http://www.modernhealthcare.com/article/20140514/SPONSORED/305149926/webinar-turning-insight-into-action-analytics-effective-denials Join us to learn how leaders at Middlesex Hospital turned insight into action by leveraging analytics to drive financial performance. This presentation will showcase how Middlesex streamlined its Denials Management process by using analytics to identify trends and opportunities for improvement, as well as for departmental managers to monitor operational aspects of the business. By attending this webinar, you will learn: - How post-denial write-off analytics provide immediate feedback for targeting payers, service type, denial type and/or high-dollar areas - The impact near-real-time data can have on the feedback loops working with clinical departments - The financial benefit of investing in a dedicated a Denials Management team

1. Analytics & Effective Denials
Management
June 10, 2014

2. Introductions
Andy LeBlanc
Supervisor, Revenue Cycle
Employed at Middlesex Hospital for the past 25 years. Director of
Patient Financial Services overseeing patient accounting, patient
access, and payer contracting. Active on Ct. Hospital Association
committees, and a member of HMFA and AAHAM. Currently using GE
Centricity Business for revenue cycle and partner with GE on focus
groups, enhancement requests and the hospital user group. Prior
employment was with a Connecticut Bank managing two branch
offices.
Employed with Middlesex Hospital a total of 6 years. Responsible for
implementing, designing and providing support for business and
administrative analytics within all revenue cycle functional areas.
Works to find revenue opportunities related to cost reductions and/or
charging efficiency. Focused on architecture of business intelligence
tools that assist in decision support activities. Holds a PMP
certification & is an active member of HFMA & PMI communities.
1
Michael Mast
Global Director, GE Healthcare IT
Michael Mast is a global director at GE Healthcare IT. Michael
manages go-to-market strategy for GEHC’s Integrated Care and
Financial Management solutions. Michael has over 10 years of
healthcare IT experience. You can follow Michael on Twitter at
@mjmast
Pat Neisser
Director, Patient Financial Services

3. About Us
2

4. Background
● 2009 - Denials were approx $3m annually
● Hired a Denial Specialist to better handle analytics & reporting
● Leveraged Analytics to identify, by Payor and/or Service Line areas of opportunity
● High-level analytics coupled with drill-down capabilities provided direction &
actionable information direct to department leads
3

5. Denial Write-Offs
Appeals Tracking
Denials Team
Progression...
2014
2013
2010
4

6. Denial Write-Offs (2010)
● Analytics
o Categorization of Write-Offs, by Payer, Service & Type of Denial
o Dashboard, single-source of truth
● Workflow/Process Controls
o Formation of Clinical Compliance teams
o Feedback loops direct to departments & physician practices
o Ability to focus on specific targeted denials, as-needed
● Measurable Outcomes
o Service Line dollars written-off, by type
o Time-based trending with goals, overall + departmental
Analytics
Workflow
Outcomes
5

7. Denial Write-Offs
Analytics
Workflow
Outcomes
● Categorization of Write-Offs, by Payer, Service & Type of Denial
● Dashboard, single-source of truth
6

8. Denial Write-Offs
Analytics
Workflow
Outcomes
7

9. Denial Write-Offs
Analytics
Workflow
Outcomes
● Formation of Clinical Compliance teams
● Feedback loops direct to departments & physician practices
● Ability to focus on specific targeted denials, as-needed
8

10. Denial Write-Offs
Analytics
Workflow
Outcomes
● Service Line dollars written-off, by type
● Time-based trending with goals, overall + departments Lab
Radiology
9

11. Appeals Tracking (2013)
● Analytics
o Visibility into Payers, Appeal Type, Time to Resolution
● Workflow/Process Controls
o Date/Time stamps
o Support for redistribution of work
● Measurable Outcomes
o Win %, by Payer, by Appeal Type for both volume & dollars
o Benchmark resolution times comparing payers
o Negotiating leverage with payers
Analytics
Workflow
Outcomes
10

12. Appeals Tracking
Analytics
Workflow
Outcomes
● Visibility into Payers, Appeal Type, Time to Resolution
*subset of total
*subset of total
11

13. Poll Question
What financial outcomes is your organization most
focused on improving?
a. Reduced A/R days
b. Improved net collections ratio
c. Improved point of service collections
d. Greater understanding of activity costs
e. Improved cash flow
12

14. Appeals Tracking
Analytics
Workflow
Outcomes
● Date/Time stamps
● Support for redistribution of work
13

15. Appeals Tracking
Analytics
Workflow
Outcomes
● Win %, by Payer, by Appeal Type for both volume & dollars
● Benchmark resolution times comparing payers
● Negotiating leverage with payers
*subset of total
*subset of total
14

16. Denial Team (2014)
● What is it?
● Why is it needed?
● How was it staffed?
Analytics
Workflow
Outcomes
15

17. Denial Team
Analytics
Workflow
Outcomes
● Categorization of Rejections, by Payer, Service & Type of Denial
● Crosstab, time-based tracking tools
16

18. Denial Team
Analytics
Workflow
Outcomes
● Reorganized 2 FTE’s to focus on rejection functional area, by payer (Medicare 1st LOB
tackled)
● More focus on consolidation & specialized work for greater overall visibility to source of
denials, yielding greater results
17

19. Denial Team
Analytics
Workflow
Outcomes
● FTE savings
● Cash flow improvement
● Reduction in volume of rejections, by Payer & Type
18

20. Next Steps

21. Imagination at work.
Michael Mast, Global Director at GE Healthcare IT
Financial Management

22. ©2014 General Electric Company – All rights reserved.
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use of information, contained in this document. All illustrations are provided as fictional examples only. Your product
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this publication may be reproduced for any purpose without written permission of GE.
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22

23. A fundamental transformation of healthcare
23
Healthcare IT is at the helm of driving a productivity
transformation across the industry
Patients seek… Providers need…
• More face time
• Care that revolves
around them
• More active role in care
decisions
• More consistent, higher
quality outcomes
• Configurable tools to
match their workflow
• Integration with existing
systems
• View of patient across
care pathway
• More consistent, higher
quality outcomes

24. The rapid rise of value-driven healthcare
24
Increased
government
policies
and financial
pressures…
…which require
software-
enabled
solutions to
deliver on cost
and quality
…drive shift
to more
integrated
and value-
based care
models…

25. 25
Poll Question
What are the biggest challenges that your
organization faces in managing risk?
a.The complexity of contracting
b.Defining attributable costs
c. Managing populations
d.Taking the first step
e.We do not plan to engage in risk-based contracting

26. Our joint opportunity
Healthcare IT transformation to help drive better outcomes
26
From treating illness to managing health
Enable patients
with more informed
and proactive
healthcare
experience
Give providers
tools to help
deliver better
outcomesAccelerating
workflows,
streamlining
processes,
improving
analytics
capabilities…
Liberate and
create new
value from data

27. Key ingredients to deliver successful outcomes
27
All three elements required to improve healthcare delivery
Software &
Analytics
Workflow
& Domain
Expertise
Strong
Ecosystem

28. Financial Management
28
Customer Challenges GE Solutions Customer Outcomes
1 Baystate Health in Massachusetts: reduced billing lag time by 69% - Source: Baystate Health in Massachusetts Case Study, 2012
2 University of Missouri Health: decreased days in A/R by 58% - Source: University of Missouri Health Case Study, 2012
3 Saint Francis Health System: increased up-front collections by $2M to $12M. Source: Optimizing Revenue Cycle Management: A
Case Study of Centricity Business at Saint Francis Health System, IDC Health Insight, August 2012
“How can we take on risk
and still deliver solid
patient outcomes?”
Financial Risk
Management Solutions
Reduced billing lag time by
69%1
Decreased A/R days by 58%2
“What type of healthcare
reform model is right
for my practice?”
Contract Modeling
& Management
Helped reduce cost to collect
to less than 4%3
“Which metrics should
I focus on to drive
maximum profitability?”
Revenue Cycle
Management
Activity-Based Costing
Increased up-front collections
by $2M to $12M3
“How do I connect my IT
systems to ensure
accuracy and great
outcomes in reporting?”
EDI & Claims
Processing

29. Enterprise Revenue Cycle: Centricity Business
Core Tenets
Reform ready. Now.
• Whether implementing full capitation or taking
your first steps in managing risk, Centricity
Business is your foundation for success.
Enterprise-wide visibility & control
• Improve financial performance with a
consolidated approach to managing both acute
care hospital billing and ambulatory billing
Comprehensive Task Management
• Flexible enterprise task management enables you
to control every aspect of your accounts
receivable; every payer, every edit, every
rejection.
29

30. Questions for Our Speakers?
Andy LeBlanc
Supervisor, Revenue Cycle
Michael Mast
Global Director, GE Healthcare IT
Pat Neisser
Director, Patient Financial Services