ALAMEDA HEALTH SYSTEM HB STABILIZATION HB KEY METRICS Metric Status As of 2/28 As of 2/21 13wk Bottom Median Top 75.1 Days $667.8M 76.2 Days $667.8M 76.1 Days 72.4 Days 65.8 Days Epic AR Days s Charging Variance r 101.7% $22.3M 101.2% $15.3M 99.3% 101.3% 104.4% -3 Weeks -$28.9M -3.4 Weeks -$32.2M -2 Weeks -1 Weeks -0.1 Weeks Payment Variance q 107.5% $10.3M 116.3% $11.1M 93.9% 97.4% 104.7% Epic Pmt Avg p Epic CFB Days q 19.1 Days $169.9M 24.2 Days $212.3M 8.3 Days 7.4 Days 5.3 Days 1 Days $8.8M 1.1 Days $9.8M 2.4 Days 1.9 Days 1 Days Coding Days r 3.4 Days $30M 3.7 Days $32.1M 2.4 Days 1.9 Days 1 Days Claim Edit Days q 3 Days $26.8M 2.6 Days $23M 2.3 Days 2 Days 1.3 Days Open Denial Days q Status Key: Bottom Threshold for the 35th percentile for the metric at week 22 p = Better than top 25% s = Below median Median Median value for the metric at week 22 r = Better than median q = In the bottom Top Threshold for the 75th percentile for the metric at week 22
Epic AR Days % AR Breakdown Top Median Bottom Alameda Health System Other Days 120 90 Outsourced Days 80 100 Credits Days 2.3 2.1 2.6 3.0 1.4 70 2.0 Self Pay Days 2.0 80 % of baseline 2.4 4.0 Open Denial 3.1 60 2.6 Days 2.4 0.7 60 2.1 32.9 36.3 36.5 Outstanding 23.1 20.7 23.3 24.3 27.4 26.6 31.8 35.6 37.6 33.9 0.6 39.6 50 Days 0.6 CFB Days AR Days 40 0.1 16.4 20.2 40 Min Hold Days Baseline AR = 75.7 Days 0.1 13.4 9.6 20 0.0 In House Days 30 6.5 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 2.9 0 20 10.0 0.0 0.9 4.8 10 0.0 0.0 1.3 0 -10
Financial Activity 18 Total Payments 16 Baseline Pmts = $9.6M 14 Expected Payments Financial Activity (in M) 12 10 8 6 4 2 0
Epic CFB Days Top Median Bottom Alameda Health System 35 30 25 20 AR Days 15 10 5 0
• 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
ALAMEDA HEALTH SYSTEM PB STABILIZATION PB KEY METRICS Status As of 2/28 As of 2/21 Bottom Median Metric 13wk Top Epic AR Days q 63.6 Days $57.7M 62.3 Days $55.5M 58 Days 54.3 Days 47 Days 101.2% $1.6M 101.1% $1.3M 98.1% 101.3% 106.8% Adj Charging Var r -2.9 Weeks -$3.4M -2.9 Weeks -$3.4M -2.4 Weeks -0.7 Weeks 0.7 Weeks Payment Variance q Epic Pmt Avg p 134.4% $1.6M 137% $1.6M 95.8% 100.7% 109.8% 5.7 Days $4.9M 5.4 Days $4.7M 2.4 Days 1.6 Days 0.9 Days Pre-AR (Bsln) q 3.4 Days $3M 3.7 Days $3.2M 2.3 Days 1.4 Days 0.6 Days Claim Edit (Bsln) q 6.9 Days $6M 6.2 Days $5.4M 4.1 Days 3.4 Days 2.1 Days Denials (Bsln) q 3.5 Days $878K 3.2 Days $807.9K 2.6 Days 1.9 Days 0.9 Days Undistributed Days q Status Key: Bottom Threshold for the 35th percentile for the metric at week 22 p = Better than top 25% s = Below median Median Median value for the metric at week 22 r = Above median q = In the bottom Top Threshold for the 75th percentile for the metric at week 22
AR Breakdown Undistributed 70 Outstanding Statement 60 Pending Statement Baseline AR = $52.8M Open Denial 50 3.3 6.0 2.9 1.7 5.4 1.7 Outstanding Claims 5.4 1.3 5.0 40 1.2 No Claim Status 1.1 AR Dollars (in M) 0.9 0.7 Claim Edit 30 0.5 31.4 40.8 40.8 40.1 40.1 Claims Pending 38.7 38.9 0.8 32.5 35.9 34.3 31.9 20 25.2 0.6 24.3 21.2 0.4 18.1 0.6 14.3 10 0.0 12.2 3.1 8.9 0.0 7.6 3.2 3.2 4.7 5.5 3.2 4.7 5.3 3.2 3.0 3.0 0.0 2.8 3.2 3.2 4.1 3.1 3.4 2.1 2.4 2.8 1.8 1.1 0.0 0.6 0.4 0.1 0 -10
Epic Pmt Avg Top Median Bottom Alameda Health System Financial Activity 160 140 3.5 Total Payments 120 % of baseline 100 3.0 80 Expected Payments 2.5 60 Financial Activity (in M) 40 2.0 20 0 1.5 Baseline Pmts = $1.2M 1.0 0.5 0.0
Claim Edit Days Top Median Bottom Alameda Health System 7 6 5 AR Days 4 3 2 1 0
• 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 • ABN – Advanced Beneficiary Notice – MediCare • Edit/Claim Edit – Rules that capture accounts with requirement to speak to patients regarding NON- missing data after a claim submission is attempted Covered services • InHouse Days – Inhouse Patients accumulating charges • HB – Hospital Billing • Min Days – minimum number of days to hold an • PB – Professional Billing account for billing purposed to allow for complete • CDM – Charge Description Master – a listing of all charge capture. Currently set at 5 days. procedures, fee schedules and chargeable items • Open Denial Days – Status of claims where payor has • CFB – Candidate for Billing, bill held due to error/edit responded asking for additional information, denied • Days (DAR) – Days in Accounts Receivable. A given payment, or claim needing correction dollar amount (such as CFB) divided by Average Daily • PAC – Post-Acute Care Revenue • Work Queue – a holding list of accounts with similar • Days Outstanding – Status of claims submitted to edits where staff work in order to submit claims for payor, awaiting payment or other payor response payments • DNB – Do Not Bill • DNFB – Do Not Final Bill • Errors – Rules that capture accounts with missing data before claim submission is attempted
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