Reviews the career of this revenue cycle director and consultant

1. Creating new opportunities
Improving existing operations
Health Care Revenue Cycle Expert

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. Companies and clients that I have served

Jim Spause
610-256-0088
jspause@comcast.net
3

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. 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. 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
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There are always choices and options – choose wisely
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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. 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