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Driving new levels of business performance with revenue cycle efficiencies
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Session Title: A Case Study with Orlando Health: Driving new levels of business performance with revenue cycle efficiencies
About us
A/R team structure
The need for information
How did we get here
Monthly reconciliation overview
ETM/reports
64,144
5,826
10,000
20,000
30,000
40,000
50,000
60,000
70,00020
0702
2007
0520
0708
2007
1120
0802
2008
0520
0808
2008
1120
0902
2009
0520
0908
2009
1120
1002
2010
0520
1008
2010
1120
1102
2011
0520
1108
2011
1120
1202
CLAIM INVOICES
Physician & Professional Services
82
10
20
30
40
50
60
70
80
9020
0702
2007
0520
0708
2007
1120
0802
2008
0520
0808
2008
1120
0902
2009
0520
0908
2009
1120
1002
2010
0520
1008
2010
1120
1102
2011
0520
1108
2011
1120
1202
Divisions
Physician & Professional Services
510
100
200
300
400
500
600
Providers
Physician & Professional Services
team member training
review notes, assess workload, summarize issues allocation of staffing resources
payer mix, payer trends, workload distribution monthly payer reconciliations
validation of information categorization of issues
Monthly payer reconciliation
Cigna East/West, Humana, Careplus, AvMed, Citrus, Freedom, Prestige, PUP, Sunshine, Wellcare
On going projects & claim events
Aetna, United, Florida Blue (BCBS), Multiplan/Beechstreet
Day 3
Compile
view
Day 12
Finalize
scrubbing
Day 15
Submit to
payer
Day 20-25
Receive from
payer
Day 25-30
Review with
payer
AR Reps
phone follow Up
review coding denials
medical recs/doc
review fee
schedules
review provider set up
update info
file appeals
payer portal
follow up
access sub
systems
Categories – payer status
Categories – payer status
Categories – payer status
Orlando Health Insurance
See what’s out there
Compile recon view on the 3rd of each month
Work each invoice and clearly document the reason why we believe the claim was processed incorrectly
update payer statusupdate status
Review status field ie: “02eval” – previous month’s carry over
Sort by Balance to review high/low or Division to review patterns
Sort by Corr (charge correction flag) –> Y or Note? –> Y
Scripting of payer notes
Response to our report
Capturing most recent note from both Orlando health and insurance
Going through our secxond round of calls with the insurance directly from the
recon view
Benefits
Review only invoices outstanding
Changes are real time
We are in control
Minimized excel spreadsheets Reduced days of workflow to xx days
Jose to update
BAR ETM Informatics
Need to update with full list of CB modules
used at Orlando
Centricity Business
Next-generation revenue cycle
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Centricity Business overview
GE Healthcare
Centricity Business Revised Positioning and Differentiators
A proven, next generation healthcare revenue cycle managementsolution that supports traditional and accountable carereimbursement models for greater profitability, efficiency and enhanced quality of care.
Interoperable
High performance
Enterprise ready
• Integrated inpatient and ambulatory revenue cycle management across multiple locations for improved transparency and efficiency
• Support for multiple reimbursement models including: fee for service, capitation, pay for performance and shared savings for accurate reimbursements and higher profitability
• Versatile, scalable revenue cycle tools and workflows to support operational excellence across the continuum of care
Centricity Business
Enterprise Ready
Centricity Business
High Performance
• Automated, exception based workflows that provide faster, cleaner claims and accelerated revenue collection
• Ability to manage increasing patient responsibility with integrated tools to manage patient access and revenue cycle processes
• Proven financial performance• 8 of the top 10 Top Performers in Faculty Practice
Solutions Center Billing Office Survey1
• 13 of the 17 Best hospitals in2011-12 honor roll2
1)UHC & AAMC, FY10 Faculty Practice Solutions Center Billing Office Survey, June 20112)US News and World Report, Best Hospitals 2011-12: the Honor Roll, July 2011
Centricity Business
Interoperable
• Revenue cycle management with clinical workflow integration to virtually any EMR
• Standards based connectivity enables freedom to choose your clinical system, while lowering total cost of ownership.
• Connect the enterprise and provide insights across clinicals and financials to drive improved care coordination and streamlined reimbursements
Centricity Business resources
• Stop by the GE Healthcare Booth #343/345• Read more about Orlando Health on our website• www.gehealthcare.com/centricitybusiness• Follow @GEHealthcareIT on Twitter and use #gecb to join
the Centricity Business conversation