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Building a Revenue Cycle Vendor Management Program Presenters:

Building a Revenue Cycle Vendor Management Program Presenters: Leah Klinke – Director Patient Financial Services, WVU Healthcare Nicholas Fricano – President, Healthfuse September 26, 2014. “ If you chase 2 rabbits…you will not catch either one” – Russian Proverb. Big shoes to fill

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Building a Revenue Cycle Vendor Management Program Presenters:

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  1. Building a Revenue Cycle Vendor Management Program Presenters: Leah Klinke – Director Patient Financial Services, WVU Healthcare Nicholas Fricano – President, Healthfuse September 26, 2014

  2. “If you chase 2 rabbits…you will not catch either one” – Russian Proverb

  3. Big shoes to fill • Growing list of projects – EPIC upgrade, meaningful use, business office consolidation, etc • “Tightening of the belt” – cost savings initiatives and revenue recovery goals • Shifted more to external partners to “share the load” (and the risk) • Required more from our vendor partners; management is a 2-way street • Focus was required achieve goals in a timely and efficient way (doing it the right way) Background

  4. WVUH Trend Similar to Industry* – Spending More (on third-parties) and Getting Less (rising cost to collect) Percentage of Revenue Cycle Operating Budget Spent on Third-Parties Cost to Collect (Headcount, Technology, Third-Party Spend/Outsourcing) * Healthfuse statistics as of January 2012 – based on combination of collected data and surveys from 983 health systems

  5. Patient complaints or compliance issues • Over invoicing or high fees in general • Sub-par performance (and functionality) or limited visibility into performance • Mistakes requiring our time to resolve (e.g. inventory reconciliation) • Limited vendor interaction or limited vendor understanding of our goals and day to day operations Our Top 5 Challenges:

  6. #1 – Developed Vendor Portfolio

  7. Manager – dedicated leader for all things revenue cycle vendors – evaluating current partnerships, new partnerships, etc. Liaison between WVUH RCM leadership and vendor • Analysts – dedicated team responsible for tracking and monitoring outcomes, evaluating trends regarding outcomes and activities, developing business cases for change, and conducting market research • Auditors – dedicated team responsible for auditing accounts and determining root causes of errors – manual audits and technology-enabled audits • Legal– full time resource is not required. Contract renegotiations required • IT – full time resource is not required. We generated reports and customized a technology to enable macro-auditing, streamline reporting, and reconcile invoices and inventories #2 – Formed a Vendor Management Office (VMO)

  8. #3 – Developed Outcome-Based Scorecards Net Liquidation Comparison #5 – And Set Goals

  9. #4 – Developed Activity-Based Scorecards (Audit) #5 – And Set Goals

  10. #6 – Monthly Reconciliations -Invoices -Inventories #7 – Consistent Operating Rhythm & Governance

  11. Common Findings • SLA and compliance discrepancies • Improper balance adjustments • Incorrect patient demographic information • Mismanagement of automated workflow tools • Unanswered requests for the application and/or release of account holds • Insufficient tracking of defaulted payment plans • Inadequate documentation of account notes #8 – Coaching & Remediation • Common Improvements • Refined inventory and transaction reconciliation to correct balance discrepancies • Revised system logic used to apply automatic f/up based on manually applied acct dispositions • Honed tracking of FA and CC apps • Elevated accounts in need of supervisory review - weekly • Shortened response requests for the app and/or release of acct holds • Augmented utilization of skip tracing protocols

  12. Invoice issues – 100% audits (and across vendors) • Accounts not worked to SLA or industry standards. SLA compliance was 8% - 100% account audit (tech-enabled) and manual review of exceptions; compliance is over 95% today • Outdated contracts; old terms – vendor getting paid, but not receiving or working accounts – renegotiated contracts • Tools not used but being paid for – discontinued contracts • Addressed RFPs (underpay, TPL, BD) that were sitting on desk for 6 months – dedicated resource to coordinate entire process High Impact Efforts (Areas of Focus) – First 180 Days

  13. Managing the Fundamentals is Key… “Barry Bonds doesn’t step up to the plate thinking home run. He steps up to the plate focused on a sweet swing” – Jim Camp (renowned expert negotiator)

  14. But Since It’s Football Season… “Success demands singleness of purpose” – Vince Lombardi

  15. For Additional Information: Leah Klinke klinkel@wvuhealthcare.com 304.598.4198 Nick Fricano nfricano@healthfuse.com 414.988.1136 Questions?

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