Revenue Cycle Management:A Team Effort

Ryan Hackett, MHAAccount Executive, GBS

Solutions Architect, GBS

• Introductions

o Ryan Hackett

o GBS Corp

• Revenue Cycle Management (RCM)

• RCM Continuum

• New Rules of Engagement

o Automation

• Organizational Impact

• Improvement Activities

• RCM Benchmarks in Healthcare

• Insourcing vs Outsourcing

o Outsourcing Models

• GBS Vision and Market Penetration

• Best Practices

Agenda

Ryan Hackett, Account Executive, Healthcare

Ryan started his career at GBS in June of 2012 and came onboard

with over 8 years of experience in the Healthcare industry. Ryan

was originally hired as an Implementation Specialist and then in

2014, he joined the Healthcare Consulting division. This transition

led to his temporary (18 months) relocation to Clearwater Beach,

FL, where he acted as an onsite Project Manager for a NextGen®

re-launch. After two years in the Consulting division, he accepted a

position as a Solutions Architect in June 2016. Ryan leveraged his

operational knowledge and experience to drive sales before

eventually being promoted to Account Executive in 2018.

Introduction

• The Ohio State University College of Pharmacy (BSPS), 2008

• The Ohio State University College of Public Health (MHA), 2012

• 1971

• Ohio Based

• $100 Million

• 500+ Team

• 43 States

• No Debt

• 100% ESOP

GBS CorpSince our founding more than 48 years ago, GBS has evolved

as a technology solutions provider, helping customers better

create, manage, deliver, and retrieve information:

• Healthcare Solutions

• Revenue Enhancement

• Marketing Services

• IT & Networking Solutions

• Imaging & Content

Management Solutions

• Print, Labeling, & Filing

Solutions

Introduction

RCM Fact of the Day

RCM

Outsourcing

Valuation:

$11.7B in 2017

RCM

Outsourcing

Valuation:

$__B in 2023

RCM Statistics• 85% of providers are looking to replace current RCM

systems

o 29% of hospitals utilize advisors and consultants

o 90% of hospitals will outsource by 2019

• 70% of practices are considering outsourcing

• 93% of CFO’s report they will eliminate under-performing

vendors

• 94% of CFO’s believe transformation can impact their

financial health

• $33% who had a plan to replace in 2016 have failed

The Healthcare Financial Management Association (HFMA) defines

revenue cycle as:

All administrative and clinical functions that

contribute to the capture, management, and

collection of patient service revenue.

“Revenue Cycle” includes the entire life of a patient account from

creation to payment. Revenue cycle processes flow into and affect

one another. If properly executed, the cycle performs predictably and

profitably. Problems early in the cycle can have significant ripple

effects. As errors travels through the cycle, the more costly revenue

recovery becomes.

Revenue Cycle Management (RCM)

The Revenue Cycle Continuum

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• A focused unit supporting Billing, Payment Posting,

Account Receivables, and Denial Management

• Research

• Follow-up

• Appeals

• Denial tracking

• Claim transmissions

• Edits corrections

• Secondary and

patient billing

• Document review for

completion

• Reconciliation of ERA

• Manual posting of

EOB

• Identification of

payment variances

• Posting of

Correspondence

• Write off

management

• Reporting and

analysis

• Current and past due

receivables follow up

• Collection of unpaid

and partially paid

claims

• Follow-up on patient

accounts

Billing Payment PostingAccount

Receivable

Management

Denial

Management

The Heart of RCM

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• Charge Entry

• Eligibility Verification (Real-Time)

• Claim Scrubbing

• Claim Submission

• Payment Posting

• ERA

• Lockbox

• Denial Management

• AR Management and Resolution

o Insurance Follow-up

o Appeals

o Document/EOB Management

Billing and Collection Services

• Engaged in quality

• More involved in choice

• Higher portion of financial responsibility

Patients Have the Power

• Multiple payment points

• Wellness reimbursed higher

• Integration of new rules

• More complex coding

Fee-for-Service vs Value-Based Care

• Rapid rule changes

• Rapid turnover of staff

• Human retention turned into alerts and measures

Tools vs People

• Service levels

• Focus on patients

• Technology needs beyond EHR and PM

Outsourcing

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• Advanced Pre-Billing (APB) solutions are rules that automate

manual processes thus reducing cost and simplifying

Standard Operating Procedures

• Automates EMR charge passing and cleans billing data

before hitting the clearinghouse and/or PM system

• Accumulation of knowledge from revenue cycle experts so

everyone in the business office can perform at their highest

level

• Clean and accurate data helps supports the shift from Fee-

for-Service to Value-Based Care

Impact of Automation

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• Increase coder productivity

• Process more charge volume without adding staff

• Automate charge passing from your Electronic Medical Record

• Avoid missed charges

• Avoid bilateral billing issues

• Reduce denials and improve COH

Benefits of APB Rules

Organizational Impact• RCM solutions should encompass entire RCM continuum,

from patient registration through collections

• RCM solutions should focus on meeting and exceeding your

needs while generating revenue and creating patient

satisfaction

• Develop Standard Operating Procedures (SOPs) to ensure

all billings are completed accurately and in a timely fashion

• Develop Key Performance Indicators (KPIs) to monitor

progress and trends over time

o Forecasting is instrumental to sustainability

• Enhanced authorization and certification• Eligibility and authorization• Complete and timely billing• Improved registration data quality• Better front office processes and technology

• Improved follow-up processes all financial classes• Access to state-of-the-art, collection tools

• Enhanced accounts receivable management• Tasking• Processes re-engineered to standards• Benchmarks and standards implemented

training and certification

2% – 4%

5% – 10% loss of cash

Denial Mgmt.

2% - 3%Reduction of aged A/R and Bad Debt Write-offs

3% - 5%Process and WorkflowImprovement

3% – 5%Underpayments

• Automated contract management• Enhanced management and performance

evaluation• Technology-enabled tools to monitor payer

compliance with contract terms and conditions• Timely follow-up of underpayments

MGMA and HFMA

study of Physician

Practices

Patching “Leaks”

Improvement Activities• Integration

o Seamless workflows and automation

• Proper Organization

o Executive buy-in

• Shared Accountability

o Marry clinical performance and quality outcomes

o Dashboard monitoring (KPIs)

• Cross Collaboration

o Communicate constantly and tear down silos

• Continuous Improvement

o Culture change and regulatory awareness

• Strategic Partnership

o Find the correct RCMS partner (outsource)

RCMS Benchmarks

• Drive workflow redesign

• Payers’ complexities are increasing

• Maximize return on investment in technology

• Staffing issues

o Retention

o Certification

• Physician are not interested being in the Human Resource business and want to concentrate on getting back to the basics

• Automation tipping point

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Why Outsource

• Maximize utilization of PM features designed to

enhance cash flow

• Allow practices to operate in the moment (focus on

patients and managing the Accounts Receivable

• Perform daily billing and collections duties leaving

clinical staff to patient care

• Reduce staffing costs

• Reduce administrative aggravation

• Produce positive return on investment

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Why Outsource

• Fully leverage software investment

• High receivables and weak cash flow

• Decreasing profit/physician compensation

• Key staff turnover

• Patient dissatisfaction

• Aging technology and unsupported software

• Data integrity and compliance concerns

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Why Outsource

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Why Outsource

• Increased time to work on what’s really important

• Less time fighting firesTime

• Transparent client dashboards

• Every service with real-time performance monitoring reports Control

• Higher, faster reimbursement

• Reduction of overall cost of reimbursementMoney

• Broad service offerings with ultimate flexibility

• Dedication to client service - local presence, personal

attention

• Live by “Best Practices” methodology

• Complete transparency - internal and external

• Proven Revenue Cycle solutions - testimonials

• Proven PM tools on hand

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Due Diligence

• Backed by resources and reputation of proven PM

platform

• Strategic plan that ranks physician services as the

number one expansion objective to pursue

• Unprecedented experience in the RCM space

• EMR workflow guidance no matter what type of

software you are implementing

• Ability to improve physician cash collections

o Improvement of 5% to 10% of gross collection

rate

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Due Diligence

RCM Models• Management Service Agreement (MSA)

o Manage from afar

o Contract Terms highly variable

• A La Carte Outsourcing

o Delegation of duties defined in Contract Terms

• Complete Outsourcing

o Rules of engagement defined in Contract Terms

o Payer complexities are on the rise making it more and more

difficult to run an efficient billing office

o Physicians need to focus on quality more than ever during this

transition to Value-Based Care

o Demand for certified coders has surpassed the supply in most

American cities

o Recent studies have proven outsourcing to be more efficient

Departmental Responsibilities

• Charge Processing

o Manual charge entry

• Coding

o Edit processing and manual coding (clinical and surgical)

• Cash Application

o Manual posting (insurance and patient)

o ERA processing

• Claims Processing

o Deliver claim uploads to clearinghouse

• Customer Service - Incoming

o Patient support, collections review, and address management

• Patient Engagement - Outbound

o Remind and collect past due amounts

• Special Billing

o Manage patient bills and assistance programs

GBS Vision• Our goal and vision is to provide the most powerful,

flexible, and fully comprehensive Revenue

Cycle Management Services available

• Our solutions create differentiation in

the Revenue Cycle Management

marketplace with respect to increased

revenue and decreased cost, and is backed

by quantifiable ROI data and references, while

simultaneously driving strong margins

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Pre-Live Work

• On-site assessments

• Verification of provider

numbers

• Verification of lock box

addresses

• End-to-end testing

of claims

• A/R recovery

• “Best Practices”

pre-built system

• Detailed Go-Live plan with

“Best Practices” upgrades

What We Do

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Electronic

Eligibility

Checking

What We Do

Billing

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What We Do

Streamline

traditional

posting utilizing

deposit images

from bank

Posting from ICS

EOBs indexing

to payment

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Utilize claims department

to maximize use of ERA

posting

What We Do

Denial

Analysis

Denial Resolution:

• GBS Solutions

o Add Claim Edit

o System

Modification

• Client

o Attach Clinical

Documentation

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What We Do

Real-time

electronic

claim status

checking

Web-based

inquiry

Telephone

follow-up

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What We Do

• Rules Engine Automation

o Advanced Pre-Billing (APB)

• Service Desk

• Patient Collections

• ERA and Payment Reconciliation

• Contract Reconciliation

• Denials Management

• Standard and Custom Reporting

• Credentialing and Re-Credentialing

RCM Offerings

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TRANSPARENCY• Ability for you, the customer, to monitor

and participate

• Create, share, and train on the same

memorized reports we use to monitor

your operations

• Reporting on all aspects of the work

being performed

• Performance clarity:

o Practice Solutions

o Employee

o Location

o Practice

o Region

Best Practices

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• Denial Management:

denials and claim edits

• A/R Follow-Up: follow-up

on EVERY claim

• Customer-defined

processes for accounts

identified as possible bad

debt

• Integrated bad debt

management partner

Best Practices

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• Maximize ERA by leveraging

clearinghouse and Internal

Claims Department

• Utilize EOB image linking

• Accept digital lockbox

deposits

• Link each line item posted to

digitally imaged EOB

• Easy audit access to

transaction detail for

customer

Best Practices

• Get paid faster

• Improve efficiency

• Reduce staffing headaches

• Quick implementation timelines

• Focus on current strategy (i.e. growth and

acquisition)

• Get the information YOU need to run YOUR

organization

• Speed to value proposition for EMR implementations

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GBS Difference

YOUR success is OUR success!• We improve revenues by removing or

repurposing staff and reducing denials

to below 1%

• As an option, we include Value-Based Care initiatives by:

o Leveraging our Healthcare Professional Services Team

to assist with MIPS/MACRA

o Establishing and documenting all practice processes

o Helping you achieve (and exceed) MGMA/HFMA performance

benchmarks

o Helping maximize your ROI as we are vested in each dollar the

practice earns

Partner Benefits

RCM Fact of the Day

RCM

Outsourcing

Valuation:

$11.7B in 2017

RCM

Outsourcing

Valuation:

$23B in 2023

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