jim spause revenue cycle career presentation 2009
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- 1. Creating new opportunities Improving existing operationsHealth Care Revenue Cycle Expert
- 2. Expert in health care revenue cycle operations with over 15 years experience in several sectors Payor, provider, and consultingDeveloped 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 staffNegotiated payor / provider contracts and settlements Executive MBA Graduate, Temple University Jim Spause 610-256-0088 [email protected]
- 3. Companies and clients that I have served Jim [email protected] 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 Publishings 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 yearJim [email protected]
- 5. Establish stretch goals Develop plan Execute - Repeat Revenue Cycle DashboardsIndicator Better Practice Hospital Cash Receipts as % of Net Business Needs100%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 collectionsA/R Over 90 Days 15 - 20% 36.2% 5. Reduce Bad Debt DNFB Gross A/R DaysPatient Admitted5 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 AccessHealth 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 Revenue1 - 2%6% Claims submitted to insurance insurance information & procedures Insurance verified & selected / patient Verify services are medically necessaryBad Debt as a % of Gross Screen services for medical Paid or Denied3%2.3 % Revenue Claim follow-up with insurance necessity Collect co-pay / deductible or patient Status within aged receivables Claim Demographics GeneratedBetterIndicator Hosp 1Hosp 4 Hosp 2Hosp 3Hosp 5Hosp 6 Practice Clinical Services Provided and Documented DNFB Gross A/R Days (includes 4-day 5 Days 4.3 Days 5.0 Days5.2 Days 4.8 Days6.8 Days 4.2 Days billhold)IP charts coded per Not Plan to ImproveDesign & Redesign23-2632 303022.532coder/per dayTracked Increase pre-registering frequencyProcesses & Services Verify insurance via EDI OP charts coded per Not 150 23055 30064.322555 coder per/day Tracked POS collections Electronic order entry EMROBS & AMS charts Not coded per coder/per 36-4050 754564.250 Electronic compliance screening1 Tracked day Clean claims ER charts coded perOut- Out-Out-Out-Out-180190- 250coder per day sourcedsourced sourced sourced sourced 1 work Transcription backlog 1 Day1 Day 1 Day1 Day1 Day 1 Day day Not NotNotNot Not % of MPI duplicates .05%.01 Tracked TrackedTrackedTracked TrackedRecord Request21-7 days1 day1-7 days 1-7 days1 day14 daysTurnaround workdays Jim [email protected] 5
- 6. Be tough on the problem but kind with people Hands-on & resourceful Brainstorming & Collaboration Mistakes are forgivable Whats unforgivable is not taking responsibility and fixing the mistake Do the hard work and analyze - Numbers dont lie There are always choices and options choose wisely 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 [email protected]
- 7. Contact me at: Jim Spause, MBA, PMPLafayette Hill, PA (H): 610-567-0295 (M): 610-256-0088 [email protected] Spause 610-256-0088 [email protected]