FLORIDA HFMA

Presentation by:

Patrick McDermottSutter Health

Michele Sutherland

VMG Healthcare Consultants, Inc.

May 2019

Sailing Through the Revenue Cycle

“Start with Culture, End with Results”

Patrick McDermottSystem Vice President, Revenue Services

Patrick McDermott, the Vice President of Sutter Health, has used his passion and drive to build a career in healthcare and build teams which outperform. Going from challenge to challenge, he has continually helped his companies reach their maximum potential. A successful consultant for years, he worked his way up through the ranks, becoming an in-demand executive for some of the top healthcare providers in the nation.

Michele SutherlandPresident, Velocity Made Good

Michele Sutherland is the President and Founder of Velocity Made Good Healthcare Consulting. Having worked in the industry for decades, she is a leading expert in the Revenue Cycle, with some of the biggest healthcare systems in the industry as clients.With Michele at the helm VMG is able to provide full revenue cycle services with her dynamic team of highly experienced, client-focused employees. Each team member has a minimum of 15 years in the industry, with a number having over thirty. It’s this level of experience that enabled VMG to provide bespoke service to each of their clients. This has resulted in millions of dollars recovered and/or net new revenue for the hospital organizations they work with.A vibrant speaker who travels the country providing educational speaking engagements about “Lessons Learned” and how to help Providers make it to the Mark first.

Getting You to the Mark

In SAILING, a boat cannot sail directly into the wind and so the fastest way to an upwind mark is seldom a direct line; thus the tactics of changing directions, tacking & gybing, while maintaining a course that will maximize your heading and boat speed is called “Velocity Made Good” or VMG.

VMG is calculated with sophisticated computations and instrumentation, plus the finesse of an experienced crew. Like the crew of a sailboat, healthcare providers must balance technologies, processes, people, and ever-changing industry regulations to find the mark of maximum recovery and patient satisfaction.

Sailing Concepts as it Relates to this Presentation

Sailboats harness wind in the its sails to convert it into motion. Similar to an airplane flying in the air, sailboats use a keel in the water as a second wing to move across the surface. Different “points of sail” allow a sailboat to move faster and or slower.

Think of Revenue Cycle as a sailboat. In this presentation we will demonstrate how your revenue cycle can move faster (increase) and slower (decrease) in cash similar to how “points of sail” effect boat speed. At the end of this presentation, we aim to give you some ideas to get you revenue cycle sailing smooth!

Things Slowing Down your Revenue Cycle Boat

Typically the fastest point of sail is a beam reach or sailing sideways to the wind. The slowest point of sail is directly into the wind or “irons”.

Today’s revenue cycle is slower and more challenging to collect. If you relate “points of sail” to revenue cycle, it would be optimal to sail on a beam reach to get more cash in the fastest timeframe. Understanding EBITDA, your Cost to Collect and Reducing Denials are some of the ways you can get out of irons and set your revenue cycle on a beam reach.

Stating the ProblemRevenue Cycle Tell Tales

“Tell tales” attached to a sail are used as a guide for sail trim and boat speed. When placed on the luff (forward or mast edge of the mainsail) they are used to indicate that the sail is luffing or coming head to wind. The solution is to bear away from the wind or sheet in to increase boat speed.

Revenue Cycle tell tales can be used as key performance indicators to optimize your revenue cycle.

What are the revenue cycle tell tales?

USING COST REPORTS DATA TO POINT

TO REVENUE CYCLE PROBLEMS

➢ O/P Bad Debts significantly lower than I/P – Not billing Medicaid secondary O/Ps➢ O/P Bad Debts significantly lower than I/P – O/P depts. not issuing ABNs➢ O/P Bad Debts significantly lower than I/P – O/P depts. not checking Med. Necessity

➢ Bad Debts lower than Market Avg. – Denials Issue: Payor loaded wrong NPI➢ Bad Debts lower than Market Avg. – Denials Issue: Site of Service incorrect

➢ Low MA IME Reimbursement – Failure to bill Shadow Bills➢ VBP & Readmit Penalties – Revenue Cycle. experiences lower cash payments

➢ Excessive OBS Days vs Pt. Volume – OBS Denials or ineffective I/P downgrade appeals➢ Insufficient OBS Days vs Pt. Volume – Not billing for OBS hours.

Stating the ProblemRevenue Cycle Tell Tales

GE/VMG INCREMENTAL PROJECTS Hospital - North Hospital - Northeast Hospital NJ Hospital Center Total May / June

Bad Debts Project

Bad Debts Project - Forecast $ 248,479 $ 893,559 $ 1,432,906 $ 1,311,550 $ 3,886,494 $ 3,886,494

Bad Debts Project - Actual $ 255,912 $ 545,050 $ 1,234,018 WIP - 1,000,000 $ 3,034,980 WIP STATUS Completed Completed Completed 06/28/18

See Note 1 See Note 1

AVAILABLE BED Project

Available Bed Project -Forecast $ - $ 832,274 $ 3,496,555 WIP $ 4,328,829 $ 4,328,829

Available Bed Project - Actual $ - $ 832,274 WIP - 1,340,000 WIP $ 2,172,274 WIP STATUS NA Complete 06/28/18 TBD

See Note 2 See Note 2

Total $ 255,912 $ 545,050 WIP - 2,574,018 WIP - 1,000,000 $ 4,374,980 $ 8,215,323

*GE/VMG INCREMENTAL PROJECTS COMPLETED AND VALIDATED BY GE/VMG

Note 1: This is $775,000 of additional crossover accounts plus an estimated $250,000 of FY2015 accounts written off in FY2016.

Note 2: This number has been reduced from approximately $2,696,000 to account for 14 bassinets in NICU & Special Care.

Cost Report Opportunity - Example

Elephant In the RoomBekx Music

Stating the Problem – Why So Difficult to Adjust our SailsDecreasing Revenue/Increase Expense

➢ Hospital Operating Margins Dropped 39% Over 3 Years

➢ Revenue growth is and will continue to constrained as the sector continues to face numerous challenges, including low patient volume growth and higher bad debt as co-pays and deductibles rise “Moody's Investors Service

says in its annual outlook”

➢ Hospital Bankruptcy Filings have increased by 53% since 2010

Stating the Problem – Why So Difficult to Adjust our SailsDecreasing Revenue/Increase Expense

• A new Navigant study analyzed for-profit and nonprofit provider networks and found that the average operating margin declined by almost 39% over the same time span, from 4.15% in 2015 to 2.56% in 2017. Nonprofit systems had a slightly lower than average decline, reporting margin drops of 34%.

• A recent Moody's Investors Service report found that not-for-profit and public hospitals spent more than they gained in revenues for the second consecutive year in fiscal 2017. Moody's said the gap puts facilities "on an unsustainable path.“

• Navigant also determined that size and market dominance didn't protect health systems against operating declines. Three of the six largest operating income declines came from the three largest for-profit systems, which all had at least $15 billion in operating revenues in 2017, according to the report.

Hospital Operating Income Falls for Two-Thirds of Health Systems

Rapidly growing hospital expenses as the primary driver of declining operating margins, Navigant reported. Hospital expenses increased three percentage points faster hospital revenue from 2015 to 2017. Top-line operating revenue growth decreased from seven percent in 2015 to 5.5 percent by 2017.

Hospital Margins

Moody's Public Healthcare Outlook to Remain Negative

• Bad debt is expected to increase by 8% to 9% as health care plans place a greater financial burden on patients. Moreover, low reimbursement rates and a shift to more Medicare patients as the population ages will also constrain hospital revenue growth.

• Expense growth is anticipated to slow through cost-cutting measures and lower increases in drug prices. However, expenses will still outpace revenues due to the ongoing need for temporary nurses, continued recruitment of employed physicians, wage increases associated with lower unemployment, innovative specialty drugs, and increased use of medical devices.

Stating the Problem – Why So Difficult to Adjust our SailsDecreasing Revenue/Increase Expense

Hospital bankruptcy

➢ Hospital Bankruptcy Filings have increased by 53% since 2010

➢ 3 of 4 Hospitals that filed are Rural

➢ 20 Hospitals filed between 2016 and 2018

➢ According to Beckers, 12 hospitals have already filed in 2019 since January 1st

Stating the Problem – Why So Difficult to Adjust our SailsDecreasing Revenue/Increase Expense

Bloomberg reports that the

Morgan Stanley examination of

data from approximately 6,000

U.S. hospitals — both private and

public — finds that 8 percent

face a pressing risk of

permanent closure and 10

percent are termed “weak.”

Morgan Stanley analysts also

note that hospital mergers

haven’t shored up budgetary

concerns as hoped. A new

working paper for the National

Bureau of Economic

Research backs that

conclusion up, finding

that hospital mergers yielded

only 1.5 percent annual savings

in supply chain efficiencies.

Stating the Problem – Why So Difficult to Adjust our SailsDecreasing Revenue/Increase Expense

Hospitals Closed States Affected Beds Lost

106 34 3,696

Since 2010, the states with the most rural hospital closures are Texas (17), Tennessee (10) and Georgia (7). Three states – Alabama, North Carolina and Oklahoma – have lost six each and three states – Kansas, Mississippi and Missouri – have each lost five hospitals. If we again look back to just the start of 2014, 14 of the 17 Texas closures, nine of the 10 Tennessee closures, and five of the six closures in North Carolina and Oklahoma have occurred within this period.

Stating the Problem – Why So Difficult to Adjust our SailsDecreasing Revenue/Increase Expense

NYE REGIONAL MEDICAL CENTER

• Located in Tonopah, NV

• Closed due to bankruptcy, leaving the towns it served without any emergency medical services

• Nye Regional served Nye county, Esmirelda and all counties surrounding

• Closest cities are located within a 200 mile radius, such as, Las Vegas and Reno

“This is a tragic loss for the population served by our hospital, This is a decision that will ultimately jeopardize the health and well being of our community and surrounding areas. We are hopeful that another health care entity will see this lack of access to health care as an opportunity.”- hospital CEO Wayne Allen.

Today’s Financial Objectives vs. Today’s Inefficiencies

Today’s Financial Objectives Today’s Inefficiencies

• Improve Operating Margin• Increase Net Revenues• Increase Services & Growth• Improve Quality Measures• Improve Outcomes for Population Health• Increase POS Collections• Improve Self Pay Conversions• Improve Payment Options• Improve Physician & Patient Loyalty Plus

Satisfaction • Reduce Barriers for Patients• Reduce Bad Debt• Reduce Operating Costs• Reduce Denials & Write Offs• Reduce Cost to Collect• IMPROVE EBITDA

• Multiple Systems with Limited or No Integration• High Staffing Levels• Ease of Access Issues• Under-Utilization of Resource Tools• Expensive Training & Re-Training• Inadequate Support from Support Services • New Technologies built to mirror the old

technologies• Physician & Patient Loyalty plus Satisfaction

Issues• Low POS & Unscreened Self Pays• Lack of Communication of End Results to PAS,

Coding, and to Clinical Teams, plus Dept Leaders• Redundancies in Workflows – “Many Touch

Points”, along with Rework Needs• No Accountability for Staff• Staff Uncomfortable to “Ask For Money”

• Let’s 1st define what and why it’s important

• Earning before interest, tax, depreciation and amortization (EBITDA) is a measure of a company’s operating performance. Essentially, it’s a way to evaluate a company’s performance without having to factor in financing decisions, accounting decision or tax environments.

• …it’s kind of like the proper point of sail to keep sailing vessel at maximum speed… all of the rev cycle steps lead to no luffing (EBITDA) – “quote from a hospital CFO.”

• …strong EBITDA gives us a unified vision and direction to work together – “quote from another CFO.”

Fast Track Playbook

EBITDA & Income Statement Improvement

How Does EBITDA Relate to Sailing?

In sailing, “luffing” refers to when a sailing vessel is steering too far towards the wind or the sheet controlling the sail is eased so past optimal trim that airflow over the surface of the sail is disrupted. The sailing vessel is slow and leaking power.

Weak EBITDA is like “luffing” your revenue cycle where best process is eased past optimal trim and or when the front and back end are not working together causing net revenue leakage and additional costs.

Where is “Luffing” in Today’sRevenue Cycle

AREA of Rev Cycle Luffing Behaviors ResultsScheduling • With No orders, nor

No CPT & or Dx Codes

• With No Auths /

Referrals

• Denials

• Delay Cash

• Rework

Registration • No Verification Ins or

Demographics

• Not running Medical

Necessity

• Not processing ABNs

• Choosing Wrong

Payor

• Not performing MSPQ

• Not asking POS

• Denials

• Delay Cash

• Cost to Collect (return

mail & SP Agencies)

• Accruals Calculations

• Increase in SP Bad

Debt

• Reduction in

Medicare Bad Deb

Physician Documentation • Lack of

Documentation to

support to Medical

Necessity; Procedure

or DX, & or Level of

Care

• Denials

• Delay Cash

• Hard Write-Offs

Barriers to Smooth Sailing Relates toBarriers in Rev Cycle

Lack of Knowledge & Experience, Lack

Of Understanding Roles & Impact

Missing

Defined Navigational Path

Lack of Equipment & Technology

Outside ForcesWeather = Unexpected StormWind Chop = Swells & WavesTides Flows = In or OutWeathered Sails & LinesMissing Crew MembersReefing the Main Sail Outside Forces =

CMS Audit; Joint Commission,FLMA & NewInitiatives

Overall Barriers for Rev Cycle

3. Reduce Excess Backlogs

8. Optimize External Vendor Performance, scope, placements

4. Stop Inflow Into Aging Buckets

5. Solve Causes of Denials, Write-Offs

at Source

6. Eliminate NVA Steps

7. Optimize Automation of EMR, Bolt-Ons, and RPA Pilots

2. Monitor & Measure

1. Leadership/Development/Culture

Revenue/AR Mgmt Must Be a Comprehensive Playbook

Resistance to Change

Why do we resist Change?

If in Questioned:• Our Identify • Our Worth• Our Security

Creates Resistance

How do we change resistance to participation? Prevent False Starts & Just Busy Work

with No Results

Managing Complex Change

Vision

Vision

Vision

Vision

Vision

Skills

Skills

Skills

Skills

Skills

Incentives Resources Action Plan Change

Confusion

Anxiety

Resistance

Frustration

False Starts

Incentives

Incentives

Incentives

Incentives

Resources

Resources

Resources

Resources

Action Plan

Action Plan

Action Plan

Action Plan

What is Missing?

Culture Definition

Top Down: Goals, Objectives, Strategies, and Tactics

Bottom Uo: Safety, Security, and Motivation

Traditional definition: Corporate Culture refers to the shared values, attitudes, standards, and beliefs that characterize members of an organization anddefine it’s nature.

Culture is energy; adoption and resistance, acceleration and breaking, momentum and inertia of a group(s).

Threats to your feelings of safety and security; your identity, value and autonomy.

Like Grasping Mercury

Culture

1. Socialize business case/burning platform.2. Establish guiding team and give each authority, clear lines

of responsibility, assigned benefit goal, and align incentives.

3. CFO advisor group (regular cadence.)4. Benefits realization.5. Hang the Scoreboard: Measurement system for day to

day, week ending performance. Examples can be stories. Go viral with your best stories.

6. Respect the past or the past will pull you back.7. Establish accountability meetings without blame. Practice

“non-judgmental” language.8. Connect efforts (why it’s worth it) to healing.

Finesse of the Revenue Cycle Crew

A good sailing crew has a Skipper to steer the boat, a Tactician to navigate where to go, Sail Trimmers to optimize the wind flow, a Foredeck in the front of the boat to change sails, Wrench Hands to move the jib and other crew to help optimize the weight disbursement.

Like a sailing crew, a good revenue team has Finance Leaders to steer the business office, Revenue Cycle Leaders to navigate the processes, Coding and HIM to optimize claim submission, Patient Access & Patient Financial Services to support the front & back end of the cycle, and other crew to optimize the whole revenue cycle process.

Just as with a first class sailing crew; Captains will bring outside resources to help the crew, such as the Rep from the Sail Makers (who knows the secrets of how the sail should perform) and at times will bring an outside professional Tactician to improve the odds of winning

The finesse, the understanding of each other’s roles, the trust that each other will perform their role perfectly, and how the crew communicates together is the difference between winning and losing in a regatta or in the revenue cycle.

Knowing Your Role in the Revenue Cycleand How You Impact Downstream Departments

SCHEDULING AND PRE -REGISTRATION PRE CERT &

INSURANCEVERIFICATION

REGISTRATIONAND POINT OF

SERVICE COLLECTION

FINANCIALCOUNSELING

REVENUE INTEGRITY / CHARGE CAPTURE

CASE MANAGEMENT

HIMCODING/CDI

CLAIM SUBMISSION

THIRD PARTYFOLLOW- UP

CASH POSTING

PAYMENT VARIANCE

SELF PAYCOLLECTIONS

CUSTOMER SERVICE

Knowing Your ConsequencesPAS Consequences of Entering Info Incorrectly…example

• Lost Reimbursement

• Denials

• Delayed Cash

• Patient Safety

• HIPAA Issue

• Red Flags

• Returned Mail - Cost

• Rework / Skip tracing - Cost

• Patient not informed of charges for services

• No attempt to Collect POS - 3rd Party Collection Costs

• Duplicate Medical Record Numbers (MRN)

How to Speed up Your Revenue Cycle Sailboat

The Most Virulent Issues in Revenue Cycle

1. Focused appeals team2. Partner with case management and their long LOS

meeting3. Physician advisor escalation4. Pre-access dedicated missing auth team5. Share examples at medical exec meetings6. Ask CDI team to assist7. Analyze patterns and sources; DRG, admitting, physician8. Monitor and report9. Daily alerts on inpatient and <2 midnights10. Add to Payor meeting dashboard

Source: HBI Revenue Cycle Academy

Fast Track Playbook

EBITDA & Income Statement Improvement

1. Send daily Dashboard to all staff2. Train and certify everyone on the KPI’s3. Cut the A/R: Divide and Conquer

• Assign elig 835s to registration team• Reduce FBNS to zero (claims team)• Assign ownership roster of DNFB (stop, DNB, edits)• Payment timing analysis: eliminate NVA 1st FUP• Root cause every account inflow into 91+• AR aged 365+; 100% reserved• Resolved all duplicate credits

4. Establish high dollar discipline5. Collect more upfront – reduce most costly collection6. Create feedback loops on negative outcomes (AWOs, 835 denials, return mail, missed insurance)7. Look at cost report for signs 8. Scope small and fast, publish win, repeat

Fast Track Playbook

EBITDA & Income Statement Improvement

1. Daily “Take Action” Dashboard – predictive and actionable:• AWOs and bad debt write-offs are the most important for root case and EBITDA impact• Insurance denials are most important for reducing cost of collect• FBNS, DNFB, no submit date, appeals not sent – can’t collect that which is billed/rebilled• Billed insurance – 1st follow-up is delinquent – predictive aging• Medical necessity appeals win/loss percentage measures the most difficult of denials• Underpayments identified and recovered• Cost to collect (CTC), separated by vendor/software CTC and in-house CTC

2. Others should be based on pain points, major gaps in performance, compliance items

Cost to Collection Reduction

1. Renegotiate rates – “Just Ask.”2. Recontract; add grace periods, payment maxes, carve out segments3. Consolidate to increase volume/lower rate4. Insource5. Dedicated Vendor management team – catch invoice errors6. Establish one quality team and error reduction taskforces:

• “1st pass denials” taskforce – pick one payor/patient type• Estimate and refund errors• Return mail errors, and feed backward to registration• Duplicate contractual allowances• Account aging into 365• High dollar accounts placed to an agency

7. Accounts with >G+3 human touches (G=Goal number of touches)

8. Spent $300k for each $10M collected

Reducing Cost to Collect

Results From Focusing of Denials, EBITDA, & Reduce Cost to Collect

FY2018 Results - $115M

Operational Financial Impact (FYE June 2018)*

Major MilestonesInitiative Targeted Achieved Projected At Risk^

Workforce $34.0 $44.2 $50.0 -$10.2 • Reduction in force

• Voluntary Severance Program

• Vacancy Management

• Productivity Improvements

Revenue Cycle 24.1 29.6 25.0 -5.5 • Clinical and Non-Clinical Denials,

POS Collections, Charge Capture,

CDI, Strategic Pricing, Cost

reporting, Credit balances,

Underpayments, etc…

Supply Chain 30.5 17.4 27.9 13.1 • Non-Labor Expense Reduction

• Cost Variation

• Physician Preference Items

Physician

Enterprise

9.7 5.7 5.7 4.0 • Practice template redesign

• Productivity and workforce

• APP model and Medical Group

redesign

• Neurosurgery program

Access and

Growth

8.0 3.8 6.5 4.2 • Urgent Care

• JH Northeast Div. improvements

• TJUH Div. Improvements

System

Integration

7.0 2.8 6.7 4.2 • JH New Jersey operational

integration (salary & non-salary)

Pharmacy 4.2 11.8 4.5 -7.6 • 340b and Specialty Pharmacy

Totals $117.5M $115.3M $126.3M $2.2M

Operational Initiative

Financial Impact for FY2018

Revenue Cycle

FY18 Documented Financial Impact

* Achieved Totals were vetted and documented by Finance Department, August 15, 2018.

^ Projected Totals as of April, 2018.

Confirmed, Finance-Documented Value of

$115M in FY2018

Revenue Cycle FY18 P&L Impact Summary

$ 13,024,606Total $ 8,326,000

Net Revenue Improvements incl. FY18 Budget

Net FY18 Total $ 8,326,000 $ 29,454,606

Opportunity by Area

TJUH

Budgeted $

TJUH

Accomplished To Date

Denial Management $ 2,500,000 $3,500,000

Cost Reporting $ 1,726,000 $8,684,000

Underpayment Reviews $ 1,600,000 $2,298,000

Credit Balances $ 2,500,000 $3,600,000

Charge Capture & Strategic Pricing $1,750,000

Contract Negotiations $1,600,000

Staffing Utilization $800,000

Point of Service Collections $1 942,606

Vendor Performance Review $780,000

CDI & Coding Optimization $4,500,000

Outsource Billing

Put People First

Be Bold & Think Differently Do The

Right Thing

4

0

FY2019 Project Portfolio

Updated: July 24, 2018

FY2019 Budget Spread

$15,300

$26,000

$6,500 En… $6,300 $5,000$12,000

$28,199$34,500

$0$10,000$20,000$30,000$40,000

FY2

01

9 E

BD

IA Im

pac

t

($1

,00

0's

)

FY2019 Operational Initiative - EBIDA Impact

Clinical Enterprise Growth($47.8M)

Advanced Clinical Transformation($22.5M)

Rev Cycle($28.2M)

Oper. Efficiency($34.5M)

FY2019 Risks and Contingency Items

$0

$50,000

Q1 Q2 Q3 Q4

FY2

01

9 E

BID

A Im

pac

t (1

,00

0's

)

FY2019 Budget Spread

Operational Efficiency

Revenue Cycle

Advanced Clin. Transformation

Clin. Enter. Growth

$15,000

$35,919$39,691

$43,219

Del

iver

y R

isks

• Senior leaderships ability to make timely decisions and drive accountability (New org structures rolling out)

• Speed of enterprise OI plan design and activation in time to achieve impact expectations (GE and PE aggressively driving)

• Divisional leadership ownership of budgets and financial improvement projects (Operating mechanisms and local support to drive ownership and accountability)

• Unforeseen market changes (Close alignment with enterprise and divisional leadership to identify and mitigate risks)

Co

nti

nge

ncy

Ite

ms

• Corporate services redesign and consolidation (New building coupled with Service Level Agreements are good catalyst)

• Purchased services expense reduction ($650M+ in expense – value assessments and purchased services consolidation)

• Payer Contract modeling (Clear identification of revenue cycle improvements – underpayments)

• Affiliated PCP and employed specialist care retention (Estimation of financial impact purely on employed PCP)

• Clinical program rationalization (JMG and Service Line Plans)

Impact

Impact

Revenue Optimization

PUT PEOPLE FIRST | BE BOLD & THINK DIFFERENTLY | DO THE RIGHT THING

Revenue Cycle Current Actual Current Budget Variance %V YTD Actual YTD Budget Variance %V

Net Patient Service Revenue per CWAD 11,709 11,976 (267) -2.2% 11,694 11,982 (288) -2.4%

Net Patient Service Revenue per wRVU New metric added Dec 17, working with Physician Enterprise team to add when available

Net Collection Rate - Hospital Working with Revenue Cycle Enterprise Initiative team to add when available

Net Collection Rate - Physician Enterprise Working with Revenue Cycle Enterprise Initiative team to add when available

11,000

11,100

11,200

11,300

11,400

11,500

11,600

11,700

11,800

Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18Net P

atie

nt Se

rvice

Rev

enue

per

CW

AD

Net Patient Service Revenue per CWADAs of August 2018

Consolidated Linear (Consolidated)

INSERT UNDERPAYMENTCHART (Lou I.)

INSERT DENIALSCHART (Lou I.)

Barriers & Risk Mitigation Plan

• Multiple groups reporting on key Revenue Cycle indicators using different tools (e.g., Net

Collection Rate. Revenue Cycle OI is actively working to understand various tools and

developing a standardized approach and comparable calculations)

• Delayed implementation of POS collections equipment - credit card machines (IS&T is

actively working with vendor to mitigate further delay)

Impact

Workstream KPI

Denials Management Total Write Offs

POS Collections POS Collections as a % of NPSR

CDI CMI (Medicare and All Payor)

Underpayments Dollars Collected for Underpayments

Example: POS Collections

Revenue Optimization: Mezzanine KPIs

Smooth Sailing – Conclusion

Future Event:

Join us at the Revenomics Summit for a 2 Day Executive event in Pensacola FL at PYC!

Hosted by: Michele Sutherland & Patrick McDermott

RSVP: Dorab@vmghcconsult.com