t-system's revcycle+, the next generation of ed coding & billing
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RevCycle+™The next generation of coding and billing
• Dallas, TX• HQ, clinical content
and R&D COE
• Williamsburg, VA• East physician
revenue cycle COE
• Kansas City, MO• Facility coding COE
• Cerritos, CA• West physician
revenue cycle COE
• 39M+ patients each year• Clinical, workflow and revenue
cycle solutions
T-System is everywhere emergency medicine is practiced.
Solutions For Entire ED Care Process
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Notification,handoff andchart access
PCP referrals,care plans andpatient transition management
PDI, eRxfollow-up
Utilization review
Professional, facility, CPT,
observation, ICD
POS collections, charge capture, billing, denials,
collections
Patient access, Published wait times, pre-notification
Tracking, triage, charting, orders, admit, transfer, optimization
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• Little automation
• Slower processing
• Accuracy relies on skill of the individual coder or biller
• Limited performance transparency
• Lack of education to providers
Today, outsourced services are often performed as they would have been 20 years ago.
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On average, EDs are only collecting 27% of charges and patient responsibility and self pay patients are increasing.
Identity & Insurance Verification
Pre-registration Registration Charge
Capture Check-Out Coding Claims Processing
Post Service
PaymentsCollections
Patient access Billing & collections
Col
lect
ions
Opportunities to collect
Likelihood of collection
Percentage of Covered Workers Enrolled in a High-Deductible Plan
Note: These estimates include workers enrolled in HDHP/SO and other plan types. Because we do not collect information on the attributes of conventional plans, to be conservative, we assumed that workers in conventional plans do not have a deductible of $1,000 or more. Because of the low enrollment in conventional plans, the impact of this assumption is minimal. Average general annual health plan deductibles for PPOs, POS plans, and HDHP/SOs are for in-network services. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006-2011.
High-deductible plans are on the rise – estimated 70% of US employers in 2013.
T-System is Transforming the Process
Automating manual process for improved efficiency and fewer
errors
Real-time performance visibility to identify areas of potential
improvement
Client service expertise such as ongoing
provider training, payer contract negotiation
and credentialing
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RevCycle+™
| RevCycle+™
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Electronic eligibility verification; claims, denial,
aging and collections management; A/R
Advanced coding with medical decision making calculator
POS collection
Patient responsibility & collections optimization, credentialing, contract management, documentation training, compliance
+ Expert client services
+ Real-time visibility
+ Advanced technology
T-System clients increase collections by $10-30 per patient visit $500,000 to $1.5 million per year.
Advancing the Coding Process with Technology
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Audit report
Details how a level of service was calculated
• Decrease the subjectivity of code choice
• Create a defensible audit report
Want to know how many charts had no social history?
RC+ can report by provider, by date, or other criteria
Reportable data
MDM calculation
• CT, lab, MRI, and more• Utilization data by
provider
Ongoing Q/A
• Clinically trained coders maintain consistency & accuracy
Regulatory changes, ICD-10 expertise, payer guidelines
Bringing Collections Management Sophistication to the ED
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Predict patient propensity to pay based on historical, local data
Tailor resources and communication to maximize collections
Estimate & collect patient payment up front
1) 2) 3)
• Customize payment options
• Calculate real-time eligibility, copay & deductible
• Capture patient satisfaction
• iPad enabled
• Define patient communication plans, timing & methods
• Improve patient engagement through specific activities
• Reduce risk of inappropriate collection activity
Providing Real-time Performance Visibility
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• Real-time data
• Easy-to-use web interface
• Drill down, decomposition, and more for analysis at all levels of data
• Standard reporting pack
• Security features to specify access by log-in
Delivering an Expert Level of Service
• Performance monitoring and proactive identification of issues
• Ongoing physician training including ICD-10 training for providers, scribes, mid-levels
• Legal/compliance support
• Credentialing
• Contract negotiation
• Regulatory change monitoring
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T-System knows the ED – and provides service beyond just coding & billing
30+ years of experience in clinical, revenue cycle and operational ED management
