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Jim Spause Revenue Cycle Career Presentation 2009

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Jim Spause Revenue Cycle Career Presentation 2009

  1. 1. Creating new opportunities Improving existing operations Health Care Revenue Cycle Expert
  2. 2. Expert in health care revenue cycle operations with over 15 years  experience in several sectors ◦ Payor, provider, and consulting Developed new services and operational turn-around strategies  Proven record of operational performance improvement  Served as the Director of centralized billing offices  Managed projects and complete A/R liquidation engagements with both  on-shore and off-shore staff Negotiated payor / provider contracts and settlements  Executive MBA Graduate, Temple University  Jim Spause 610-256-0088 jspause@comcast.net 2
  3. 3. Companies and clients that I have served  Jim Spause 610-256-0088 jspause@comcast.net 3
  4. 4. Senior Manager of Product Development, McBee Associates:  ◦ Developed and launched 3 new revenue cycle service lines with annual revenue projections of over $2 million Director of Revenue Operations, DaVita:  ◦ Improved collections by an average of $1.2 M per month within a 9-month period ◦ Increased payor appeal wins by more than $12 M ◦ Reduced non-contracted DSO by more than 50-days in one year ◦ Settled several disputes with managed care and commercial payors totaling $3 million in additional collections Lead Consultant, McKesson:  ◦ Performed hospital revenue cycle assessments leading to $3.8 million of additional software and services sales ◦ Co-published an article examining the use of technology in Patient Access processes for Aspen Publishing’s Healthcare Registration newsletter Engagement Manager, Deloitte Consulting:  ◦ Managed outsourcing projects with a total accounts receivable of $150 M – resolved over 97% Corporate Director, Patient Financial Services, Kennedy Health System:  ◦ Reduced hospital days in accounts receivable from 72 to 59 in one year ◦ Negotiated settlements with managed care payors totaling $2 M ◦ Directed a multi-departmental effort which increased net revenue and collections by $1.9 M Network Services Coordinator, Aetna US Healthcare:  ◦ Received the prestigious “Gold” Service Star Award for service excellence twice in one year Jim Spause 610-256-0088 jspause@comcast.net 4
  5. 5. Establish stretch goals – Develop plan – Execute - Repeat  Revenue Cycle Dashboards Indicator Better Practice Hospital Cash Receipts as % of Net Business Needs 100% 97.1% Revenue The Hospital Revenue Cycle Viewed as a System 1. Reduce claim submission rejections 2. Reduce DNFB A/R Days (Net) 55 Days 50.5 Days 3. Reduce aged receivables 4. Improve collections A/R Over 90 Days 15 - 20% 36.2% 5. Reduce Bad Debt DNFB Gross A/R Days Patient Admitted ≤5 Days 5.1 Days (includes 4-day bill hold) Point-of-Service Collections as % Claim coded for initial billing .8% average ≥2% of Net Revenue Patient Access Health Information Management Patient Accounting • Collect and document all clinical notes • Claims “scrubbed” for accuracy Billing Backlog Gross A/R Days ≤ 1 - 2 Days 1.6 Days (Registration/Admissions) • Collect patient demographic / • Utilize patient chart to code diagnoses and compliance Denials as a % of Gross Revenue ≤1 - 2% 6% • Claims submitted to insurance insurance information & procedures • Insurance verified & selected / patient • Verify services are medically necessary Bad Debt as a % of Gross • Screen services for medical • Paid or Denied ≤3% 2.3 % Revenue • Claim follow-up with insurance necessity • Collect co-pay / deductible or patient • Status within aged receivables Claim Demographics Generated Better Indicator Hosp 1 Hosp 4 Hosp 2 Hosp 3 Hosp 5 Hosp 6 Practice Clinical Services Provided and Documented DNFB Gross A/R Days (includes 4-day ≤ 5 Days 4.3 Days 5.0 Days 5.2 Days 4.8 Days 6.8 Days 4.2 Days billhold) IP charts coded per Not Plan to Improve Design & Redesign 23-26 32 30 30 22.5 32 coder/per day Tracked • Increase pre-registering frequency Processes & Services • Verify insurance via EDI OP charts coded per Not 150 – 230 55 300 64.3 225 55 coder per/day Tracked • POS collections • Electronic order entry – EMR OBS & AMS charts Not coded per coder/per 36-40 50 75 45 64.2 50 • Electronic compliance screening 1 Tracked day • Clean claims ER charts coded per Out- Out- Out- Out- Out- 180 190- 250 coder per day sourced sourced sourced sourced sourced ≤ 1 work Transcription backlog 1 Day 1 Day 1 Day 1 Day 1 Day 1 Day day Not Not Not Not Not % of MPI duplicates ≤ .05% .01 Tracked Tracked Tracked Tracked Tracked Record Request ≤2 1-7 days 1 day 1-7 days 1-7 days 1 day 14 days Turnaround workdays Jim Spause 610-256-0088 jspause@comcast.net 5
  6. 6. Be tough on the problem but kind with people  Hands-on & resourceful  Brainstorming & Collaboration  Mistakes are forgivable – What’s unforgivable is not  taking responsibility and fixing the mistake Do the hard work and analyze - Numbers don’t lie  There are always choices and options – choose wisely  Keep pushing - You never know how much you can do  until you push yourself Confidence breeds accomplishments (and vice versa)  Jim Spause 610-256-0088 jspause@comcast.net 6
  7. 7. Contact me at:  Jim Spause, MBA, PMP Lafayette Hill, PA (H): 610-567-0295 (M): 610-256-0088 jspause@comcast.net Jim Spause 610-256-0088 jspause@comcast.net 7

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