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ManagingMissedOpportunitiesIdentifyYourPractice’sPotentialLoriLaubach,CHC,Principal

OR/WAMGMAConferenceMonday,May16,2016

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Thematerialappearinginthispresentationisforinformationalpurposesonlyandshouldnotbeconstruedasadviceofanykind,including,withoutlimitation,legal,accounting,orinvestmentadvice.Thisinformationisnotintendedtocreate,andreceiptdoesnotconstitute,alegalrelationship,including,butnotlimitedto,anaccountant-clientrelationship.Althoughthisinformationmayhavebeenpreparedbyprofessionals,itshouldnotbeusedasasubstituteforprofessionalservices.Iflegal,accounting,investment,orotherprofessionaladviceisrequired,theservicesofaprofessionalshouldbesought.

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AGENDA

•  Operations•  BusinessExpansion•  Consumers•  Competition

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2016TRENDSPOISEDTOTRANSFORMHEALTHCARE

1.  Telemedicine2.  “Everything”asaservice(XaaS)gains

prominence3.  Socialmediatoresearchandmakehealthcare

decisions4.  Applicationprogramminginterfaces(APIs)

evolveasastrategicenabler

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2016TRENDSPOISEDTOTRANSFORMHEALTHCARE

5.  NextgenerationanalyticsandartiTicialintelligence(AI)

6.  TheexplosionoftheIoT7.  Cybersecuritywillevolvefromprotectionto

prediction8.  Robotsandprintedpartsareontheirway

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OPERATIONS

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AREASOFFOCUS

•  RevenueCycleStafTing•  Registration/FrontDesk•  ProductLines

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CURRENTSTATEOFSTAFFINGFORREVENUECYCLE

•  EstablishedbasedonmanualworkTlow•  Papertransactions•  Reactive•  Perceivedneedformorestaff

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PHASE1-STEPSTOCALCULATECURRENT•  Determinestepsinrevenuecycle•  Documentthetimespentineacharea•  Obtaindata•  Determinestaffhours•  Estimatetotaltimebystepinminutesandthendeterminenumberofhours

•  Dividetotalnumberofhoursbystaffhours

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PHASE2-STEPSTOCALCULATEFUTURE

•  UtilizingPhase1stepsinrevenuecycle•  Obtainbestpracticeorindustrystandardtimeforeacharea

•  Estimatetotaltimebystepinminutesandthendeterminenumberofhours

•  Dividetotalnumberofhoursbystaffhours

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DETERMINENUMBEROFHOURSINYEAR

Hoursavailable 2,080

LessPTO(vacaMon&sick) 5weeks 40hours (200)

LessEducaMon (40)

LessAdmin 4hours 46weeks (184)

Hoursavailabletowork 1,656

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EXAMPLESPAYMENTPOSTING-LOCKBOXANDERA

Unit/Min

CalculaGons TotalHrs

Needed

FTE Unit/Min

CalculaGons

TotalHrsNeeded

FTE

TotalpaymentlinesrequiringindividualposMng

186,960.00

TotalMme-perlineperminute(add10%reservefordroptocoins)

.88 164,524.80 .40 74,784.00

Hours 2,742.00 2,742 1.66 1,246.00 1,246 .75

AsIsAutomate

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EXAMPLESREJECTIONS

Unit/Min

CalculaGons TotalHrsNeeded

FTE Unit/Min

CalculaGons TotalHrsNeeded

FTE

Totalclaimsbilled 144,961.00

PercentofclaimswithrejecMons

10% 14,496.00

AverageMmetoreviewandcorrect

5 72,480.00 2 28,992.00

Hours 1,208.00 1,208 .73 483.00 483 .29

AsIsAutomate

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EXAMPLESDENIALS

Unit/Min

CalculaGons TotalHrsNeeded

FTE Unit/Min

CalculaGons TotalHrsNeeded

FTE

CountofANSIdenialsposted

7,508.00

Assumenotalldenialsareposted

200% 15,016.00 80% 12,013.00

AverageMmetoreviewandcompleteacMons

15 225,240.00 4.8 72,077.00

Hours 3,754.00 5,631 3.40 1,201.00 1,201 .73

AsIsAutomate

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EXAMPLESPAYERFOLLOWUP

Unit/Min

CalculaGons TotalHrsNeeded

FTE Unit/Min

CalculaGons TotalHrsNeeded

FTE

Numberofagedaccounts

16,468.00

PaMentlinesperaging

14,144.00 60% 8,486.00

TotalMme 8 113,152.00 6.4 54,310.00

Hours 15,087.00 15,087 9.11 5,793.00 5,793 3.50

AsIsAutomate

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EXAMPLESPATIENTACCOUNTFOLLOWUP

Unit/Min

CalculaGons TotalHrsNeeded

FTE Unit/Min

CalculaGons TotalHrsNeeded

FTE

Numberofagedaccounts

16,468.00

PaMentlinesperaging

1,836.00

TotalMme 6 11,016.00 4 7,344.00

Hours 1,102.00 1,102 .67 490.00 490 .30

AsIsAutomate

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PATIENTCOLLECTIONS

•  Trainyourstaff•  Putitinwriting•  Beprepared•  Optionsforpayment•  Upfrontpolicy

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PATIENTCOLLECTIONS

RevenueCycleFuncGon RevenueCycleLeadingPracGcePerformanceIndicator

Pre-RegistraMon&InsuranceVerificaMon

Onaverage,pre-registraMonandinsuranceverificaMonacMviMesarecompleted7daysoutforscheduledservices

Pre-RegistraMon&InsuranceVerificaMon

95%+ofpaMentsarefinanciallysecureatregistraMonforscheduledorelecMvecases

FinancialCounseling 90%+ofuninsuredorunderinsuredpaMentsarefinanciallyscreenedatcheckout

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REVENUECYCLE:BESTPRACTICES

•  Monthlyreconciliationofpayments,charges,adjustmentsandrefunds,collectionwriteoffwithagency

•  Monthlyanalysisofaccountsreceivablestatistics•  Monitoringofnon-contractualadjustments•  Electronictransmissionofclaims•  Controlstoensurechargesarecapturedandbilledinatimelyfashion

•  Lagreports•  Missingfeeticketreports•  Monitoringofchargecorrections•  Formalcollectionmatrix

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•  30daysfromtimeofdenialtopaymentbypayer•  Documentationtosupportthedenialfollowup•  Payeragingbalancesstaywithinindustrybenchmarks

•  CalculationofdaysinAccountsReceivablebypayer

•  Denialmanagementreports•  Denialqueuesinbillingsystem•  Managementofworkqueues

REVENUECYCLE:BESTPRACTICES

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EXPANDINGBUSINESSPORTFOLIOS

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EXPANDBUSINESSPORTFOLIOS

•  Marketexpansiono  Acquireotherphysicians,practices,groupso  Usethisstrategytoachievespecialtymix,criticalmass

o  Scaleasnecessarytomeetyourmedicalgroupgoals•  Productexpansion

o Newclinicalproductofferings–urgentcare,retailclinics,telemedicine

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BEYONDPATIENTS

•  Newpotentialcustomerso  Otherproviderentitieso  Employersandhealthplanshoppers

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CONSUMERS

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CONSUMER-DRIVENHEALTHCARE

•  Consumerssavvieraboutspending•  Shoparoundforservices•  Potentiallyselectinglessexpensiveproviders•  Higherout-of-pocketcostscancausedelaysoravoidanceofnecessarycare

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CONSUMERDRIVENCARE

•  Deductiblesincreasing•  Electronictoolsallowforpatienttoexploreotheroptions

•  Whyyourpractice?•  Dopatientscomplainthatit’shardtogetappointments?

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LOYALTY

•  Securelong-termconsumerloyalty:o  Transparentandfavorablesearchfunctiono  Convenientschedulingo  Excellentcustomerserviceo  Fullsuiteofcaredeliveryandserviceofferings

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HEALTHCARERELATIONSHIPMANAGER

•  Costs90%lesstogetcurrentpatientstoreturnthantoattractnewpatients

•  Practiceslose50%ofpatientbaseeveryTiveyears

•  UtilizeEMRandbillingtoidentifypatients•  Establishapproachtominingcurrentdatabasetoensurereturnofcurrentpatients

•  Considerutilizingsameapproachfornoshowappointments

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COMPETITION

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DON’TIMITATECOMPETITION

•  Leverageyourmedicalgroupassetstoprovidethebestoption

•  Offervalue-orientedproductthatyourcompetitioncannotmatch

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VIRTUALACCESS

•  Combinedigitalaccesswithclinicalexpertise

•  Createaproducttosurpassyourcompetitionbyleveragingyouruniqueclinicalexpertise

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TELEMEDICINEKEYDETAILS

•  Whatarethegoals?•  Whoareyoutargeting?•  Whatisourbudget?•  Whatdoweplantodowithit?•  Arethereanymajoractivitiesoritemsworthnoting?

•  Howwillwemeasuresuccess?

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QUESTIONS?