2. Expert in health care revenue cycle operations with over 15 years
experience in several sectors
◦ Payor, provider, and consulting
Developed new services and operational turn-around strategies
Proven record of operational performance improvement
Served as the Director of centralized billing offices
Managed projects and complete A/R liquidation engagements with both
on-shore and off-shore staff
Negotiated payor / provider contracts and settlements
Executive MBA Graduate, Temple University
Jim Spause
610-256-0088
jspause@comcast.net 2
3. Companies and clients that I have served
Jim Spause
610-256-0088
jspause@comcast.net
3
4. Senior Manager of Product Development, McBee Associates:
◦ Developed and launched 3 new revenue cycle service lines with annual revenue projections of over $2
million
Director of Revenue Operations, DaVita:
◦ Improved collections by an average of $1.2 M per month within a 9-month period
◦ Increased payor appeal wins by more than $12 M
◦ Reduced non-contracted DSO by more than 50-days in one year
◦ Settled several disputes with managed care and commercial payors totaling $3 million in additional
collections
Lead Consultant, McKesson:
◦ Performed hospital revenue cycle assessments leading to $3.8 million of additional software and services
sales
◦ Co-published an article examining the use of technology in Patient Access processes for Aspen
Publishing’s Healthcare Registration newsletter
Engagement Manager, Deloitte Consulting:
◦ Managed outsourcing projects with a total accounts receivable of $150 M – resolved over 97%
Corporate Director, Patient Financial Services, Kennedy Health System:
◦ Reduced hospital days in accounts receivable from 72 to 59 in one year
◦ Negotiated settlements with managed care payors totaling $2 M
◦ Directed a multi-departmental effort which increased net revenue and collections by $1.9 M
Network Services Coordinator, Aetna US Healthcare:
◦ Received the prestigious “Gold” Service Star Award for service excellence twice in one year
Jim Spause
610-256-0088
jspause@comcast.net 4
5. Establish stretch goals – Develop plan – Execute - Repeat
Revenue Cycle Dashboards
Indicator Better Practice Hospital
Cash Receipts as % of Net
Business Needs 100% 97.1%
Revenue
The Hospital Revenue Cycle Viewed as a System 1. Reduce claim submission rejections
2. Reduce DNFB
A/R Days (Net) 55 Days 50.5 Days
3. Reduce aged receivables
4. Improve collections A/R Over 90 Days 15 - 20% 36.2%
5. Reduce Bad Debt
DNFB Gross A/R Days
Patient Admitted
≤5 Days 5.1 Days
(includes 4-day bill hold)
Point-of-Service Collections as %
Claim coded for initial billing
.8% average
≥2%
of Net Revenue
Patient Access Health Information Management Patient Accounting
• Collect and document all clinical notes • Claims “scrubbed” for accuracy Billing Backlog Gross A/R Days ≤ 1 - 2 Days 1.6 Days
(Registration/Admissions)
• Collect patient demographic / • Utilize patient chart to code diagnoses and compliance
Denials as a % of Gross Revenue ≤1 - 2% 6%
• Claims submitted to insurance
insurance information & procedures
• Insurance verified & selected / patient
• Verify services are medically necessary Bad Debt as a % of Gross
• Screen services for medical • Paid or Denied ≤3% 2.3 %
Revenue
• Claim follow-up with insurance
necessity
• Collect co-pay / deductible or patient
• Status within aged receivables
Claim Demographics Generated
Better
Indicator Hosp 1 Hosp 4
Hosp 2 Hosp 3 Hosp 5 Hosp 6
Practice
Clinical Services Provided
and Documented
DNFB Gross A/R Days
(includes 4-day ≤ 5 Days 4.3 Days 5.0 Days 5.2 Days 4.8 Days 6.8 Days 4.2 Days
billhold)
IP charts coded per Not
Plan to Improve Design & Redesign 23-26 32 30 30 22.5 32
coder/per day Tracked
• Increase pre-registering frequency Processes & Services
• Verify insurance via EDI OP charts coded per Not
150 – 230 55 300 64.3 225 55
coder per/day Tracked
• POS collections
• Electronic order entry – EMR OBS & AMS charts
Not
coded per coder/per 36-40 50 75 45 64.2 50
• Electronic compliance screening 1 Tracked
day
• Clean claims
ER charts coded per Out- Out- Out- Out- Out-
180
190- 250
coder per day sourced sourced sourced sourced sourced
≤ 1 work
Transcription backlog 1 Day 1 Day 1 Day 1 Day 1 Day 1 Day
day
Not Not Not Not Not
% of MPI duplicates ≤ .05% .01
Tracked Tracked Tracked Tracked Tracked
Record Request ≤2
1-7 days 1 day 1-7 days 1-7 days 1 day 14 days
Turnaround workdays
Jim Spause
610-256-0088
jspause@comcast.net 5
6. Be tough on the problem but kind with people
Hands-on & resourceful
Brainstorming & Collaboration
Mistakes are forgivable – What’s unforgivable is not
taking responsibility and fixing the mistake
Do the hard work and analyze - Numbers don’t lie
There are always choices and options – choose wisely
Keep pushing - You never know how much you can do
until you push yourself
Confidence breeds accomplishments (and vice versa)
Jim Spause
610-256-0088
jspause@comcast.net 6
7. Contact me at:
Jim Spause, MBA, PMP
Lafayette Hill, PA
(H): 610-567-0295
(M): 610-256-0088
jspause@comcast.net
Jim Spause
610-256-0088
jspause@comcast.net
7
