aaham / copam retreat annual education conference lyman sornberger executive director, patient...

AAHAM / COPAM RetreatAnnual Education Conference

Lyman SornbergerExecutive Director, Patient Financial Services

Cleveland Clinic Foundation

September 16 -17, 2010

Agenda

• Definition of Accountability• Global Metrics• Scheduling• Financial Clearance• Registration• HIM Coding• Edits• Billing• Collections• Customer Service• Monitoring Productivity and Quality• External Controls

Definition of Accountability

•Subject to giving an account: answerable

•Capable of being accounted for : explainable

True or False?

Processes supporting the Revenue Cycle are the result of evolution, not design? External requirements and changes are usually responded to by the addition of work-arounds and patches and not by fundamental process redesign?

True

The result is:

1. Non Standardization

2. Compliance Risk

3. Excessive Hand-off’s

4. Decreased Patient Satisfaction

5. Increased Cost

6. Untimely Data Capture

True or False?

Accountability for the Revenue Cycle are not usually fragmented and incentives are generally aligned with the health systems mission and financial goals?

False

The end-result is:

1. Sub-optimal financial outcomes and frustration among management and staff.

2. Difficulty changing behavior.

3. Management fails to focus on process and focuses on functional outcomes.

4. Responsibility and Authority are not vested in the same results.

Performance Evaluation and Measurements

The ability to monitor, assess, and improve Revenue Cycle performance relies upon the establishment of clear metrics and tools that define and COMMUNICATE performance expectations.

Attributes of effective PERFORMANCE metrics are that they are:

• Clearly Defined• Quantifiable• Accessible• Objective• Relevant to Desired Outcomes• Leading and Lagging• Cascading and Multi-Level

Global MetricsGlobal Metrics

ALL CLEVELAND CLINIC ENTITIES *Compass Based

INDICATOR

2010 2009 Inc/(Dec)Accounts Receivable (Per Compass, Gross Debit) [000,000's] 2,294.29$ 1,966.65$ 16.66%

% of AR >90 Days (Total Debit AR by Date of Service) 25.0% 24.3% 2.87%YTD Cash Collections to Net Revenue (Less BD Expense) 100.84% 99.00% 1.86%

Gross Days in Credit Balances 1.56 1.68 -7.11%

YTD Charity as a % of Gross Revenue 2.8% 2.2% 24.35%

YTD Gross BD Write-offs as a % of Gross Revenue 2.1% 1.8% 20.37%

YTD Controllable Loss as a % of Gross Revenue 1.04% 1.01% 3.28%% of True Self Pay Collections <90 Days from Discharge 97.2% 91.4% 6.33%

MTD Total True Self Pay Collections [000's] 1,895$ 2,797$ -32.23%% of Residual Self Pay Collections <90 Days from Discharge 66.4% 64.7% 2.61%

MTD Total Residual Self Pay Collections [000's] 16,637$ 17,316$ -3.92%

% of Insurance Collections <90 Days from Discharge 90.4% 91.5% -1.12%

MTD Total Insurance Collections [000's] 388,522$ 380,166$ 2.20%

$ Collected Pre-Aged (Pre-Admits & Inhouse) $ Collected 0-30 Days from Discharge Date $ Collected 31-60 Days from Discharge $ Collected 61-90 Days from Discharge

% of Cash Collections <90 Days from Discharge for True Self Pay, Residual Self Pay, or Insurance $ Collected >90 Days from Discharge

All Cleveland Clinic Entities, Hospital and Physician

All Cleveland Clinic Entities A/R Balance and % of A/R > 90 Days (Debit Only, DOS)

$1,100

$1,300

$1,500

$1,700

$1,900

$2,100

$2,300

$2,500

JUL'09 AUG'09 SEP'09 OCT'09 NOV'09 DEC'09 JAN'10 FEB'10 MAR'10 APR'10 MAY'10 JUN'10 JUL'1010%

15%

20%

25%

30%

35%

40%

45%

All Cleveland Clinic Entities MTD Cash to Net Revenue

80%

85%

90%

95%

100%

105%

110%

115%

120%

125%

130%

JUL'09 AUG'09 SEP'09 OCT'09 NOV'09 DEC'09 JAN'10 FEB'10 MAR'10 APR'10 MAY'10 JUN'10 JUL'10

All Cleveland Clinic Entities Gross Days in Credits Balances

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50


All Cleveland Clinic Entities MTD Charity & Gross BD Write-off & Controllable Loss as a % of Gross Revenue

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%


All Cleveland Clinic Entities True Self Pay Cash by Aging Bucket & <90 Days Collection %'s

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

$4,500,000


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All Cleveland Clinic Entities Residual Self Pay Cash by Aging Bucket & <90 Days Collection %'s

$0

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

$18,000,000

$20,000,000


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All Cleveland Clinic Entities Insurance Cash by Aging Bucket & <90 Days Collection %'s

$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

$350,000,000

$400,000,000

$450,000,000


80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

ALL CLEVELAND CLINIC ENTITIES *G/L Based

INDICATOR

2010 2009 Inc/(Dec)

DRO 67.06 70.79 -5.27%

Days in Unapplied Cash 0.60 1.18 -49.07%

Average Daily Net Revenue (per DRO Schedule) 14.06$ 13.21$ 6.40%

All Cleveland Clinic Entities, Hospital and Physician

All Cleveland Clinic Entities DRO

70.79 74.61 69.84 66.25 67.0670.8370.04 70.76 66.6274.6872.00 71.04 67.13

-102030405060708090

100

Jul2009

Aug2009

Sep2009

Oct2009

Nov2009

Dec2009

Jan2010

Feb2010

Mar2010

Apr2010

May2010

Jun2010

Jul2010

All Cleveland Clinic Entities Average Daily Net Revenue

$-

$5.00

$10.00

$15.00

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2009 2010

All Cleveland Entities Days in Unapplied Cash

0.00

0.40

0.80

1.20

1.60

2.00

Jul2009

Aug2009

Sep2009

Oct2009

Nov2009

Dec2009

Jan2010

Feb2010

Mar2010

Apr2010

May2010

Jun2010

Jul2010

The Cleveland Clinic Health Systems - Patient Financial ServicesPFS Daily Dashboard -As of Saturday July 31, 2010*

Inhouse DNFB Insurance Patient Total AR

Central Region

CCP - Cleveland Clinic Professional 64,142,253 180,193,896 6,186,224 5,240,050 - - 279,967,719 103,972,724 # 383,940,443 CCH - Cleveland Clinic Technical 207,931,713 375,389,419 13,797,634 8,597,878 92,069,992 165,654,421 686,117,062 162,762,767 1,106,604,241

Total: Central Region 272,073,966 555,583,315 19,983,858 13,837,928 92,069,992 165,654,421 966,084,781 266,735,490 1,490,544,684 Community Hosp

MDE - Euclid 8,645,878 19,296,902 1,386,160 1,173,095 2,542,505 6,993,194 25,192,474 10,486,708 45,214,880 MDH - Huron 5,595,833 16,645,853 3,170,258 1,565,914 1,762,367 5,435,924 20,654,153 24,141,571 51,994,014 MDS - South Pointe 9,517,520 25,167,161 1,225,054 1,730,267 2,715,552 10,030,474 34,611,107 14,818,625 62,175,759 MDL - Hillcrest 25,414,678 57,029,828 1,472,395 2,502,553 5,947,718 27,760,581 74,784,104 20,038,088 128,530,491 MAR - Marymount 12,240,692 37,793,084 1,761,195 2,310,710 3,921,445 16,217,971 45,177,595 15,786,142 81,103,153 MED - Medina 6,473,281 14,204,094 749,701 532,803 1,394,902 4,903,378 23,233,626 6,858,907 36,390,813 FVW - Fairview 29,539,602 72,111,530 3,357,723 2,026,437 8,531,320 21,917,668 95,369,751 27,663,220 153,481,959 LUT - Lutheran 7,241,851 18,427,109 1,823,651 751,057 2,366,184 6,987,394 26,050,559 8,356,924 43,761,060 LAK - Lakewood 9,409,591 26,698,074 2,409,248 1,251,597 3,204,506 5,363,605 30,669,998 14,209,560 53,447,669

Total: Community Hosp 114,078,928 287,373,636 17,355,386 13,844,434 32,386,499 105,610,189 375,743,367 142,359,744 656,099,798 Florida

CC1 - Florida Professional 10,571,227 24,621,817 115,978 1,045,261 - - 43,851,679 8,112,689 51,964,368 WES - Weston 13,819,600 36,054,945 520,132 1,970,488 5,903,146 10,733,395 58,743,507 17,540,430 92,920,478

Total: Weston Pro & Tech 24,390,827 60,676,763 636,110 3,015,749 5,903,146 10,733,395 102,595,185 25,653,120 144,884,846

Total Cleveland Clinic Entities 410,543,721 903,633,713 37,975,355 30,698,111 130,359,637 281,998,004 1,444,423,333 434,748,353 2,291,529,328 Total Hospitals 335,830,240 698,818,000 31,673,153 24,412,800 130,359,637 281,998,004 1,120,603,935 322,662,940 1,855,624,517 Total Physicians 74,713,481 204,815,713 6,302,202 6,285,311 - - 323,819,398 112,085,413 435,904,811

Charity AdjustmentsAdjustments Posted

Accounts ReceivableBad Debt TransfersHospitals

Payments Posted

Inhouse DNFB Insurance Patient Total AR

June 2010 (Month End)Central Region

CCP - Cleveland Clinic Professional 63,143,007 155,403,853 4,727,421 3,850,882 - - 297,069,498 102,160,429 # 399,229,926 CCH - Cleveland Clinic Technical 209,755,930 356,965,364 8,655,987 7,694,047 91,450,747 161,997,502 702,041,505 163,111,844 1,118,601,598

Total: Central Region 272,898,938 512,369,218 13,383,408 11,544,929 91,450,747 161,997,502 999,111,003 265,272,272 1,517,831,524 Community Hosp

MDE - Euclid 9,085,833 20,582,151 1,388,195 925,777 3,220,426 6,847,291 26,786,690 10,278,640 47,133,047 MDH - Huron 5,521,251 16,300,061 2,563,471 1,259,921 2,041,143 5,358,923 21,277,459 22,595,915 51,273,440 MDS - South Pointe 10,065,249 27,086,862 1,868,075 1,434,150 2,569,407 8,316,481 33,770,042 14,535,234 59,191,164 MDL - Hillcrest 27,360,613 57,066,449 1,781,335 1,636,522 6,789,181 26,857,345 72,914,488 20,042,648 126,603,663 MAR - Marymount 14,007,029 41,309,141 1,606,068 1,140,366 2,955,051 15,548,792 44,947,320 16,399,277 79,850,440 MED - Medina 6,751,886 14,250,539 659,180 410,964 1,302,775 5,177,212 22,254,342 7,465,175 36,199,504 FVW - Fairview 33,057,000 74,586,083 3,516,279 2,462,181 10,291,365 22,047,703 95,782,092 25,814,783 153,935,943 LUT - Lutheran 8,843,156 20,205,902 1,178,828 744,171 2,182,861 5,519,249 25,275,602 8,292,338 41,270,050 LAK - Lakewood 9,967,382 28,340,276 1,995,406 1,313,886 4,260,470 5,000,415 31,757,356 13,925,249 54,943,489

Total: Community Hosp 124,659,399 299,727,464 16,556,837 11,327,940 35,612,680 100,673,411 374,765,390 139,349,260 650,400,740 Florida

CC1 - Florida Professional 10,644,217 21,908,144 43,710 1,100,566 - - 46,009,290 8,366,651 54,375,941 WES - Weston 15,484,906 40,008,173 129,208 2,021,314 5,437,807 10,009,146 57,365,998 17,990,369 90,803,320

Total: Weston Pro & Tech 26,129,123 61,916,317 172,918 3,121,880 5,437,807 10,009,146 103,375,288 26,357,020 145,179,260

Total Cleveland Clinic Entities 423,687,459 874,012,999 30,113,163 25,994,749 132,501,233 272,680,059 1,477,251,681 430,978,552 2,313,411,525 Total Hospitals 349,900,235 696,701,002 25,342,032 21,043,300 132,501,233 272,680,059 1,134,172,893 320,451,473 1,859,805,658 Total Physicians 73,787,224 177,311,997 4,771,131 4,951,449 - - 343,078,788 110,527,079 453,605,867

Adjustments PostedCharity

AdjustmentsBad Debt Transfers

Accounts ReceivableHospitals

Payments Posted

SchedulingScheduling

Financial Financial ClearanceClearance

RegistrationRegistration

HIM CodingHIM Coding

Metric/Measurement Target

Transcription Quality* 98.0%

Transcription Turnaround Time (%within 24 hours) 98.0%

Unbilled Chart Dollars at Month End Inpatient < $5M

Unbilled Chart Dollars at Month End Outpatient

Coding Timeliness: Discharge > Bill < 8 days 94%

Medical Record Completion Timeliness 0>30 days

Request of Information (ROI) Turnaround < 7 days

DEPARTMENT OF FINANCEHEALTH DATA SERVICES

Key Performance Indicators 2010

First Quarter, 2010 Facilities

CDI Benchmarks

CCF Main

Total Medicare Cases

Medical CMI

Surgical CMI

Overall CMI

Program Performance

YTD Financials Projected $

YTD Financials Achieved $

YTD Financials Achieved - RAC adjusted $

% Attainment

BENCHMARK

Case Coverage Rate 85%

Query Rate 35% - 45%

Physician Response Rate 80%

SOI Weight Change over baseline

ROM compared to the state

Medical Capture Rate

BENCHMARK

MJCC v. NMJCC 32%

MCC/CC v. NMCC/CC 67%

MCC+CC v. NCC 79%

MCC v. CC 47%

Surgical Capture Rate

MJCC v. NMJCC 21%

MCC/CC v. NMCC/CC 46%

MCC+CC v. NCC 74%

MCC v. CC 45%

Color depiction Example only- Green meet or above, Red below target

EditsEdits

ClaimsClaims

BillingBilling

Billing Operations Monthly Scorecard

Monthly Performance Indicator 2010 Goal January FebruaryRAC Completion % by Hospital Euclid 100% N/A N/AFairview 100% N/A 100%Hillcrest 100% N/A N/AHuron 100% N/A 100%Lakewood 100% N/A N/ALutheran 100% N/A 100%Main 100% N/A 100%Marymount 100% N/A N/AMedina 100% N/A 100%Southpointe 100% N/A N/AWeston 100% 100% 100%Appealed within 30 days of the demand letter Euclid 100% N/A N/AFairview 100% N/A N/AHillcrest 100% N/A N/AHuron 100% N/A N/ALakewood 100% N/A N/ALutheran 100% N/A N/AMain 100% N/A N/AMarymount 100% N/A N/AMedina 100% N/A N/ASouthpointe 100% N/A N/AWeston 100% N/A N/ALevel 1 - Learner Feedback on New Hire Training Programs PAS West >90% 96% 100%PAS East >90% 0% 0%PAS Central >90% 100% 100%PFS West >90% 0% 97%PFS East >90% 85% 84%PFS Central >90% 98% 95%Level 2 - New Hire Training Final Assessment Scores PAS West >89% 97% 92%PAS East >89% 89% 87%PAS Central >79% 96% 94%PFS West >84% 0% 96%PFS East >84% 93% 93%PFS Central Signature >84% 93% 88%PFS Central HBO >84% 96% 96%PFS Florida Signature >84% 95% 89%Cash Reconciliation % of Batches With Errors <2% 2.5% 1.8%Average days for batch distribution to vendors 2 Days 1.63 Days 1.78 DaysAverage days to receive verification of posting and amount posted from billing vendors 4 Days 3.49 Days 3.21 DaysDocument Processing Correspondence inventory (average days outstanding) Future Updates Future FuturePayer Denial Management Denial Inventory (average days outstanding) 21 days To Be Updated 11.6

CollectionsCollections

Customer ServiceCustomer Service

Innovations: Innovations: Follow-Up Tracking Follow-Up Tracking

and Productivity and Productivity SystemSystem

Patient Financial Services l 08/19/2010

Agenda

• Customer Service Follow Up and Productivity System

• Patient Complaint Tracking System

• Hospital Billing Productivity and Financial Results System


Follow-Up and Productivity Tracking

• Old Way of Thinking:– Productivity = “Take as many calls as you can” or “Touch as many

accounts as you can”– 21 CEO level complaints per month– Handwritten Paper Tracking Lists

• New Way of Thinking:– Quality. Are we delivering what we promise to the patient?– 10 CEO level complaints per month– Customer Surveys

• Productivity– Motivating Results Reporting– Automated Work Item Measurement

Patient Financial Services l 08/19/2010 9


8

External ControlsExternal Controls

Managed Care - Market and Network Services

Hospital (Technical) Enterprise Payer Scorecard: Sample Payers (Data is not Valid)

Year-End: December 31, 2008

Metric Primary Payer

YTD: Payer A Payer B Payer C Payer D Payer E Payer F Payer G Payer H

IP Cases # 6,032 198 829 7,902 1,677 2,418 250 2,101

OP Cases # 106,114 3,909 15,345 171,224 6,873 50,756 5,409 44,155

IP Charges $ $ 217,079,299 $ 4,767,740 $ 22,269,816 $ 216,374,795 $ 43,239,130 $ 69,123,930 $ 8,100,557 $ 62,581,265

OP Charges $ $ 197,914,595 $ 6,397,231 $ 26,329,210 $ 281,815,261 $ 20,978,136 $ 79,324,793 $ 10,586,761 $ 70,885,926

Avg IP Charges $ $ 15,470 $ 10,365 $ 11,545 $ 11,772 $ 11,087 $ 12,289 $ 13,942 $ 12,806

Avg OP Charges $ $ 802 $ 703 $ 738 $ 708 $ 1,312 $ 672 $ 841 $ 690

Average Length of Stay Days - IP 2.1 1.8 1.9 1.9 1.8 1.9 1.9 1.9

As of Month-End (all DOS):

Gross DRO-AR Days 20.8 29.4 27.3 22.3 22.0 20.6 26.1 20.4

Gross Active AR $ $ 55,127,403 $ 1,745,910 $ 8,402,280 $ 69,686,881 $ 9,066,706 $ 18,804,488 $ 2,891,421 $ 16,714,675

Gross Active AR Over 90 Days $ $ 10,294,256 $ 329,910 $ 1,156,076 $ 7,099,343 $ 948,121 $ 2,067,185 $ 775,445 $ 1,973,323

Gross Active AR Over 90 Days % 8.0% 8.1% 5.9% 4.4% 4.5% 4.7% 11.5% 5.1%

Gross Active AR Over 90 Days Cases # 1,858 129 381 1,555 145 541 92 651

Gross Active AR with Denial % 11.3% 6.6% 6.8% 5.6% 6.0% 5.6% 8.2% 6.1%

YTD for 2009 Dates of Service:

Total Payment $ (Primary/Secondary/Patient) $ 201,245,430 $ 6,321,437 $ 24,751,778 $ 217,201,390 $ 25,637,536 $ 77,785,320 $ 11,523,155 $ 65,673,654

Average IP Payments $ $ 7,492 $ 6,363 $ 5,833 $ 5,551 $ 4,267 $ 6,247 $ 9,111 $ 7,021

Average OP Payments $ $ 423 $ 425 $ 406 $ 311 $ 610 $ 379 $ 547 $ 325

Total Payment as % of Pd Chgs 21.6% 25.9% 23.0% 19.2% 17.6% 23.0% 27.7% 21.8%

Average Days to Bill 7.8 7.8 7.9 8.0 7.8 8.1 8.1 7.8

Average Days to Payment 10.1 12.4 10.9 10.4 13.2 9.3 7.8 8.6

Late Payments as a % of Paid Cases 0.1% 3.8% 0.8% 0.1% 2.0% 0.4% 0.7% 0.2%

Secondary/Self Pay Residual % Expected Revenue 3.1% 4.7% 3.0% 3.6% 1.9% 3.6% 2.3% 3.2%

Bad Debt/Charity $ 5,838,002 $ 362,866 $ 668,482 $ 6,518,977 $ 424,606 $ 2,015,108 $ 212,077 $ 1,837,544

Bad Debt/Charity % of Expected Revenue 1.2% 2.3% 1.1% 1.3% 0.7% 1.1% 0.8% 1.2%

Patient EducationPatient Education

Patient Education

Patient Feedback ForumsIdentified TopicsLaunched Educational Programs

Basics of Insurance and BillingPreparing for Your Surgery: From a Financial PerspectiveAbout to Retire: Preparing for Medicare

Patient Education

•Additional ProgramsLost Your Health InsuranceReading Your Cleveland Clinic StatementUsing Cleveland Clinic Website ToolsWhat Healthcare Reform Means to You (11/2010)

Patient Education

•Enabling Greater Participation

Online Videos

Community Partnerships

http://vsm-rob.ccf.org/Play.dyn?m2=t3pv87e27v11oqg78u8o9jodeguxsu3brdv2tyxyw9sklxy07a64esnw6fdn

Questions???Questions???

aaham / copam retreat annual education conference lyman sornberger executive director, patient...

Documents

revenue cycle performance

performance expectations

performance evaluation

financial goals

truethe result

result of evolution

suboptimal financial

falsethe endresult