ALAMEDA HEALTH SYSTEM HB STABILIZATION HB KEY METRICS Metric - - PowerPoint PPT Presentation

Metric 13wk Top

Epic AR Days

s

75.1 Days $667.8M 76.2 Days $667.8M 65.8 Days

Charging Variance

r

101.7% $22.3M 101.2% $15.3M 104.4%

Payment Variance

q

• 3 Weeks
• $28.9M
• 3.4 Weeks
• $32.2M
• 0.1 Weeks

Epic Pmt Avg

p

107.5% $10.3M 116.3% $11.1M 104.7%

Epic CFB Days

q

19.1 Days $169.9M 24.2 Days $212.3M 5.3 Days

Coding Days

r

1 Days $8.8M 1.1 Days $9.8M 1 Days

Claim Edit Days

q

3.4 Days $30M 3.7 Days $32.1M 1 Days

Open Denial Days

q

3 Days $26.8M 2.6 Days $23M 1.3 Days

Bottom Median Top

ALAMEDA HEALTH SYSTEM HB STABILIZATION

HB KEY METRICS

As of 2/28 Bottom Median Status As of 2/21

76.1 Days 72.4 Days 99.3% 101.3% 1.9 Days

• 2 Weeks
• 1 Weeks

2.4 Days 1.9 Days 2.3 Days 93.9% 97.4% 8.3 Days 7.4 Days 2.4 Days 2 Days

p = Better than top 25% s = Below median

Status Key:

r = Better than median q = In the bottom

Threshold for the 35th percentile for the metric at week 22 Median value for the metric at week 22 Threshold for the 75th percentile for the metric at week 22

Epic AR Days %

20 40 60 80 100 120

% of baseline

Top Median Bottom Alameda Health System

Baseline AR = 75.7 Days 1.3 4.8 10.0 12.1 13.8 18.9 19.3 18.3 20.8 24.1 22.7 20.9 20.7 20.3 20.9 20.6 21.8 22.4 29.3 25.2 24.2 19.1 0.0 0.9 2.9 6.5 9.6 13.4 16.4 20.2 23.1 20.7 23.3 24.3 27.4 26.6 31.8 35.6 37.6 33.9 32.9 36.3 36.5 39.6 0.0 0.0 0.0 0.0 0.1 0.1 0.6 0.6 0.7 2.1 2.4 2.6 3.1 4.0 2.4 2.0 1.4 2.0 2.1 2.3 2.6 3.0

• 10

10 20 30 40 50 60 70 80 90

AR Days

AR Breakdown

Other Days Outsourced Days Credits Days Self Pay Days Open Denial Days Outstanding Days CFB Days Min Hold Days In House Days

Baseline Pmts = $9.6M 2 4 6 8 10 12 14 16 18

Financial Activity (in M)

Financial Activity

Total Payments Expected Payments

Epic CFB Days

5 10 15 20 25 30 35

AR Days

Top Median Bottom Alameda Health System

• ED Account Not Reviewed - Level 4/5 Manual review,

routine process

• CM/UR Review Needed – Case Management Processing
• Case Management Review Needed - Case Management

Processing

• Accounts to be manually date range bill – Accounts with

Bed Days Error, this will not be an ongoing process

• Claim Has External Errors – Task Force addressing high

volume/high dollar edits

• Procedural Log with Unposted Charges – Routine

process of loading hardware into Epic and/or missing charges

• Law Enforcement Coverage Review – manual process

for all patient under law enforcement control

• Account Cannot be Coded – various documentation

deficiencies

• CM Authorization missing – Care Management to post

approval codes

• PAC Acct Needs TAR Review – SNF accounts that need

processing

Metric 13wk Top

Epic AR Days

q

63.6 Days $57.7M 62.3 Days $55.5M 47 Days

Adj Charging Var

r

101.2% $1.6M 101.1% $1.3M 106.8%

Payment Variance

q

• 2.9 Weeks
• $3.4M
• 2.9 Weeks
• $3.4M

0.7 Weeks

Epic Pmt Avg

p

134.4% $1.6M 137% $1.6M 109.8%

Pre-AR (Bsln)

q

5.7 Days $4.9M 5.4 Days $4.7M 0.9 Days

Claim Edit (Bsln)

q

3.4 Days $3M 3.7 Days $3.2M 0.6 Days

Denials (Bsln)

q

6.9 Days $6M 6.2 Days $5.4M 2.1 Days

Undistributed Days

q

3.5 Days $878K 3.2 Days $807.9K 0.9 Days

Bottom Median Top

58 Days 54.3 Days 98.1% 101.3% 1.4 Days

• 2.4 Weeks
• 0.7 Weeks

4.1 Days

ALAMEDA HEALTH SYSTEM PB STABILIZATION

PB KEY METRICS

As of 2/28 Bottom Median Status As of 2/21

3.4 Days 2.6 Days 95.8% 100.7% 2.4 Days 1.6 Days 2.3 Days 1.9 Days

p = Better than top 25% s = Below median

Status Key:

r = Above median q = In the bottom

Threshold for the 35th percentile for the metric at week 22 Median value for the metric at week 22 Threshold for the 75th percentile for the metric at week 22

Baseline AR = $52.8M 0.1 0.6 1.1 1.8 2.4 2.8 3.4 4.1 4.7 5.3 5.5 2.8 3.1 3.1 3.2 3.2 3.2 3.2 3.2 3.0 3.2 3.0 0.4 2.1 4.7 7.6 8.9 12.2 14.3 18.1 21.2 24.3 25.2 31.9 34.3 31.4 38.7 40.8 40.1 40.8 32.5 35.9 38.9 40.1 0.0 0.0 0.0 0.0 0.6 0.4 0.6 0.8 0.5 0.7 0.9 1.1 1.2 1.3 1.7 1.7 2.9 3.3 5.0 5.4 5.4 6.0

• 10

10 20 30 40 50 60 70

AR Dollars (in M)

AR Breakdown

Undistributed Outstanding Statement Pending Statement Open Denial Outstanding Claims No Claim Status Claim Edit Claims Pending

Epic Pmt Avg

20 40 60 80 100 120 140 160

% of baseline

Top Median Bottom Alameda Health System

Baseline Pmts = $1.2M 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5

Financial Activity (in M)

Financial Activity

Total Payments Expected Payments

Claim Edit Days

1 2 3 4 5 6 7

AR Days

Top Median Bottom Alameda Health System

• Claim Has External Errors – Task Force addressing high

volume/high dollar Registration edits

• Insurance Type Code Check – Rule fires when Insurance

changes order

• Medi-Cal must be last in filing Order – Registration Edits

– Rules are being built to force Medi-Cal to last place

• TAR Procedures requiring authorization – Manual

process, seeking an automated resolution

• EOB Balancing Validation – Firing when there are

multiple coverages. Seeking an automated resolution

• Claim Has External Errors – Task Force addressing high

volume/high dollar Billing edits

• MC Cap Primary and Mcal MC Secondary – Filing Order

rule being created to address

• PB Claims Alameda Alliance Capitation Claim Hold –

Holding all Alameda Alliance Capitation Claims for future processing

• Claims Cannot Bill VRAD Medicare – VRAD hold for

Medicare Accounts – awaiting decision to automate

• Claim Has External Errors – Task Force addressing high

volume/high dollar Revenue Integrity edits

• On-Site, Cross-functional Teams (IT, EPIC, Contractor) matched with Revenue Cycle leaders

and their teams

• Increased Elbow Support for Revenue Cycle
• Resulting in additional education and productivity
• Additional onsite support from Epic
• Resulting in improved ticket resolution
• Additional Leadership support for targeted training, support and improve overall

performance

• ARCR twice-weekly “Continuous Revenue Cycle Improvement ” huddles to review and

address high and low- level issues drive down CFB and Denials

• Increased and intense focus on overall Operational and System issues
• Weekly Command Center Activities – Continuing collaboration with IT to eliminate build

and workflow issues by focusing on high-value tickets

• Significant improvement in focus of Operations leadership on critical success

factors:

• More regular cadence to management activities
• Attention to key performance indicators
• Attention to staff productivity
• Consequent clear performance improvements:
• HB CFB reduction
• HB Clean Claims rates improvement
• HB and PB Average Daily Revenue increase
• PB Charge Lag reduction

• Shift focus to overall management of Revenue Cycle as a whole and not simply on CFB
• Improved Registration accuracy with a goal of 95%
• Clean Claims Rate improvement with a goal of 90%
• AR Aging Follow Up activities with a goal of >90 Days should be 15%
• Denial Rate stabilization at <4%
• Payment Posting within 24 hours of deposit
• Effective use of System Reports/Dashboards and automations
• Staff Productivity
• WQ Aging
• Increased automation of workflow processes
• Full Ownership of Charge Capture by Clinical Areas

• Shifting to full reliance on AHS resources for all system functionality and upkeep
• ABN Process (a compliance concern)
• Work with Clinical Leaders, IT and Revenue Cycle to put in place
• Will reduce write offs for our MediCare Claims
• Contract Review
• Ongoing workgroup to review contract discrepancies and payment variances
• CDM Review
• Improving our CDM updating process and pricing
• Ensuring compliance integrity
• Prepare for Full System Optimization

Often used Epic Terminology

• Edit/Claim Edit – Rules that capture accounts with

missing data after a claim submission is attempted

• InHouse Days – Inhouse Patients accumulating charges
• Min Days – minimum number of days to hold an

account for billing purposed to allow for complete charge capture. Currently set at 5 days.

• Open Denial Days – Status of claims where payor has

responded asking for additional information, denied payment, or claim needing correction

• PAC – Post-Acute Care
• Work Queue – a holding list of accounts with similar

edits where staff work in order to submit claims for payments

• ABN – Advanced Beneficiary Notice – MediCare

requirement to speak to patients regarding NON- Covered services

• HB – Hospital Billing
• PB – Professional Billing
• CDM – Charge Description Master – a listing of all

procedures, fee schedules and chargeable items

• CFB – Candidate for Billing, bill held due to error/edit
• Days (DAR) – Days in Accounts Receivable. A given

dollar amount (such as CFB) divided by Average Daily Revenue

• Days Outstanding – Status of claims submitted to

payor, awaiting payment or other payor response

• DNB – Do Not Bill
• DNFB – Do Not Final Bill
• Errors – Rules that capture accounts with missing data

before claim submission is attempted