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Health Tech Revenue Cycle Solutions


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Health Tech Revenue Cycle Solutions

  1. 1. HealthTech Solutions Group Company Overview Optimizing Clients Financial & Revenue Cycle Results through People, Process and Innovative Technology Solutions Albert Einstein "The definition of insanity is doing the same thing over and over again and expecting different results"
  2. 2. Company Profile:  Headquarters in Plano, TX (DFW Area)  Experienced management team  Proven results from CAH to multi-hospital systems  Focus on effective use of technology in driving performance  AR – Billing/Collections  Software – Business Intelligence, Claims Analysis  Services – Implementation, Revenue Recovery AR/Central Business Office Synapse Software Suite Consulting – Services Billing/Collections Business Intelligence Process Improvement Revenue Recovery ED Claims Transfer DRG Recovery AR reduction projects myClaimIQ genie Revenue Recovery Outsourced BO Collection Management Interim Directors
  3. 3. Revenue Recovery Services Case Study: ED Claims Project Tool: myClaimIQ genie “Our facility saw an almost immediate increase in net revenue and cash collections from this project. The process was seamless and the results speak for themselves ” – CEO Facility Overview - Results - Critical Access Hospital  11% increase in Net Rev per account $ 15 Million Annual Net Revenue  over $300k recovered in first 6 months ~ 6,000 ED Visits per Year  4% increase in total facility annual NR
  4. 4. Accounts Receivable/RSC Services Services Overview  Interim BO placements – BOD, Manager Level  Outsourced Billing/Collections  Aged AR Liquidation/Reduction Services  Hospital  Physician  Physician Billing/Collections  Outsource Entire Revenue Cycle  Revenue Recovery projects – charging, coding  provided on a contingency fee basis
  5. 5. Outsourced Revenue Cycle Why HealthTech Solutions Group? Current Revenue Cycle Model HTSG Technology Focused Approach Facility based Correct cash focused  Cash collections AR Day focused  Revenue optimized - Synapse Lack of scale in operations Technology critical efficiency Limited use of technology Centralized & scalable Low level specialization Highly specialized functions
  6. 6. Accounts Receivable/RSC Services What is “Correct Cash” focus?  Typical cash focus is on stated Accounts Receivable (AR) balance  HTSG Correct Cash focus: 1. AR balance is correct per contract terms and conditions 2. Claim has been correctly coded – Synapse ClaimIQ, ED ClaimIQ 3. Claim has all correct charge components – Implant charges, high cost drugs etc 4. Claim has no codes that are incorrect, deleted or no longer in use 5. Claim is collected in a timely manner  Result – improvement in cash and cash collected/account
  7. 7. Revenue Service Center (RSC) – Operations Overview  Facility located in Plano, TX (DFW area)  Highly experienced & successful executive team  Currently perform operations for Brim owned hospitals  AR Liquidation projects – Physician & Hospital AR  All current staff highly experienced  Ability to expand scope of services without disruption  Location provides access to large pool of experienced Revenue Cycle and Technology staff  DFW provides a very cost competitive value proposition
  8. 8. AR Liquidation & Recovery Services A Service Redefined  Dedicated team & reporting portal for each project  Physician  Hospital  Project starts almost immediately via VPN connection  Team experience on all major hospital and physician HIT systems  Engagement structured as contingency fee basis  0-180 Days – 10%  181-365 Days – 15%  + 365 Days – 25% All claims run through Synapse ClaimIQ software ensures all revenue captured
  9. 9. Revenue Recovery Services Post Acute Care Transfer Recovery  CMS currently has 273 DRG’s subject to Transfer DRG rules  Payment to Acute Care hospital is reduced if the LOS (+1 day) is less than the GLOS  Can affect up to 50% of a PPS facilities discharges  HTSG researches all applicable Medicare discharges  Identify all accounts that have potential for Revenue Recovery  Work with facility to validate all information correct  Refile and correct all applicable claims  Revenue Recovery process is quick, seamless and no-risk to the facility  Engagement structured as a contingency of recoveries (25%)
  10. 10. Revenue Recovery Services Process Overview  HTSG provides each facility with a risk free assessment of potential opportunity  HTSG will analyze previous 12 months of data for free  All we require is standard data file & BAA (HTSG can assist in data extraction)  Run the data through our proprietary algorithms  Turn the file around within 7-10 days  Process is extremely targeted and non invasive  Synapse ClaimIQ algorithms allow us to identify specific accounts  We don’t bring in a team of consultants taking up your team members time  Revenue Recovery can start almost immediately  Targeted approach means we can start rebilling accounts, capturing revenue within hours of starting the engagement  ClaimIQ can provide ongoing monitoring and concurrent charge capture toolset  Engagement can be structured as either on a fee basis or as a contingency (25%)
  11. 11. Accounts Receivable/RSC Services Pricing Overview  Outsourced Billing/Collections – short term  provided on a per hr basis for short term projects  if longer than 90 days quote provided based on length  AR reduction projects  typically contingency fee (%) based on age & quality receivables  Physician and Hospital AR Reduction projects  Interim Business Office Directors  Synapse product suite provided free if project > 90 Days  Outsource Entire Revenue Cycle Operations  work with each facility to provide competitive quote  Revenue Recovery projects 25% contingency fee of $ recovered  focus on charging, coding, contract compliance
  12. 12. Synapse myClaimIQ genie Revolutionary desktop Claim Analytic tool -  Downloads and installs in minutes – no IT involvement  Desktop application can be managed by anyone  Analyzes all billing claims instantly for:  Charge capture components – implants, procedures  Claims data integrity – all claim components are correct  Potential coding and documentation opportunities  CPT (CDM) audit for incorrect, deleted or non valid codes  Invalid combinations of codes  Facility has ability to run analytics on entire facility or sub-section e.g. just ED if this is an area of focus  Charge is on a per claim basis – reduces cost increases value to client
  13. 13. Business Intelligence Services Synapse Intelligent Analytics  Web based Business Intelligence application  Intuitive interface provides for easy analysis of operations, AR, clinical indicators  Keep track of Key Indicators through KPI’s and dashboards  Real time access to information from aggregate level down to patient detail
  14. 14. Synapse EDCalc Application Overview Correctly calculates E&M Level for every patient  Average increase in Net Revenue ~ $25 per patient  Ensures compliance with CMS 11 guiding principles  Level calculation documentation produced for audit purposes  Intuitive interface improves productivity  Chart analyzed potential charge capture opportunities that are often overlooked  Missing procedures  Supply charges  Analysis of prior claims for revenue recapture opportunities  Improved revenue covers cost of application
  15. 15. Synapse ClaimIQ ClaimIQ is an integrated collections and AR management tool created to improve collector productivity and cash results in a Centralized Business Office environment. ClaimIQ works with any hospital or physician IT system and can be implemented as a collections platform in days. “Since implementing ClaimIQ for Brim Healthcare’s owned facilities, we have seen a consistent increase in cash collections and over a 100% increase in bad debt recoveries in the first few months of operations.” Brim Healthcare CFO
  16. 16. Synapse ClaimIQ Application Overview  Integrated AR & Collections Management tool  Collections module provides real time productivity monitoring  Work list management – specific focus problem areas  AR Analytics Portal with Business Intelligence toolset  Charge Capture Analysis tool highlights potential lost $  Charge Reconciliation Tool for Nurse Auditors  CPT Code Analyzer – corrects for deleted, invalid codes  Analysis of prior claims for revenue recapture opportunities