revenue cycle digital transformation · management 3. - clinical documentation improvement (cdi) 4....
TRANSCRIPT
![Page 1: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/1.jpg)
![Page 2: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/2.jpg)
2
Revenue Cycle
Digital Transformation
Spectrum Health
Jason Joseph, SVP Chief Information Officer
Amy Assenmacher, SVP Finance - Revenue Cycle
Becker’s Hospital Review
![Page 3: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/3.jpg)
3
![Page 4: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/4.jpg)
4
Our Patient-Centered Revenue Cycle
![Page 5: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/5.jpg)
5
Journey to Industry Best Practice
![Page 6: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/6.jpg)
6
Transformation Workstreams
1A. – Patient Access
Service Centers (PASC)1B. - Schedgistration 2. - Patient Liability
Management3. - Clinical Documentation
Improvement (CDI)4. - Underpayments
5. - Physician Coding 6. - Revenue Management7. - PFS Workforce
Management8. - DNFB Reduction
10. - Revenue Cycle
Operating Model
Consolidate fragmented
Pre-Registration and
Financial Clearance
Migrate to an integrated
scheduling and registration
model
Improve patient liability
collection and increase
efficiency of vendors
Improve overall quality &
accuracy of clinical
documentation to support
accurate reimbursement
Prevent underpayment
revenue leakage
Improve accuracy of E&M
code selection and migrate
to exception-based coder
review
Implement processes
to appropriately align
ED E&M levels with
acuity & resource
usage
Work AR backlog and
transform PFS workforce
Lower overall Discharge
Not Final Billed levels
Build out Spectrum
Health’s revenue cycle
support capabilities
![Page 7: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/7.jpg)
7
Digital Capabilities
Revenue Cycle Data Flow
![Page 8: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/8.jpg)
8
Digital Capabilities – Key Platforms
![Page 9: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/9.jpg)
9
Transformation Digital Enhancements
1A. - Patient Access
Service Centers (PASC)1B. - Schedgistration
2. - Patient Liability
Management
3. - Clinical Documentation
Improvement (CDI)4. - Underpayments
5. - Physician Coding 6. - Revenue Management7. - PFS Workforce
Management8. - DNFB Reduction
• Epic patient workqueue
optimization
• RPA for automated
authorizations
• Epic Prelude enhancements
• RTE functionality
• Epic Cadence Decision
Trees
• Telephony infrastructure &
configuration
• Epic Patient Estimation
• Epic Financial Assistance
• Epic Single Business Office
• Epic Cash Drawer Module
• Patient Statements
• M*Modal CDI Engage /
Collaborate
• Epic Documentation
Templates
• Epic Reporting Workbench
• Epic Expected
Reimbursement Calculator
• Custom Epic SmartForms
for E&M suggestions
• Epic charge review
workqueue optimization
• Exception based charge
review system logic
• Epic ASAP Module for ED
levels
• Epic Revenue Guardian
• Epic workflow optimization
• RPA for claims statusing
• Claim edits rationalization
![Page 10: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/10.jpg)
10
Digital Capabilities – Epic Optimization
• Monitor and manage revenue variances
• Track, prioritize and fix critical issues
• Get claims out the door!
• Return to operational and financial baselines
• Assess user competency and fill knowledge gaps
• Refine Workflows
• Enhance the patient experience
• Drive incremental net revenue and accelerate cash
• Improve clinician satisfaction
![Page 11: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/11.jpg)
11
Transformation Journey By The #’s
![Page 12: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/12.jpg)
12
Transformation – Net AR Days Improvement
![Page 13: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/13.jpg)
13
Transformation – Staff Engagement & Satisfaction
![Page 14: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/14.jpg)
14
Critical Success Factors
1. Create a burning platform
2. Establish IS / Revenue cycle leadership alignment
3. Communicate clarifying objectives
4. Create a dedicated team on both sides working toward the same goal
5. Keep momentum and celebrate milestones
6. Leverage consulting for best practices
![Page 15: Revenue Cycle Digital Transformation · Management 3. - Clinical Documentation Improvement (CDI) 4. - Underpayments 5. - Physician Coding 6. - Revenue Management 7. -PFS Workforce](https://reader034.vdocument.in/reader034/viewer/2022050511/5f9ba258de1189223d44f119/html5/thumbnails/15.jpg)
15