Introducing - Experian · Current Feedback + Open Discussion. Why was coverage missed initially?...

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Murry Ford, MBA, MHADirector, Revenue Strategy, Emergency Registration Grady Health System Atlanta, GA

Minda McMann Sr. Director, Product ManagementExperian Health

Introducing:

©2016 Experian Information Solutions, Inc. All rights reserved. Experian Public.

Driving Revenue OpportunityThrough

Coverage Discovery On-Demand


953 bed, Level I trauma center

Verified burn & stroke centers

Safety Net for Fulton & DeKalb Co., Ga ($250m uncompensated care)

Teaching facility for Emory & Morehouse Schools of Medicine

Over 140,000 ED visits

135,000 EMS trips in city of Atlanta

Epic version 2014 (Live October 2010) Interstate 75/85 @ “The Grady Curve”

About Grady Health System


About Grady Health System


Agenda

What is Coverage Discovery

How On-Demand is helpful

How it functions

Implementation

Results

Lessons learned


User-driven utility that finds potentially unknown coverages

270/271 transactions to deliver data electronically

Accessible in Health Information System or through Passport eCare NEXT

Limits exposure to “phishing” as data is queried in internal Experian networks

What is Coverage Discovery On-Demand?


Batch process

Automated

Checks all self-pay accounts

Next day resultsOn-Demand

Triggered

Check any account

Results within seconds or minutes

What is Coverage Discovery On-Demand?


When patients do not communicate insurance status

MVA patients who don’t think it’s their responsibility

ACA & other high deductible policy holders not wanting to use coverage

Patients who are medically unable to communicate

Dependents who may not know insurance status


Denial avoidance

Late inpatient admission notification denials

Authorization denials

Timely filing denials

Billing the appropriate party

Incorrectly billing the patient

Coordination of Benefits

How is On-Demand Helpful?


1) On-Demand coverage queried by Access Rep.

2) Record queried against Experian

database with scoring algorithm

-SSN, Name, DOB, Address

3) Identified coverage appears as new response in response history

4) Access Rep. attaches coverage

How On-Demand works


How On-Demand works


Original workflow involved Financial Counseling use of Epic patient WQ to find and attach coverages not attached at TOS

Counselor completes Inpatient admit notification if applicable

System action adds “Found by Coverage Discovery” billing indicator for reporting purposes

Currently using in ED, Inpatient & Ambulatory Surgery

New workflow leverages Epic ADT confirmation records

How On-Demand works


How On-Demand works


6-8 weeks implementation timeline (4 weeks if already using batch)

Interface setup (270/271)

On-Demand plan code build

Bad plan code detection plan mapping

Patient workqueue build

Unattached coverage workflow

Registrar training & tip sheets for On-Demand

Implementation


Bad plan code detection plan mapping

Facilitates identification and attachment of On-Demand coverages

Started with largest commercial payors

Difficult out-of-network exchange plans

Medicare/Advantage plans

Implementation


Training

Training minimal due to use of current Epic workflows

Registration/Financial Counseling all-hands discussion

Tip sheets on how to query using the On-Demand coverage record

Implementation


Workqueues & process monitoring

Registrars attempt real-time attachment

Routed to dedicated patient WQ

Financial Counseling ownership

► Coverage attachment

► Inpatient admit notifications

Billing prevention setup to avoid billing patient with On-Demand found coverage

Implementation


Results$7.3m in On-Demand assisted payments over 7 month period

Source: Passport Analytics/

Epic Clarity

Commercial44%

Blue Cross21%

Medicare Managed Care21%

Medicare7%

Medicaid Managed Care

3%

Commercial Non-Contract

2%

Medicaid2%

Average age of Medicare patient found through On-Demand Coverage Discovery =45 years


Use automation where possible

Lessons Learned

Leverage Epic confirmation records to trigger On-Demand vs. patient WQ approach

Admit to Inpatient ADT confirmation message currently in use

New RTE status of “Eligible-CD” to track On-Demand attachments

Discharged ED/Observation under development

Trigger based on Address Verification under review for all accounts


Bad plan code detection plan map testing should be conducted by insurance SME

Lessons Learned

Testers may understand technology but may not familiar enough with insurance to spot mapping issues

May lead to incorrectly mapped coverage records

Can lengthen project timeline


Coverage Discovery®

Product Updates and Strategic Direction

Minda McMann

Sr Director, Product Management Experian Health


Coverage DiscoveryYear in Review Highlights

Fall 2016: Duplicate Inquiry

Re-Use Rules

*NEW*:Power

Reporting for Coverage Discovery!

Launched January 2016

16.5%Average Found Coverage Hit Rate

34.74%Commercial Coverage

65.26%Government

Coverage

1.3+ millionFound

Coverages

370+Payers

Benefitting 284 Clients

Coverage Discovery Core Improvements


Coverage Discovery 2.0 Initiative

Coverage Discovery®

will be the market leading discovery solution for all integration points in

the Revenue Cycle.

Enterprise Coverage Discovery: Advanced Analytics End-to-end Workflow Safety Net Feature Risk-Free Option Claims Reconciliation Increased Intelligence Increased Data Assets


Coverage Discovery 2.0Primary Focus

Connected intelligence – Front End / Back OfficeCombined data for all discovery touchpoints for actionable insight; Leverage additional data assets and industry intelligence to continually enhance the discovery engine

User experienceDiscovery specific workflow, action oriented specific alerts, enriched address + identity data for action clarity

Safety net processLeverage industry intelligence rules based triggers and data mining technology for non-user-triggered primary and secondary coverage opportunities

ROI analysisDiscovery reconciliation to Claims + Remit data for concrete ROI

Executive insight Data consolidation; advanced analytics; strategic performance dashboards


Coverage Discovery 2.0 – Key ComponentsEnterprise Functionality Detail

Comprehensive Workflow: Patient Centric View “Maybe” Work Queue Address + Identity Data Actionable + Informational Alerts

Advanced Analytics: Monthly Trending: User, location, account

trigger analysis Source and Trigger Analysis Data-Based Training Recommendations

Goal: Create an evolving engine to continually reduce noise for the users, streamline questions, quantify non-productive found coverages + policy limitations, and focus efforts on actionable data.

Learning Intelligence: User Disqualification Process Auto-Exclusion Queue + add-back workflow Account Question + Resolution Process

Goal: Provide executive level reporting on value of the discovery touchpoints, and highlight both high and low performing departments/users for ongoing process optimization insight

Goal: Provide all levels of Coverage Discovery users with actionable intelligence for process improvement, with specific recommendations based on usage to find patterns.

Goal: Continually empower and educate users and managers with easy to understand, actionable data and directed workflow.

ROI + Billing Reconciliation: Lifetime Value Dashboard Fiscal Year Value Dashboard ROI + A/R Days improvement No Claim Submitted Report Payment Pending Report


Current Feedback + Open Discussion

Why was coverage missed initially?

Could it have been prevented?

Did my team act on the

found coverage?

What was the actual value of the found

coverage to my organization?

Is there additional coverage opportunity

in my non-self pay accounts?

Introducing - Experian · Current Feedback + Open Discussion. Why was coverage missed initially?...

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