup, security and codesupport
    231. 231. 2012• We closed over 19,000 Cases,80% of which were closed in less than 1 hour.• The average wait time for a Trace supportagent was 40 seconds or less.• Created several new roles for our supportteam to better serve your needs.
    232. 232. 2013• Close 90% of cases in less than 1 hour• Continuous improvement of server monitoring• Cut down average queue wait time• Continue to put together focused teams ofdedicated people to raise the bar on our levelof support• Provide you with more self service options
    233. 233. Today’s Customer Portal
    234. 234. Today’s Customer Portal• Download help documents• Request training• Submit a support case• Submit new users
    235. 235. A Note About Self ServiceOur goal is to provide you as many opportunitiesas possible to get the information, access andsupport that you need, as efficiently as possiblein order to make trace successful in yourorganization.
    236. 236. Self ServiceWhat features would you like to see in 2013?
    237. 237. Would you like the ability to manage yourcases online?1. Interested2. Not Interested
    238. 238. Would You Like the Ability to Have RemoteSupport from Tracker?1. Interested2. Not Interested
    239. 239. Would You Like to Be Able to Chat With TraceSupport?1. Interested2. Not Interested
    240. 240. How Interested Are You in “Ideas”?1. Interested2. Not Interested
    241. 241. How Interested Are You in Improvementsto User Submission?1. Interested2. Not Interested
    242. 242. Questions?
    243. 243. Thank You!I want to hear your ideason how we can continueto improve your supportexperience. Email me atben.obrien@twsg.comwith thoughts or ideas.THANK YOU!
    244. 244. Final Wrap-Up• Surveys• Boxed Lunches• Rides to Airport• Rides to Corporate Office• Room Key is Parking Pass

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