payment assurance for hospitals - washington-alaska hfma · payment assurance for hospitals...
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Payment Assurance for Hospitals
Applying [Data] Science to the Art of Patient Access:
How artificial intelligence and machine learning is improving Patient Access Performance, Net Revenue and Patient Experience
Speakers: aul Shorrosh
WA AK HFMA May 1-3, 2019
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About Our Speaker
Paul Shorrosh
Founder and CEO, AccuReg- Payment Assurance For Hospitals
Former Revenue Cycle Management Operations
HFMA Member and Sponsor >20 years
Former Board and Committee Chair, NAHAM
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Today’s Discussion Points
• What is Patient Access?
• What is Data Science?
• Can Data Science apply to Revenue Cycle Performance?
• Can Data Science apply to Patient Financial Engagement?
• Partnering to bring science and prediction to the revenue cycle
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Patient Access is Front-End RCM
Revenue Cycle Management
Front (FERC)
Order Schedule Pre-Reg Arrival Registration
BackMiddle
Revenue Capture Management
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Patient Access Objectives
• Patient experience• Speed - efficiency• Accurate data capture• Collect patient liabilities• Offer financial assistance• Prevent denials:
• Eligibility (COB)• Authorizations• Medical Necessity• Data Quality
5 OPPORTUNITY POINTS:1. Ordering2. Scheduling3. Pre-Registration4. Arrival5. Registration
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Patient Access – Multiple Complex Processes and Tasks
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Patient Access - Financial Goals
Collect Cash
Prevent Denials
Improve Net
Revenue
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What is Data Science?
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Data Science Terms
• Artificial Intelligence- the development of computer systems to make decisions and perform tasks that normally require human intelligence.
• Predictive Analytics- the practice of analyzing data to identify past patterns to create algorithms that reliably predict the future.
• Algorithms- a logical rule that can be used to identify a current or future situation that meets that same pattern from the past.
• Machine Learning- the systematic process of identifying new patterns and algorithms that constantly improve a system’s ability to make predictions and decisions.
• Learning Rules Engine- a software system with rules (algorithms) that are constantly updated based on new input.
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Artificial Intelligence –Computers with the ability
to reason as humans
Machine Learning –Computers with the ability to learn without being explicitly
programmed
Deep Learning –Network capable of
adapting itself to new data
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Can Data Science Apply to Revenue
Cycle Performance?
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Predictive Intelligence in PA Workflow
Data Analysis
Patterns
RulesRCM Data Sources:• Provider Claims• Payer Remits• Patient Payments• Payer EV/Benefits• Physician Orders• Scheduling• Registration• Propensity• Errors• Charge Post
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Data Science - Impact on Net Revenue in PAS
• Patient Revenue – POS Collections:• Predictive Estimation & Accuracy Validation (CQI)• Scheduled Patient Rate• Complete Order Rate (CPT present)• Complete Pre-Reg Rate (Tier 4)• Estimate to Registration Rate
• Payer Revenue – Denials Prevention:• Payer denial patterns -> rules engine -> real time alerts -> intervention• Predictive Authorization• Changing Payer Requirements;
• Eligibility and benefit limitations, COB complexities• Medical Necessity requirements
• Outsmart payer tactics in the reg booth
Collect Cash
Prevent Denials
Improve Net
Revenue
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Can Data Science Apply to Patient Financial Engagement?
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Source; HFM Nov 2018Survey on
Patient Financial Engagement
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Source; HFM Nov 2018Survey on
Patient Financial Engagement
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Data Science Improves Patient Estimates
• Accuracy Measurement and Improvement Process
• Accuracy defined: estimates within 10% of remit
• Variance analysis: good 85% / better 90% / best 95%
• CQI improvement process
• Product
• Provider
• Predictive Estimates based on order patterns
• To increase POS Collections, increase the Estimate to Registration Rate
• To increase the Estimate to Registration Rate, automate estimate generation
• To automate estimate generation, capture CPT codes and partner carefully
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Predicting the Affordability Tipping Point
0
25
50
75
100
125
150
175
200
225
250
275
300
0 100 200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000
FPL
Account Patient Balance Due
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Predictive Charity Qualification
20
FPL
Credit Score
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3D Financial Assistance Policies
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Data Science Improves Financial Counseling
• Redesign FAPs based on payment patterns and consumer data
• New FAPs can be built into a rules engine which;• Matches up patients to FAPs in pre-service or point of service• Prompts registrars when a patient qualifies• Scripts the registrar to offer the right FAP to the right person
• Allowing registrars to do financial counseling!
• FAPs are prioritized and sequenced
• Patient Financial Communication is standardized
• Financial Assistance options are personalized AND consistent• Treat people the same – depending on individual situation: balance due,
ability and willingness
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Data Science andPatient Access Partners
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4 Front-End RCM Models
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Intelligence in PA - Tech Partnerships
• Does the company specialize in Patient Access?
• What is their vision and strategy for Patient Access?
• Do they have a dedicated team for data analytics/validation?
• Do they have an adaptive learning rules engine?
• Do they maintain your payer rules?
• Do they service and train well – and often?
• How engaged will they be with optimization and customization?
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Patient Access Intelligence
An analytics team and a dynamic rules engine that brings intelligence into the Patient Access workflow to improve Net Revenue and Patient Experience.
Shared Vision
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www.accuregsoftware.com
251-338-4443
Founder & CEO, AccuReg
Paul Shorrosh
251-209-0110
Payment Assurance from the Front-End
Thank You!Questions?