Select Health Mangement Inc. - Confidential shminc.org 2009 1

“Focusing on Results”

Healthcare Revenue Cycle SpecialistsJacqueline (Jackie) Francis,

MPA, FACHE, CHFP, FHFMA, President

239.775.7773

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SHM Inc. Presentation OutlineSHM Inc. Presentation Outline

• Our background & experience• Our clients • Core areas of expertise• How we define “revenue cycle”• Why SHM Inc? • Thoughts for the day

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•• SHM Inc. background & experience

• 100% Revenue Cycle Management Consulting• Managing change & people – the intangibles• Focus on results – the tangibles• ‘Big Picture’ & the ‘Details’• Established in 1991

– By Jackie Francis:• BS, MPA & registered medical technologist• FACHE, FHFMA, CHFP• Former Dir. of Admissions & Registration, Penn State University Hospital • Former Corporate Dir. CBO, UVMC, multi hospital system• 15 years in hospital key management positions (real jobs)• 17 years of consulting experience, all with my own company • Obtain results thru ‘hands on’ practical experience• National client base• ‘Virtual’ consulting group, with consultants who have been with us for many years• No junior MBA’s• National publications & HFM cover articles

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Sample Consultants in our group

• Gary Prala, BS• Barbara Bedard, MBA, Trainer• Mary Arent, BA, MA, Trainer• Kathy Kelly, Training Certifications• Susan Keller, AA, Trainer• Jan Norris, BA, BS, CPC, CHCC, CCP, CPC-H• Jeanne Solberg, RHIA• Vicki Rogers, BS, MS, RHIA• Pat Wagner, RN, CPC, Compliance• Vince Ciotti, BA

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•• Our Clients

–– Hospitals & Health SystemsHospitals & Health Systems–– Central Business OfficeCentral Business Office’’s (CBO)s (CBO)–– National Hospital Turnaround CompaniesNational Hospital Turnaround Companies–– Managed Care OrganizationsManaged Care Organizations–– Hospital based providersHospital based providers–– Consulting FirmsConsulting Firms–– See client listing, references, case studies, See client listing, references, case studies,

& articles, in marketing packet& articles, in marketing packet

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•• Core areas of expertiseCore areas of expertise•• Central Business Office Central Business Office –– CBOCBO

–– UVMC, Troy, OHUVMC, Troy, OH–– St. VincentSt. Vincent’’s Medical Center, NY, NYs Medical Center, NY, NY–– HUP, Phila. PAHUP, Phila. PA–– Catholic Health Partners, Cinci, OHCatholic Health Partners, Cinci, OH

•• Patient AccessPatient Access•• Business OfficeBusiness Office•• Health Information ManagementHealth Information Management•• Information TechnologyInformation Technology•• Training Training –– Staff evaluationsStaff evaluations•• ‘‘Charge Capture Integrity ProgramCharge Capture Integrity Program’’ & CDM& CDM

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Core areas of expertise, cont.Core areas of expertise, cont.•• Patient Access & Patient SchedulingPatient Access & Patient Scheduling•• Patient Financial ServicesPatient Financial Services•• Charge Capture Integrity Program with CAAT TechnologyCharge Capture Integrity Program with CAAT Technology•• Assessments/Recommendations Assessments/Recommendations •• Policy & Procedure Policy & Procedure •• Strategic PlanningStrategic Planning•• A/R TurnaroundsA/R Turnarounds•• CDM Strategic Pricing and Coding ReviewsCDM Strategic Pricing and Coding Reviews•• Clinical Coding ExpertiseClinical Coding Expertise•• Key Indicator & Tool DevelopmentKey Indicator & Tool Development•• Vendor evaluation, selection & managementVendor evaluation, selection & management•• Interim management Interim management –– multiple areasmultiple areas•• Specialty Billing : Physicians billing, Home Health, otherSpecialty Billing : Physicians billing, Home Health, other

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Patient SchedulingCustomer Service Patient Registration:

Pre registration, IP, OP and ED registration, ABN, Training, Financial Aid, Quality Tracking,

Self Pay Management,HIPPA

Insurance Verification,Front End Collections,

Financial Counseling

Case ManagementCare Management andDenial Prevention

Discharge Planning,Discharge Not FinalBilled, Late Charges

Health Information Management:Diagnosis Coding, Physician Documentation andProcedure CodingSelect Health Management Inc. 2009

BillingPrimary and Secondary Billing,Rebilling, Statements,Bill edits

Collections and Pt.Follow-up,Payor Relations,UnderpaymentRecovery, CustomerContact

Bad Debt ManagementBad Debt, Vendor Mgmt.A/R Aging Mgmt.

Cash and CreditPayment & Adj. Posting,Denial Management,Credit ManagementExpected ReimbursementCash Management

Revenue Cycle Process

• Charge Capture

• Error Management

• Charge Reconciliation

• Compliance/ Regulations

• Managed Care Contracts

• Training and Quality

Assurance

• Process Improvement

• Policy and Procedures

• Technology + Bolt On’s

• Regulations

• Resources/People/HR

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Patient AccessPatient Access

•• Patient SchedulingPatient Scheduling•• Bolt on TechnologiesBolt on Technologies•• Financial Counseling/Insurance VerificationFinancial Counseling/Insurance Verification•• Financial Policies and ProceduresFinancial Policies and Procedures•• PrePre--registration, Registrationregistration, Registration•• Registration AccuracyRegistration Accuracy•• Key IndicatorsKey Indicators•• POS CollectionsPOS Collections•• Regulatory RequirementsRegulatory Requirements•• Customer Service, Custom Training ProgramsCustomer Service, Custom Training Programs•• Implementation of Tools/Scorecards for AccessImplementation of Tools/Scorecards for Access

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Our Management StyleOur Management Style•• Partner oversight & managementPartner oversight & management•• Team approach, participativeTeam approach, participative•• Strong consultants as leadersStrong consultants as leaders•• Obtain results by:Obtain results by:

–– Defining the scope of the work,Defining the scope of the work,–– Working handWorking hand--inin--hand with client staff,hand with client staff,–– Identify & manage barriers,Identify & manage barriers,–– Maintain professional & ethical conduct,Maintain professional & ethical conduct,–– Documentation via action plan & daily activities, Documentation via action plan & daily activities, –– Planning, implementation, while staying on focus,Planning, implementation, while staying on focus,–– Tap into our resources,Tap into our resources,–– Regular reporting,Regular reporting,–– Manage expenses.Manage expenses.

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•• ““How we define Revenue CycleHow we define Revenue Cycle””

•• Processes within a facility, Processes within a facility, supported by technology, to supported by technology, to secure net revenuesecure net revenue

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Achieve Results•• PlanPlan

•• DoDo

•• CheckCheck

•• ActAct

TEAMWORK

PEOPLE

PROCESS TECHNOLOGY

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••How SHM Inc. can partner with How SHM Inc. can partner with you?you?

•• Confirm & define how SHM Inc. team will support Confirm & define how SHM Inc. team will support your facility, scope of the workyour facility, scope of the work

•• Define both parties needsDefine both parties needs•• SHM Inc. provide proposal, pricing & define SHM Inc. provide proposal, pricing & define

timeframestimeframes•• Allocate resources, schedule & initiate project Allocate resources, schedule & initiate project •• Facilitate data requests & become familiar with all Facilitate data requests & become familiar with all

facilitiesfacilities•• Regularly present findings, barriers, Regularly present findings, barriers,

recommendations with strategic/status planningrecommendations with strategic/status planning•• Track progressTrack progress•• Implementation, with focus on resultsImplementation, with focus on results

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Why SHM Inc?Why SHM Inc?•• Many combined years of 100% revenue cycle Many combined years of 100% revenue cycle

–– focused businessfocused business•• Availability Availability –– commitment of resourcescommitment of resources•• Seasoned real world executives/ consultantsSeasoned real world executives/ consultants•• In revenue cycle consulting business 17 yrsIn revenue cycle consulting business 17 yrs•• Resources in BO, CBO, Access, HIM, Charge Resources in BO, CBO, Access, HIM, Charge

Capture, IT, CDMCapture, IT, CDM•• Excellent referencesExcellent references•• History with national client base:History with national client base:–– Hospitals & Health Systems, CBOHospitals & Health Systems, CBO’’ss

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SHM Inc. PricingSHM Inc. Pricing•• SHM Inc. prices SHM Inc. prices

competitive with competitive with marketmarket

•• Able to Able to ‘‘project project priceprice’’

•• ‘‘Scope of workScope of work’’drives the pricingdrives the pricing

•• Reasonable Reasonable expensesexpenses

•• LetLet’’s get starteds get started

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Thoughts for the dayThoughts for the day““Change has a considerable psychological impact on Change has a considerable psychological impact on

the human mind. To the fearful it is threatening the human mind. To the fearful it is threatening because it means that things may get worse. To the because it means that things may get worse. To the hopeful it is encouraging because things may get hopeful it is encouraging because things may get better. To the confident it is inspiring because the better. To the confident it is inspiring because the

challenge exists to make things better.challenge exists to make things better.””King Whitney Jr.King Whitney Jr.

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Questions & CommentsQuestions & Comments

““However beautiful However beautiful the strategy, you the strategy, you

should occasionally should occasionally look at the resultslook at the results””

Sir Winston ChurchillSir Winston Churchill

THE PLAN

THEPROCESS

THEGOAL