Driving new levels of business performance with revenue cycle efficiencies

2. subtitle
Session Title: A Case Study with Orlando
Health: Driving new levels of business
performance with revenue cycle
efficiencies

3.  About us
 A/R team structure
 The need for information
 How did we get here
 Monthly reconciliation overview
 ETM/reports

4. 64,144
5,826
10,000
20,000
30,000
40,000
50,000
60,000
70,000 200702
200705
200708
200711
200802
200805
200808
200811
200902
200905
200908
200911
201002
201005
201008
201011
201102
201105
201108
201111
201202
CLAIM INVOICES
Physician & Professional Services

5. 82
10
20
30
40
50
60
70
80
90 200702
200705
200708
200711
200802
200805
200808
200811
200902
200905
200908
200911
201002
201005
201008
201011
201102
201105
201108
201111
201202
Divisions
Physician & Professional Services

6. 510
100
200
300
400
500
600
Providers
Physician & Professional Services

8.  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

9.  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

10. 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

11.  Categories – payer status

12.  Categories – payer status

13.  Categories – payer status

14. Orlando
Health
Insurance

16.  See what’s out there

17.  Compile recon view on the 3rd of each month

18.  Work each invoice and clearly document the reason why we believe the claim was processed incorrectly
update payer statusupdate status

19.  Review status field ie: “02eval” – previous month’s carry over

20.  Sort by Balance to review high/low or Division to review patterns

21.  Sort by Corr (charge correction flag) –> Y or Note? –> Y

24.  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

28.  Minimized excel spreadsheets
 Reduced days of workflow to xx days
Jose to update

29.  BAR
 ETM
 Informatics
Need to update with
full list of CB modules
used at Orlando

30. Centricity Business
Next-generation
revenue cycle

31. ©2012 General Electric Company – All rights reserved.
This does not constitute a representation or warranty or documentation regarding
the product or service featured. All illustrations are provided as fictional examples
only. Your product features and configuration may be different than those shown.
Information contained herein is proprietary to GE. No part of this publication may be
reproduced for any purpose without written permission of GE.
DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION,
ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A
COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY
REMAIN AT GE’S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE
REGULATORY CLEARANCE.
* GE, the GE Monogram, Centricity and imagination at work are trademarks of
General Electric Company.
General Electric Company, by and through its GE Healthcare division.

32. Centricity Business overview
GE Healthcare

33. Centricity Business Revised Positioning
and Differentiators
A proven, next generation
healthcare revenue cycle
management
solution that supports
traditional and
accountable care
reimbursement models for
greater profitability,
efficiency and enhanced
quality of care.
Interoperable
High performance
Enterprise ready

34. • 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

35. 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 in
2011-12 honor roll2
1)UHC & AAMC, FY10 Faculty Practice Solutions Center Billing Office Survey, June 2011
2)US News and World Report, Best Hospitals 2011-12: the Honor Roll, July 2011

36. 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

37. 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