novant health: transforming revenue cycle services in the ambulatory setting making healthcare...
TRANSCRIPT
![Page 1: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/1.jpg)
Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting
Making Healthcare Remarkable
R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician Services & Medical Group CMIO Novant Health
Geoffrey Gardner, CPA, VP of FinanceNovant Health
![Page 2: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/2.jpg)
Novant Health
FPO
Bringing together world-class technology and clinicians to provide care that works with patients’ schedules, preferences and needs. Creating a healthcare experience that is simpler, more convenient and more affordable, so that our patients can focus on what really matters:
getting better and staying healthy.
Click icon to add picture
![Page 3: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/3.jpg)
![Page 4: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/4.jpg)
![Page 5: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/5.jpg)
100
![Page 6: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/6.jpg)
Billing offices consolidated into one
![Page 7: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/7.jpg)
Practice management system implementation timeline
Begin system build
60 clinics go live
266 clinics live
Jan. 2011
July 2011
Jan. 2012
July 2012
Feb. 2013
July 2013
289 clinics live
301 clinics live
ROLLOUT COMPLETE343 clinics
live
![Page 8: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/8.jpg)
FOOTER AREA
Single system and operational transformation
![Page 9: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/9.jpg)
FOOTER AREA
Led to increased efficiency, higher collection rates and lower contractuals
![Page 10: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/10.jpg)
RCS performance
2010 20140
10
20
30
40
50
60
70 121+ aging
66%
10%
![Page 11: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/11.jpg)
RCS performance
1 20
20
40
60
80
100
120 AR days
98
35
2010 2014
![Page 12: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/12.jpg)
RCS performance
2010 Epic Only35
40
45
50
55
49.3%
54.1%
Collection rate
![Page 13: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/13.jpg)
RCS performance
2010 2013$300 $310 $320 $330 $340 $350 $360 $370 $380 $390 $400
$359
$389
Charge per encounter
![Page 14: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/14.jpg)
What does RCS look like today?
FPO
![Page 15: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/15.jpg)
RCS staffing
320 employees in core RCS
Cash posting Cash reconciliation Credit resolution Insurance follow-up Customer service Patient follow-up Support & analysis
20 employees in technical billing (for split bill clinics)
71 employees in advocates
57 employees in coding
76 employees in preverification
![Page 16: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/16.jpg)
Enhanced RCS services
July 2011 Advocates October 2012 Preverification
![Page 17: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/17.jpg)
Revenue Cycle Advocates
Serve as clinics’ primary point of contact for any billing issues
Resolves complex patient billing issues escalated by Customer Service
Navigates the patient through the financial assistance application process
Partners with the clinics to collect any patient outstanding self-pay and bad debt balances owed prior to the patient’s next appointment
![Page 18: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/18.jpg)
Coding
Executes comprehensive coding program including backend review functions and on-site clinic support for providers and clinic staff
Partners with compliance and coding education
Delivers feedback to providers for improved documentation and payer requirements
![Page 19: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/19.jpg)
Preverification
Ensures that patient’s registration is accurate with insurance information verified and loaded correctly prior to the patient’s visit
Navigates automated eligibility tools to locate coverage(s) and add appropriate coverage to the patient’s account
Optimizing and streamlining current workflow to target higher risk encounters
![Page 20: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/20.jpg)
Integrated approach to Revenue Cycle Services
Revenue Cycle
Advocates
Optimization Team
Patients
Customer Service
Clinic Operations
Core RCS
![Page 21: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/21.jpg)
FOOTER AREA
38
![Page 22: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/22.jpg)
FOOTER AREA
Percent decrease in RCS core cost
![Page 23: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/23.jpg)
RCS costs
2010 2011 2012 2013
94% 87%66% 56%
PRCPreverificationCodingAdvocatesCore RCS
Payment rec-onciliation
40
35
30
25
20
15
10
5
0
In m
illio
ns
Year
![Page 24: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/24.jpg)
RCS costs
2010 2011 2012 2013Gross revenue
billed $545.3 million $869 million $940 million $1.2 billion
Gross revenue collected $422.8 million $423.9 million $531.8 million $613.1 million
Core RCS cost as a % of collection 7.7% 7% 4.7% 3.8%
![Page 25: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/25.jpg)
RCS costs
2010 2011 2012 2013 $-
$100,000,000
$200,000,000
$300,000,000
$400,000,000
$500,000,000
$600,000,000
$700,000,000
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
Core RCS Cost as a % of Cash RCS Cash Collected
Typical outsource cost as % of collections
Core RCS Cost as a % of Collections
RCS Case Collected
![Page 26: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/26.jpg)
48
![Page 27: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/27.jpg)
Percentage reduction in total cost as related to total dollars billed
![Page 28: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/28.jpg)
Patient engagement tools
FPO
![Page 29: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/29.jpg)
MyNovant
![Page 30: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/30.jpg)
The road of continuous improvement
![Page 31: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/31.jpg)
What’s next?
Enhanced analytics
Coding optimization
ICD-10
Improvement of self-pay outstanding balances through integration of “propensity to pay” technology
Additional front-end process and staffing redesign
Denial management
![Page 32: Novant Health: Transforming Revenue Cycle Services in the Ambulatory Setting Making Healthcare Remarkable R. Henry Capps Jr., MD, FAAFP, Senior VP of Physician](https://reader035.vdocument.in/reader035/viewer/2022062713/56649cd65503460f9499e1dc/html5/thumbnails/32.jpg)
Let’s chat