Health Tech Revenue Cycle Solutions
Transcript of Health Tech Revenue Cycle Solutions
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HealthTech Solutions Group Company Overview
Optimizing Clients Financial & Revenue Cycle Results through People, Process and Innovative
Technology Solutions
Albert Einstein
"The definition of insanity is doing the same thing over and over again and expecting different results"
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Company Profile:
AR/Central Business Office
Billing/CollectionsRevenue RecoveryAR reduction projectsOutsourced BO
Synapse Software Suite
Business IntelligenceED Claims myClaimIQ genieCollection Management
Consulting – Services
Process ImprovementTransfer DRG RecoveryRevenue RecoveryInterim Directors
Headquarters in Plano, TX (DFW Area) Experienced management team Proven results from CAH to multi-hospital systems Focus on effective use of technology in driving performance
AR – Billing/Collections Software – Business Intelligence, Claims Analysis Services – Implementation, Revenue Recovery
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Revenue Recovery Services
Case Study: ED Claims Project
Tool: myClaimIQ genie
Facility Overview -
Critical Access Hospital$ 15 Million Annual Net Revenue~ 6,000 ED Visits per Year
Results -
11% increase in Net Rev per account over $300k recovered in first 6 months 4% increase in total facility annual NR
“Our facility saw an almost immediate increase in net revenue and cash collections from this project. The process
was seamless and the results speak for themselves ” –CEO
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Accounts Receivable/RSC Services
Interim BO placements – BOD, Manager Level
Outsourced Billing/Collections
Aged AR Liquidation/Reduction Services Hospital
Physician
Physician Billing/Collections
Outsource Entire Revenue Cycle
Revenue Recovery projects – charging, coding provided on a contingency fee basis
Services Overview
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Outsourced Revenue Cycle
Why HealthTech Solutions Group?
Current Revenue Cycle Model
Facility basedAR Day focusedLack of scale in operationsLimited use of technologyLow level specialization
HTSG Technology Focused Approach
Correct cash focused Cash collections Revenue optimized - Synapse
Technology critical efficiencyCentralized & scalableHighly specialized functions
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Accounts Receivable/RSC Services
Typical cash focus is on stated Accounts Receivable (AR) balance
HTSG Correct Cash focus:
1. AR balance is correct per contract terms and conditions
2. Claim has been correctly coded – Synapse ClaimIQ, ED ClaimIQ
3. Claim has all correct charge components – Implant charges, high cost drugs etc
4. Claim has no codes that are incorrect, deleted or no longer in use
5. Claim is collected in a timely manner
Result – improvement in cash and cash collected/account
What is “Correct Cash” focus?
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Revenue Service Center (RSC) – Operations
Overview
Facility located in Plano, TX (DFW area)
Highly experienced & successful executive team
Currently perform operations for Brim owned hospitals
AR Liquidation projects – Physician & Hospital AR
All current staff highly experienced
Ability to expand scope of services without disruption
Location provides access to large pool of experienced Revenue Cycle and Technology staff
DFW provides a very cost competitive value proposition
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AR Liquidation & Recovery Services
Dedicated team & reporting portal for each project
Physician
Hospital
Project starts almost immediately via VPN connection
Team experience on all major hospital and physician HIT systems
Engagement structured as contingency fee basis
0-180 Days – 10%
181-365 Days – 15%
+ 365 Days – 25%
All claims run through Synapse ClaimIQ software ensures all revenue captured
A Service Redefined
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Revenue Recovery Services
CMS currently has 273 DRG’s subject to Transfer DRG rules Payment to Acute Care hospital is reduced if the LOS (+1 day) is less than the GLOS
Can affect up to 50% of a PPS facilities discharges
HTSG researches all applicable Medicare discharges Identify all accounts that have potential for Revenue Recovery
Work with facility to validate all information correct
Refile and correct all applicable claims
Revenue Recovery process is quick, seamless and no-risk to the facility
Engagement structured as a contingency of recoveries (25%)
Post Acute Care Transfer Recovery
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Revenue Recovery Services
HTSG provides each facility with a risk free assessment of potential opportunity
HTSG will analyze previous 12 months of data for free All we require is standard data file & BAA (HTSG can assist in data extraction) Run the data through our proprietary algorithms Turn the file around within 7-10 days
Process is extremely targeted and non invasive Synapse ClaimIQ algorithms allow us to identify specific accountsWe don’t bring in a team of consultants taking up your team members time
Revenue Recovery can start almost immediately Targeted approach means we can start rebilling accounts, capturing revenue within hours of starting the engagement ClaimIQ can provide ongoing monitoring and concurrent charge capture toolset
Engagement can be structured as either on a fee basis or as a contingency (25%)
Process Overview
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Accounts Receivable/RSC Services
Outsourced Billing/Collections – short term provided on a per hr basis for short term projects if longer than 90 days quote provided based on length
AR reduction projects typically contingency fee (%) based on age & quality receivables Physician and Hospital AR Reduction projects
Interim Business Office Directors Synapse product suite provided free if project > 90 Days
Outsource Entire Revenue Cycle Operations work with each facility to provide competitive quote
Revenue Recovery projects25% contingency fee of $ recovered focus on charging, coding, contract compliance
Pricing Overview
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Synapse myClaimIQ genie
Revolutionary desktop Claim Analytic tool -
Downloads and installs in minutes – no IT involvement
Desktop application can be managed by anyone
Analyzes all billing claims instantly for: Charge capture components – implants, procedures
Claims data integrity – all claim components are correct
Potential coding and documentation opportunities
CPT (CDM) audit for incorrect, deleted or non valid codes
Invalid combinations of codes
Facility has ability to run analytics on entire facility or sub-section e.g. just ED if this is an area of focus
Charge is on a per claim basis – reduces cost increases value to client
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Business Intelligence Services
Synapse Intelligent Analytics
Web based Business Intelligence application
Intuitive interface provides for easy analysis of operations, AR, clinical indicators
Keep track of Key Indicators through KPI’s and dashboards
Real time access to information from aggregate level down to patient detail
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Synapse EDCalc
Application Overview
Correctly calculates E&M Level for every patient Average increase in Net Revenue ~ $25 per patient
Ensures compliance with CMS 11 guiding principles
Level calculation documentation produced for audit purposes
Intuitive interface improves productivity
Chart analyzed potential charge capture opportunities that are often overlooked
Missing procedures
Supply charges
Analysis of prior claims for revenue recapture opportunities
Improved revenue covers cost of application
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Synapse ClaimIQ
ClaimIQ is an integrated collections and AR management tool created to improve collector productivity and cash results in a Centralized Business Office environment. ClaimIQ works with any hospital or
physician IT system and can be implemented as a collections platform in days.
“Since implementing ClaimIQ for Brim Healthcare’s owned facilities, we have seen a consistent increase in cash collections and over a 100% increase in bad
debt recoveries in the first few months of operations.” Brim Healthcare CFO
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Synapse ClaimIQ
Application Overview
Integrated AR & Collections Management tool
Collections module provides real time productivity monitoring
Work list management – specific focus problem areas
AR Analytics Portal with Business Intelligence toolset
Charge Capture Analysis tool highlights potential lost $
Charge Reconciliation Tool for Nurse Auditors
CPT Code Analyzer – corrects for deleted, invalid codes
Analysis of prior claims for revenue recapture opportunities