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All Services 1 Page Collateral 040612


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All Services 1 Page Collateral 040612

  1. 1. re|grip re|grip re|gripGuaranteed Revenue Improvement ProgramOverviewUsing a comprehensive initial assessment of the revenue cycle, re|solution identifies areas wherethe facility has not received the reimbursement for which it is entitled. The assessment looks at allphases of the revenue cycle including: scheduling, registration, charge capture, coding, billing, col-lections and reimbursement. The assessment will identify claims to be rebilled, changes in processthat will generate additional dollars and other opportunities to move towards a best practices reve-nue cycle. re|solution guarantees that the cost of the assessment will be covered by opportunitiesfound for additional reimbursement.Once the initial assessment is completed, re|solution works with two departments each quarter toassist them in improving charge capture, documentation and coding practices to insure that the facil-ity is being paid the correct amount for all services that are performed. In addition, for a year follow-ing the assessment, re|solution will monitor the implementation of each recommendation to insureeffective implementation. Once again, re|solution guarantees that the cost of this quarterly imple-mentation and monitoring is covered by additional reimbursement.ChallengeThe challenges faced by rural and community hospitals are enormous. The same charge capture,coding and reimbursement issues that plague larger facilities also affect rural and community hospi-tals with less resources to insure compliance and appropriate reimbursement for services|solution’s re|grip program provides a safety net to insure that the provider receives all the moniesthey are due.BenefitsUsing proprietary technology, interviews and a proven continuous improvement and monitoringprocess, this no-risk program allows personnel at the departmental level to work with the revenuecycle personnel in optimizing reimbursement. This is the key to an effective revenue cycle whenyou can get the clinicians and the business people working together. The process also allows thefacility to explore other opportunities for improvement such as point of service collections, denialmanagement, self pay management, contract payment review and EHR implementation for mean-ingful use. This safety net gives our clients the peace of mind that all services are being reimbursedat an appropriate level. For additional information: Robin Bradbury toll free 800-355-0410
  2. 2. re|cover re|cover re|coverCash AccelerationImmediate Cash “The re|solution team was so helpfulOther benefits include: and had so many good ideas that• Reduced days in A/R they quickly gained the trust of the• Improved bottom line full-time staff. Everyone was happy• On-site training to have them on board and soon real-• Proprietary reporting tools ized the value of their expertise.”• Improved management information John Wilker, Chief Financial Officer• Sustainable results Portneuf Medical Center• Peace of mindReal Life ResultsCarson Tahoe Regional Medical Center (“CTRMC”) is a 140 bed facility just south of Reno, Nevada.With over 30,000 patient visits per year, CTRMC had a negative adjustment to their net AccountsReceivable of nearly $6,000,000 when their management embarked on a process to find any and allopportunities for cash and bottom line|solution was engaged in November 2006 and assigned all insurance accounts over 90 days.During the first quarter of the engagement, cash collections were 40% higher than cash collectionsfor the same quarter in the prior year.In addition, re|solution provided added services for CTRMC’s business office staff, such as trainingin billing and follow-up techniques and a detailed revenue cycle assessment at no additional cost.The hospital administration was ecstatic about the increased cash flow. The improvements identi-fied and implemented by re|solution were continued after the engagement ended.Methodology• Experienced and knowledgeable analysts work your aged accounts• On-site training and mentoring of your staff insures long-term improvements• Inefficiencies identified and recommendations made for customized process improvements• Safety net of re|solution resources provide post engagement support• Post engagement quarterly benchmark reports verify your success
  3. 3. re|source re|source re|sourceInterim StaffingImmediate Access to Proven, Qualified PersonnelOther benefits include:• Cash increases with improved staff skills• On-site knowledge transfer produces competent local employees• On-site training/mentoring increases skill retention• Temporary or long-term placementsReal Life ResultsLavaca Medical Center (“LCMC”) is a 25-bed community hospital in south central Texas providing awide range of inpatient and outpatient services. LCMC’s business office manager resigned in 2002.Months of searching for a replacement resulted in no qualified candidates, so LCMC identified anindividual from another department to become the new business office|solution was engaged to mentor/train the individual selected. During the first three months of theengagement, the on-site re|solution interim business office manager managed the business officewhile the new business office manager shadowed and learned effective business office manage-ment. During the second three months, the new business office manager managed the businessoffice and the on-site re|solution interim business office manager provided support while writingpolicies and creating a reporting structure.During the six month engagement, LCMC also underwent a difficult system conversion. Cash re-mained relatively steady even with the turnover and system conversion problems. The new businessoffice manager received continued support from the re|solution interim business office managerwho remained a resource after the training/mentoring engagement ended.Methodology• You select from our elite reserve of qualified personnel• Mentoring option for training managers or higher level personnel• Implementation of unique reporting and productivity tools with monthly reports to measure em- ployee performance• Safety net of re|solution resources provide post engagement support“Your placement of an interim business office manager helped us begin the processof implementing the recommendations made in your assessment. Your continuedsupport in the months following the engagement, including assistance in interview-ing candidates for permanent business office manager, enabled us to put the blocksin place during this transitional period as we worked toward long-term stability.” Bob Ellzey, President/CEO Laird Memorial Hospital
  4. 4. re|train re|train re|trainTraining and MentoringImproved Skills Increase CashOther benefits include:• Training provided by highly skilled revenue cycle management experts• On-site, one-on-one training insures retention• Create well-trained staff without recruiting new personnel• Application of proprietary software to monitor employee progress and performance• Sustainable business office process improvementTraining Programre|train is a cost-effective way to provide new or less experienced business office staff and manage-ment with receivables management skills. The service is conveyed one-on-one by a re|solutionrevenue cycle operations expert. Throughout the training, your staff completes a series of writtenand oral exercises to verify comprehension and retention of the material. re|solution also appliesproprietary software to monitor employee performance.Methodology• Review and compare your facility’s key revenue cycle indicators to those of best practice organi- zations, with instructions on how to use benchmarking to monitor, manage and improve busi- ness office performance.• A re|solution revenue cycle operations expert will provide in-depth instruction on: ◊ Bad debt and contractual reserves ◊ A/R management influences on the income statement and balance sheet ◊ Determining if changes in A/R are due to revenue fluctuations or process breakdowns ◊ Understanding the causes of key indicator variances and options for corrective actions ◊ Utilizing the Aged Trial Balance and other reports as management tools.• Create a responsibility matrix that optimizes the skills of individual staff members in assignment of key business office functions and processes.• Develop performance expectations and productivity standards including prioritizing tasks and developing effective time management strategies. Apply proprietary re|solution management tools and motivational techniques to improve revenue cycle performance.• Daily performance tracking, monthly site visits or calls to review progress and answer questions.• Verbal exit conference and written report for hospital senior management at the conclusion of the engagement.
  5. 5. re|store re|store re|storeVirtual Business OfficeGuaranteed Performance Improvement “We had been without a busi- ness office manager and ourOther benefits include: issues were severe. The transi-• No more staffing issues tion was relatively easy, and the• Dashboard reporting results practically immediate.• Implementation of new technology re|solution took over only the• Peace of mind necessary positions, trained those we desired to have stay, and the billing office began to function efficiently. I can’t say enough good things about our experience with re|solution” Mike Click, CEO Brownfield Regional Medical CenterReal Life ResultsWhen Brownfield Regional Medical Center (“BRMC”) in NW Texas engaged re|solution in a cashacceleration project, BRMC’s AR days outstanding were at 131, compared to a peer average of 48days, the days of unbilled AR was at 27 compared to the peer average of only 10, and total AR wasat $4.5 million. Motivated by re|solution’s success in cleaning up the large backlog of old accounts(down to just $2 million, BRMC’s CEO Mike Click determined that moving full operation of his busi-ness office to re|solution was imperative to getting his hospital back on|solution assumed responsibility for BRMC’s 21 revenue cycle FTE’s in February 2002. Duringthe re|store engagement, re|solution was able to trim BRMCs business office staff to 10 FTEs,making their revenue cycle much more efficient than ever|solution was also able to assist BRMC in returning to an in-house Business Office once opera-tions were stabilized and BRMC desired to bring the work back in-house.Methodology• On-site and remote solutions tailored to your needs• Option to manage and train current staff• Optimize your current patient accounting system• New technology upgrades and training provided• Monthly productivity and benchmarking reports
  6. 6. re|implement re|implement re|implementICD-10 ImplementationICD-Transition Services to ICD-10 ICD-Other benefits include:• Successful migration to ICD-10• Coding accuracy• Increased compliance• Improved reimbursementChallengeCompliance and the transition to ICD-10 is in a state of flux with the October 1, 2013 deadline de-layed to some point in the future. However, industry analysts agree that there will be a transition toICD-10 in the near future. The transition represents a significant impact to healthcare providers andprocesses. ICD-10 code sets include updated medical technology and are more detailed and clini-cally accurate. There will be an estimated 68,000 codes included instead of the current 13,000 inICD-9. It is necessary for providers to take steps now to mitigate the inevitable financial impact.The transition to ICD-10 will be time and resource-intensive for all organizations. Every tool, system,report and program must be adapted for ICD-10. Most facilities lack the resources to integrate ICD-10 throughout every aspect of their business and coordinate clinical, financial, claims, analytical, andespecially, information technology.The time to begin the planning and preparation for ICD-10 compliance is now. Regardless of anydelays that occur, ICD-10 is coming.Methodology and SolutionMost ICD-10 consultants are performing this work for the first time as it is all new for the US. How-ever, Canada and other countries have been using ICD-10 for years. re|solution has teamed upwith consultants who have done this work in Canada and have seen the process through from startto finish. Our team will:Review current state coding operationsIdentify coding gaps across people, process and technologyDetermine current staffing and training needsAssess ICD-10 readiness and identify heavily impacted providersDevelop project implementation planProvide recommendations and risk mitigation strategiesTransition to ownerPut our experience to work for you.
  7. 7. re|charge re|charge re|chargeCharge Capture ReviewLost and Found - CashOther benefits include:• Increased outpatient reimbursement• Process improvement to capture all charges• Reduce auditing costs• Increased complianceThe Office of Inspector General of the Department of Health and Human Services has issued a re-port indicating that it is doubtful that any hospital in the country is billing correctly for APCs, espe-cially in the area of drugs. The Center for Medicaid and Medicare Services (CMS) has noted a num-ber of services in which hospitals have not billed correctly for services. CMS has acknowledgedtheir errors in the payment of services and has requested hospitals to resubmit the claims containingthese services.Real Life ResultsDCH Health System in Tuscaloosa, Alabama is a three hospital system. Management realized thatwith the large number of outpatient procedures it was nearly impossible to insure that all servicesprovided were actually billed. DCH contracted with re|solution in a re|charge program designed toreview two years of Medicare outpatient claims looking for uncaptured revenue. Over $715,000 wasfound in additional cash reimbursement at DCH. In addition, several process improvement initia-tives were started that assisted the facility in improving their charge capture processes in its cardiol-ogy group.MethodologyUsing proprietary technology and a process which reviews all claims that have potential for addi-tional APC reimbursement, re|charge will identify suspect claims, review the medical record associ-ated with the claim and return a revised claim to the facility. All of this work is done on contingencywith no payment to re|solution unless additional dollars are found. A no risk program that helpsbring your billing back in compliance.
  8. 8. re|assess re|assess re|assessRevenue Cycle AssessmentA Customized Plan to Improve Your Bottom LineOther benefits include:• Process improvement• Comprehensive proprietary reports• Increase cash and reduce AR• Peace of mindReal Life ResultsShenandoah Medical Center is a facility serving southwest Iowa for more than 80 years. Whenre|solution was engaged to provide re|assess, their A/R over 90 days was increasing. Their newbusiness office manager, though strong in accounting and management skills, was new to the reve-nue cycle.With the participation of management, re|solution developed a comprehensive assessment whichincluded recommendations for A/R cleanup, management and staff training, and consulting in a vari-ety of areas which ultimately led to a reorganization of their revenue cycle operation.Based on the re|assess engagement, SMC reduced it’s days in A/R nearly 25% from 73 to 56 duringthe project, had increased cash collections, and re|solution subsequently provided targeted trainingfor their staff and management, creating a foundation for their continued success and sustainableimprovements.Methodology• Observations, data review, and comprehensive interviews provide the basis for recommenda- tions for improvement• Results compared to peer group and best practices• Action plan developed and presentation made to key management• Implementation design and support“We had just lost our Business Office Director and our A/R was growing. We en-gaged re|solution to assist us. They proposed a comprehensive solution including arevenue cycle assessment to identify root cause problems… The results were ex-ceptional. In addition to the assessment, $2,500,000 in aged A/R was placed withre|solution of which 92% was resolved. re|solution reduced our Medicare A/R over90 days by 94% and collected nearly $800,000 in cash for us. re|solution’s onsiteconsultant took the major recommendations from the assessment and worked di-rectly with our revenue cycle staff to improve our operations.” Chris Cronberg, CEO Northern Cochise Community Hospital
  9. 9. re|search re|search re|searchUnidentified Payer SearchOverviewAt the point of registration, obtaining accurate demographics can often be a challenge. Even withtoday’s sophisticated software platforms, patient data accuracy can easily be compromised byhuman error. re|search rapidly matches patient records to previously unidentified third party payers.Identifying, correcting, and billing the claims which other automated third party payer validation ser-vices miss.ChallengeThe portion of accounts receivable that is classified as patient responsibility is growing. The pooreconomic environment, job losses (with accompanying loss of employer provided insurance) and theoverall climate of patients frequently changing insurance cause many patients to arrive at a facilitywith a lack of insurance information. When the patient lacks the appropriate insurance information,the claim generally ends up in the self pay bucket.In our experience, from three to five percent of the claims within the patient responsibility bucket areactually covered by third party insurance. The majority of these misclassifications relate to Medi-caid, but there are also many Medicare and commercial insurances that are unidentified. This mis-identification results in frustration to both the patient and the facility.SolutionUsing proprietary data mining technology that does not replace other Medicaid eligibility or collectionagency solutions, the re|search program continuously mines your registration information retroac-tively and proactively searching for insurance programs that will cover patient responsibility balancesdue. In addition, the technology will find additional DSH days that can be used to recover additionalmonies through amended cost|search works because it is done strictly on a contingency fee where dollars are paid only on founddollars and not on a per search basis. Once the claims are determined to be eligible, re|solutionwill return the accounts to be billed to the hospital for billing or re|solution can bill the claims on thehospital’s behalf.The hospital experiences additional dollars from self pay accounts, reduced costs of chasing ac-counts that are misclassified and increased patient satisfaction.ResultsLet us help you increase your reimbursements as we have for our clients listed below: Hospital System 120 Bed Hospital $800,000 recovered $200,000 recovered
  10. 10. Disbursement Auditre|solution uses proprietary sophisticated software developed by Oversight Systems that detects disbursement errorsother systems miss. Errors generally fall into one of three categories: duplicate payments, duplicate line items andpricing not in accordance with GPO or other vendor contract terms. Such results have been proven in healthcare andwith non-healthcare clients such as MD Anderson, The Coca-Cola Company, Yahoo!, McDonalds, Martin Marietta,Pfizer, Celanese, W. W. Grainger, and the Department of Defense. re|solution identifies past payment errors for the prior three years, validates the errors with both the client and thevendor, and then files claims for refund, credit or future discount.Analyzing the payback for your hospital is simple. All you need to do is provide us data that is representative of yourpast three years of disbursements. We will analyze your data and validate suspected errors and analyze the financialimpact. It is as simple as that, there is no cost to the hospital, and it will take just two meetings with you. Getting Started Hospital Oversight re|solution Provide Data Analyze Data Validate Errors Present Findings Go/No-GoThat is the upfront diagnostic. Running the ongoing project is just a simple continuation: You will provide re|solutionthe same data as before on a regular basis. Oversight will use our analytics to detect the errors and re|solution willvalidate the errors and prepare claims for vendor submission. You pay only for the claims and credits you actuallycollect. Generate Analyze Validate File Confirm Report Data Errors Claims CollectionHospitalOversightre|solution Robin Bradbury toll free 800.355.0410for additional information
  11. 11. re|pay re|pay re|payPayment ReviewOptimized PaymentsOther benefits include:• Contingency fee based service with no up front charges• Additional cash• Stronger negotiations of future contracts• Peace of mindChallengeAre you certain payers are sending reimbursement that complies with the negotiated contract? Doyou currently use a post payment audit process to optimize and identify any reimbursement issues?Contracts with payers are negotiated, discounts and payment terms change and errors in paymentoccur for a number of reasons. Perhaps a contract amendment update was missed, or incorrectproration applied. Employees posting payments may not have immediate access or time to reviewrevised contracts. A higher reimbursement rate may be missed for many months while the payerpays at the old rate. re|pay identifies errors that cause reduced|pay will identify underpayments and inappropriate denials. Once identified, our analysts will ap-peal underpaid and inappropriately denied accounts.Methodology and Solution• Payer contracts are reviewed and compared actual payments• Identify accounts with underpayments and inappropriate denials for appeal• Initiate proactive communication with payers to optimize reimbursement for identified accounts.• Provide feedback on specific problem payers and specific contract issues• Assists facility in staying current in payer contract renewals, updates, and billing policies.• Monthly status reports of appealed claims
  12. 12. re|transfer re|transfer re|transferTransfer DRG reviewImmediate CashOther benefits include:• Identify additional reimbursement on TrDRG’s• Improved payment accuracy• Retrospective cash collection• Sustainable results prospectively• Peace of mindChallengeMany times a patient should receive post acute care and is discharged based on this recommenda-tion from their physician. Medicare pays a reduced DRG payment based on the assumption that thepatient will comply with the physician’s recommendation. When a patient, for whatever reason, doesnot follow through in receiving post acute care, your facility is entitled to the full DRG payment.Facilities have no way of knowing that a patient did not follow through and that they should havereceived the full DRG payment from Medicare. Using a proprietary software with algorithms to checkadmissions and other medicare payments for each TrDRG patient, re|transfer identifies and assistswith rebilling of retroactive claims and continues to verify payments are not missed on a go forwardbasis.IT support is minimal and the service is provided on a contingency basis with no up front fees.Methodology and Solution• Identifies Medicare accounts that have a discharge status inconsistent with claims data• Improves accuracy of claim payments for designated transfer DRGs• Validates and documents that patients received post acute care• Provides a conclusive list of claims that require review for possible rebilling and/or appeal• Assistance with billing or re-billing of identified accounts• Reporting demonstrates program’s effectiveness• Monthly reporting on account statuses and identified issues
  13. 13. re|view re|view re|viewCandidate ScreeningIdentify Qualified Candidates QuicklyOther benefits include:• Save time and money wasted on processing unqualified candidates• Expert screening ensures candidate knowledge• Identify candidates who will integrate seamlessly with your current staff• Quickly identify permanent candidates• Interim Staffing assistance available if neededScreening Programre|view is a cost-effective way to determine a candidate’s business office skills, and managementstyle. We work with you to asses the position criteria, and then use re|solution’s candidate screen-ing to combine the best of competency-based selection with behavioral-based interviewing. Usingour competency analyzer, and conducting structured and action interviews, suitable candidates arequickly identified. The program can be tailored to fit your budget and needs.Methodology and Options• Initial resume screening to pre-qualify candidates• Qualified candidate screening using critical questions to further determine eligibility• Detailed skills screen• Detailed structured and action interview• Report on individual candidate Service Cost per candidate Detailed Skill Screen $100 Detailed Structured and Action Interview $200 Candidate Report $100
  14. 14. Transcription AccountabilityTranscription accountability management provides a powerful dictation/transcription workflow application thatincludes a broad spectrum of capabilities for managing in-house, outsourced and speech recognition programs whilereducing costs and improving patient care quality. Historically reduces transcription costs by at least 17%. Predictability, Visibility, TransparencyCo ntro l—maintain control and accountability over document creation and management processes, PHI, andcompliance with user interface and data organization.Ca s h S a vin g s —deliver optimal savings by structuring transcription operations. Usage based fee structuredelivers advanced proprietary technology that is continuously upgraded and professionally supported.Qu a lity—standardizes specifications, sets uniform templates, controls security and privacy policies, reducesmanual effort, and extends operational methods uniformly to current in-house and outsourced transcriptionservices. PROGRAM FEATURES: • Dictation and document tracking and management • Advanced outsource and subcontract management module • Line counting, with standardization and calibration • Data analysis and reporting capabilities • Software tracks transcription service utilization at the facility, department, location, and author levels • Integrated speech recognition services • Unparalleled security insures access control, Protected Health Information (PHI), and activity logs to meet compliance requirements Robin Bradbury toll free 800.355.0410for additional information