SlideShare uma empresa Scribd logo
1 de 36
Baixar para ler offline
Revenue Cycle

         Stephen M. Mooney
Senior Vice President, Patient Financial Services
The Story of Measuring, Monitoring, & Collecting

• Flashback to 2005 through 2007
• 2008 & beyond
• What we‟re doing to improve:
  – Pre-patient care experience
  – Collections & Follow-Up

• The future of PFS




                                                   1
Flashback to 2005

        Centralization
         to Improve
            Scale


                           Integrity &
        Data Integrity   Transparency


          Business
         Intelligence




                                         2
A Year Ago…

• Optimize processes




                       3
A Year Ago…

• Optimize processes

• Consumer-focused




                       4
A Year Ago…

• Optimize processes

• Consumer-focused

• Shift in focus




                       5
Our Vision is Maturing…

 Become a full-service, revenue cycle service delivery organization
 that leads the industry in seven distinct ways.
 1. Maximize yield of the revenue cycle in alignment with our
    customers‟ missions
 2. Utilize business intelligence to drive our decisions
 3. Drive innovation into the healthcare industry revenue cycle
 4. Be an employer of choice for the best talent in the healthcare
    industry
 5. Provide superior service to our customers, on par with the best
    service delivery organizations in the world
 6. Make the patient experience with the revenue cycle as
    transparent, integrated and easy to navigate as possible
 7. Make our services a positive differentiator with physicians
    for the customers we serve



                                                                      6
We Can Drive Volume and Satisfaction…

                   High                                                 Being kept
                                                   Scheduling
                                                                        informed
                                                   appointments

                                                Ease of
                                                                Timeliness of
                                                billing
                                Supportive
Importance to
                                                                appointments
                                environment
physicians in
 determining
                           Convenience
where to send
                           for the
   patients                           Ease of
                           patient    registration
                                                                            Room
                                                             Value for      amenities
                                                             money
                                  Common
                                  areas
                                                                                                        Aligned on importance
                                                                  Room options
                                                                                                        Not aligned on importance
                   Low

                          Low                                                           High

                                         Importance to patients for
                                          determining future visits

                                                                                                                                7
                Source: 2007 McKinsey Patient Experience Survey; 2007 McKinsey Physician Survey Regarding Patient Experience
Ronald Kelley
Senior Director, Revenue Assurance
Continued Improvements in Patient Access
More focus on Patient Access drives our
ability to…
• Make it easy to do business with Tenet
• Improve the patient experience
• Reduce bad debt and increase cash


                  QA &
                             Rapid         Online
       CPAS      Pricing
                           Registration    Bill Pay
                  Tools



                                                      9
Center for Patient Access Services (CPAS)
      Implementations finishing in our new Pre-Service Center

1 Hospital schedules patient     2 CPAS processes the account
                                                         Center for Patient
                                                         Access Services




                                                                          Certification &

                                                                                            Checks (ABN)
                                                         Verification &


                                                                          authorization
                                       Pre-Register




                                                                                                             Pre-Service
                                                                                                             Counseling
                                                          Insurance




                                                                                             Necessity
                                                           Eligibility




                                                                                                              Financial
                                                                                              Medical
                                                                               Pre-

                                                                               Pre-
                                   Payors             Payors         Payors
                                                                                                           Patients
                                      Payors             Payors           Payors


                                                                                             ™
         3 Patient arrives and goes through an
            expedited check-in at the hospital

                                                                                QA &
                                                                                               Rapid            Online
                                                              CPAS             Pricing
                                                                                             Registration       Bill Pay
                                                                                Tools
                                                                                                                           10
CPAS Progress as of Q1 2008
 Percent of Accounts                                    Percent of Accounts                                              24-Month Change in
   Pre-Registered                                             Verified                                                     POS Collections

60%                                                 90%                                                              25%

                                                    80%
50%
                                                                                                                     20%
                                                    70%

40%                                                 60%
                                                                                                                     15%
                                                    50%
                   CPAS




30%




                                                                                      CPAS
                                                    40%




                                                                                                                                                       CPAS
        Non-CPAS




                                                                                                                     10%
                                                                          Non-CPAS
20%                                                 30%




                                                                                                                                           Non-CPAS
                                                    20%                                                                5%
10%
                                                    10%

0%                                                    0%                                                               0%


                          Source: Corporate Patient Access Scorecard, through March 2008. Comparison of “Y” CPAS vs. “N” non-CPAS hospitals. POS
                          improvement based on Q1-08 vs. Q1-06 change in actual dollars collected at Point-of-Service; Pre-Registration and Verification
                                                                                                                                                              11
                          metrics based on actual number of accounts in Q1-08
Quality Assurance (QA) & Pricing Tools
                                      Q1-2008 Quality Improvements
• New QA tool alerts           100%
  Registration if inaccurate   90%
  data is entered              80%

                               70%


• Reduced QA staff by >50%     60%

                               50%

                               40%

• Standard tools calculate     30%


  patient-liability balances   20%

                               10%

                                0%




                                                               Insured Name




                                                                                                           Insured Name
                                        Documentation




                                                                                        Documentation
• Written estimates given to


                                          Complete




                                                                                          Complete
                                                                   Match




                                                                                                               Match
                                            Auth




                                                                                            Auth
  patients
                                      Medicaid HMO Managed Care                         Medicaid          Medicare
• Automatic processing of
  applications for funding
                                                                               QA &
                                                                                             Rapid          Online
                                                        CPAS                  Pricing
                                                                                           Registration     Bill Pay
                                                                               Tools
                                                                                                                          12
Rapid Registration: Kiosk & e-Signature
                                                         • 3 sites piloted
                                                           beginning
                                                           December 2007

                                                         • 87% reduction in
                                                           paper used during
                                                           registration
   West Boca: Desktop        Park Plaza: Wall Mount

                                                         • 30% initial
                                                           improvement in
                                                           cycle time

                                                         • 3 minute average
                                                           check-in time
Lake Pointe: Free Standing        All: Tablets
                                                              QA &
                                                                         Rapid        Online
                                                      CPAS   Pricing
                                                                       Registration   Bill Pay
                                                              Tools
                                                                                                 13
Rapid Registration: Kiosk & e-Signature


                        What patients see when using
                             a kiosk in the pilot




                                                       14
Rapid Registration: Kiosk & e-Signature

                           Patients can sign forms
                           electronically, which are
                          automatically fed into our
                               imaging system




Later in 2008 patients
 will be able to make
co-payments directly
      at the kiosk


                                                       15
Online Bill Pay




                          QA &
                                     Rapid        Online
                  CPAS   Pricing
                                   Registration   Bill Pay
                          Tools
                                                             16
Jeffrey Nieman
Vice President, PFS Operations
PFS Segmentation is Gaining Momentum…
We are collecting about $9 million more per quarter than our average collections in the pre-
redesign period. About $15 million per quarter has been accelerated out of bad debt into
collections in active A/R. While net patient billed dollars have declined 34% due to Compact
and divestitures.
                                                    Early Out/CFC Total Cash Collections, 2004 – 2008 Q1
               $100                                                                                                                                                                              $500
                                                                                                                                                                                                                   Early Out
               $90                                                                                                                                                                               $450
                                                                                                                                                                                                                                       Growth
                                                                                                                                                                                                                   CFC
                                                                                                                                                                                                                                       Q1 2008
                                                                                                                                                                                                                   Net Patient Bills
               $80                                                                                                                                                                               $400
                                                                                                                                                                                                                                         vs.
               $70                                                                                                                                                                               $350
                                                                                                                                                                                                                                       Q1 2004
 Collected $




               $60                                                                                                                                                                               $300




                                                                                                                                                                                                        Billed $
                                                                                                                                                                                                                                        EO
               $50                                                                                                                                                                               $250
                                                                                                                                                                                                                                       +49%
               $40                                                                                                                                                                               $200

               $30                                                                                                                                                                               $150
                                                                                                                                                                                                                                       Total
               $20                                                                                                                                                                               $100
                                                                                                                                                                                                                                       +11%
               $10                                                                                                                                                                               $50

                $0                                                                                                                                                                               $0                                     CFC
                      Q1 2004

                                Q2 2004

                                          Q3 2004

                                                     Q4 2004

                                                               Q1 2005

                                                                         Q2 2005

                                                                                   Q3 2005

                                                                                             Q4 2005

                                                                                                       Q1 2006

                                                                                                                 Q2 2006

                                                                                                                           Q3 2006

                                                                                                                                     Q4 2006

                                                                                                                                               Q1 2007

                                                                                                                                                         Q2 2007

                                                                                                                                                                   Q3 2007

                                                                                                                                                                             Q4 2007

                                                                                                                                                                                       Q1 2008
                                                                                                                                                                                                                                       (-44%)




                                                                                                                                                                                                                                                 18
MicroSegmentation™

• PFS employs an in-house PhD statistician
• Unlimited number of custom models can be
  implemented
• Models can be continuously “tuned” with most
  recent actual data
  – Easy to identify macroeconomic trends and adjust work
    processes to compensate
  – Quick response to shifts in payor behavior




                                                            19
MicroSegmentation™    MicroSegmentation™
                          (44 variables)


                      New insurance:
                      - payor variables
                      - Clinical/service
                        details
                      - Denial/dispute
                        details

                      New self pay:
         Original     - Census block data
     Segmentation     - Credit report detail
                      - Prior visits &
      (8 variables)     payments


                      Original self pay:
 Original self pay:
                      - Credit Score
 - Credit Score
                      - Visit Variables
 - Visit Variables
                      - Demographics
 - Demographics




                                               20
MicroSegmentation™

• 99% of payments come from 71% of patients
                                                                                                                    New model
                                                                                                                  much better at
                                                                                                                  identifying the
                                                 Comparison of Tenet Segmentation Models                            non-paying
                                                            Early Out Self Pay                                       accounts


                         100%

                         90%
                                      Near-perfect
                                     prediction for
                         80%
 Accounts With Payment




                                     30% of paying
                                       population
                         70%

                         60%

                         50%

                         40%

                                                                                                Microsegmentation™
                         30%
                                                                                                Original Segmentation
                         20%
                                                                                                Random
                         10%
                                                                                                Theoretical Max
                          0%
                                0%   10%        20%     30%    40%         50%      60%   70%    80%       90%          100%

                                                                     Total Population



                                                                                                                                    21
MicroSegmentation™
• Our pilot model was secondary bad debt self pay accounts
• Significant improvement in predictive strength
                                                     Comparison of Tenet Segmentation Models
                                                         Secondary Bad Debt Placements

                           100%
                                   At the 10th percentile
                                   MicroSegmentation™ captures
                           90%
                                   45.6% of good accounts vs.
                                   25.7% under original model
                           80%
   Accounts With Payment




                                            77% Improvement!
                           70%

                           60%

                           50%

                           40%

                           30%
                                                                                                        Microsegmentation™
                           20%
                                                                                                        Original Segmentation
                           10%
                                                                                                        Random
                            0%
                                  0%      10%        20%         30%   40%         50%      60%   70%      80%       90%        100%

                                                                             Total Population




                                                                                                                                       22
Next Iteration – Managed Care

• MicroSegmentation™ is predicting the number of
  days it will take a commercial or managed care
  payor to respond to an initial bill
• Opportunity is to refocus people resources to
  spend time following up on claims at the optimal
  point to accelerate cash and reduce aging




                                                     23
Distribution of Predicted Follow Up Dates
• Modeling shows that about 45% of accounts should be
  worked by day 28 and 60% by day 34
                        Predicted Follow Up Date

                30000

                25000

                20000
 Claim Volume




                15000

                10000

                5000

                   0
                        10
                        11
                        12
                        13
                        14
                        15
                        16
                        17
                        18
                        19
                        20
                        21
                        22
                        23
                        24
                        25
                        26
                        27
                        28
                        29
                        30
                        31
                        32
                        33
                        34
                        35
                        36
                        37
                        38
                        39
                        40
                        41
                        42
                        43
                        44
                        45
                        46
                        47
                        48
                        49
                        50
                        51
                        52
                        53
                        54
                        55
                        56
                        57
                        58
                        59
                                 Days from Bill Date




                                                        24
Insurance Follow Up Model Variables
• The MicroSegmentation™           Major Insurance Payor
                                     (Blue Cross, United, etc.)
                                   Payor‟s Zip Code
 process identified 15 data          (regional payor claims processing differences)
                                   Category of Services Rendered
                                   Hospital
 elements as statistically         Financial Class
                                     (contracted vs. non contracted payors; managed government vs. managed care)

 significant based on regression   Expected Reimbursement from Payor
                                   Type of Insurance Product
                                     (HMO, PPO, etc.)
 analysis of recent actual Tenet   Length of Stay in Hospital
                                   Managed Care IPA Group
 data                                (IPA may pay managed care bills rather than the payor)
                                   Hospital Department
                                   DRG Primary Illness Category

• Insurance tree has 4,200+        Inpatient or Outpatient
                                   Pass Through Flag
                                     (contract requires copies of invoices for medical equipment)
 branches and leaves which are     Emergent or Non-Emergent Services
                                   Days from Discharge for Initial Bill to Payor
 different possible outcomes
        Example MicroSegmentation™ Tree with 1,000 Leaves




                                                                                                                   25
Validating the Model
• 22,000 accounts have been modeled and have had enough time to
  measure accuracy of predictions
• ~70% of accounts paid on or before the expected date

                                                    Actual Payment Date vs. Predicted Date

                          75%
       % of Claims Paid




                          50%




                          25%




                          0%
                                or Before
                                            1

                                                2

                                                      3

                                                          4

                                                               5

                                                                    6

                                                                         7

                                                                              8

                                                                                   9

                                                                                        10

                                                                                             11

                                                                                                  12

                                                                                                       13

                                                                                                            14

                                                                                                                 15
                                Paid On




                                            +   +     +    +   +    +    +    +    +
                                                                                        +    +    +    +    +    +
                           Paid On or Before
                            Predicted Date

                                            Variance (in Days) between Actual Payment Date and Predicted Date




                                                                                                                      26
What does MicroSegmentation™ Mean?

• Optimized use of resources based on scientific
  models
• Ability to focus on resolving billing issues quickly
• Patients experience shorter delays in
  copay/deductible billing when there is an issue
  to be resolved with the payor




                                                         27
Continuing the Focus on Physicians
and Patients
                                                                                                    Initiatives Driving
                   High                                                 Being kept
                                                   Scheduling
                                                                                                       Satisfaction
                                                                        informed
                                                   appointments

                                                                                               • CPAS
                                                Ease of
                                                                Timeliness of
                                                                                               • Quality Assurance
                                                billing
                                Supportive
Importance to
                                                                appointments
                                environment
physicians in
                                                                                               • Pricing Estimates &
 determining
                           Convenience
where to send                                                                                    Point of Service
                           for the
   patients                           Ease of                                                    Collections
                           patient    registration                                             • Rapid Registration
                                                                            Room
                                                             Value for                         • Online Bill Pay
                                                                            amenities
                                                             money
                                  Common
                                                                                               • Segmentation &
                                  areas
                                                                                                 MicroSegmentation™
                                                                  Room options
                   Low

                                                                                                        Aligned on importance
                          Low                                                           High
                                                                                                        Not aligned on importance
                                         Importance to patients for
                                          determining future visits

                                                                                                                               28
                Source: 2007 McKinsey Patient Experience Survey; 2007 McKinsey Physician Survey Regarding Patient Experience
Continued Momentum & Efficiencies…
     Across our hospitals, A/R days Managed Care and Medicare aging are
     all down, releasing significant incremental cash.
                                                              Managed Care                                              Medicare A/R
                  Days1
            A/R                                              A/R Greater than                                          Greater than 60
                                                                180 days2                                                  days2

                                  Q1                                                                                                                 Q1
                                                                                                 Q1
2003 2004 2005 2006 2007                                                                                    2003 2004 2005 2006 2007
                                      2003 2004                2005       2006       2007
                                 2008                                                                                                               2008
                                                                                                2008

74     56   58     55     54       54                                                                      $63M $40M $28M $13M $15M $34M
                                            N/A $481M $357M $324M $247M $217M



             Overall                                               Reduced                                                   Reduced
            reduction                                              MC A/R by                                                 MCR A/R
            of 20 days                                             $264M or                                                  by $29M
              or 27%                                                 55%                                                      or 46%



                    1 Same store hospital only core acute facilities with prior year cost settlement for all years plus new facilities
                    2 Same store hospital only core acute facilities plus Rio and Pinecrest Rehab excluding Plaza Specialty, Coastal Carolina,
                      Centennial, Bartlett and Norris Cancer Center for all years; 2003 Managed care data not available – no detail at that level in 2003



                                                                                                                                                      29
Revenue Cycle Initiatives to Decrease
A/R Days, Increase Cash Collections,
& Improve Patient Satisfaction

• Increase Point of Service (POS) Collection

• MicroSegmentation™

• Reduction in Discharged Not Final Coded (DNFC)

• Payor collaboration

• Legal action when appropriate



                                                   30
Patient Financial Services

                  Moving forward…




                                    31
External Business – Market Maturity: Current
Evolution of Three Outsourcing Markets
RCO’s market evolution can be best understood by analyzing the evolution of two other
outsourcing industries: ITO and HRO
                 I. Proof of Concept                     II. Growth                     III. Maturation



                                                                                               ITO
 Adoption
                                                              HRO
  Rate



                                     RCO



                                                                                                             Time
                Few end-to-end offers            Offers increasingly                SLAs are standard
                                                                              
 Offers                                          standardized and                   industry practices
                                                 comprehensive

                                                 Consider „value‟ of offer in
                Differences in acceptance,                                          View as an accepted,
                                                                              
                sophistication and               addition to potential cost         strategic component of
Customers
                expectations                     savings                            their operations


                Heavily fragmented               Rapid consolidation of             Few, large players
                                                                              
Providers       landscape with no                providers                          dominate market
                dominant providers                                                                             32
External Business – Market Opportunity
                                             2004 U.S. Hospital Market
                      7,000
                              6,556


                      6,000                1,146
Number of Hospitals




                                      Less Non-Acute Care
                                                                746
                      5,000                Hospitals
                                                                                     195
                                                                                                   4,469
                                                            Less Military and
                                                                                  Less Stand-
                                                              VA Hospitals
                                                                                 Alone Critical
                      4,000
                                                                                Access Hospitals


                                                                                                           2004 Net Patient
                      3,000
                                                                                                           Revenue (NPR)
                                                                                                            of addressable
                                                                                                           hospital market
                      2,000
                                                                                                           baseline ~$536B
                                                                            Remaining
                                                                        Addressable Hospital
                                            Total AHA                        Baseline
                                             Baseline
                      1,000



                         0




                                                                                                                              33
External Business – Addressable Market:
 Revenue Cycle Spend Estimate
Based on a conservative 4% cost-to-collect estimate, we can approximate
the revenue cycle spend for our addressable market as ~$20Bn
                                                                                                      Estimate of Revenue Cycle Spend by Function

                                                                                                                                                           Patient
                                     Cost-to-                                                                                                              Access
                    2004                               2004 Revenue Cycle
                                     Operate                                               Billing and
                   NPR ($B)                            Spend Estimate ($B)
                                     Estimate                                               Follow-up
                                                                                                                                                         27%
Patient
                                      1% to 2%                 ~$5 to ~$11
                                                                                                          46%
Access
HIM and
                                      1% to 2%                 ~$5 to ~$11
Coding
AR
                                      2% to 3%                ~$10 to ~$16
Management
Total                 ~$536           4% to 7%                ~$20 to ~$38

                                                                                                                                                    27%

                                                                                                                                                   HIM & Coding


   Sources: The Monitor Group - 2006-2007 Target Market Survey, Tenet Internal Data, Modern Healthcare, Center for Medicare and Medicaid Services, AHA




                                                                                                                                                                     34
Closing – Roadmap

• Continuing our focus on patient and physician
  satisfaction

• Driving performance improvement

• Carrying operations momentum forward through
  innovation and thought leadership

• Provides an opportunity to leverage our services
  in a third party market



                                                     35

Mais conteúdo relacionado

Semelhante a 15_Mooney_RevenueCycle_Final

Linked In Conifer Overview
Linked In Conifer OverviewLinked In Conifer Overview
Linked In Conifer Overviewmuncheck
 
Manage the Revenue Cycle
Manage the Revenue CycleManage the Revenue Cycle
Manage the Revenue CycleMaggieLewis
 
Medical Billing - Login Services Profile
Medical Billing - Login Services ProfileMedical Billing - Login Services Profile
Medical Billing - Login Services ProfileLoginClinic Inc.
 
Proposal for implementing agra nii healthsol
Proposal for implementing agra nii healthsolProposal for implementing agra nii healthsol
Proposal for implementing agra nii healthsolagraNii Technologies
 
Step-by-step Physician Marketing
Step-by-step Physician MarketingStep-by-step Physician Marketing
Step-by-step Physician MarketingEndeavor Management
 
The impact of eHealth on Healthcare Professionals and Organisations: Health I...
The impact of eHealth on Healthcare Professionals and Organisations: Health I...The impact of eHealth on Healthcare Professionals and Organisations: Health I...
The impact of eHealth on Healthcare Professionals and Organisations: Health I...Plan de Calidad para el SNS
 
ERP Wellness Solution-TCSiON
ERP Wellness Solution-TCSiONERP Wellness Solution-TCSiON
ERP Wellness Solution-TCSiONChirantan Ghosh
 
Rwandafinalpresentation 130419162730-phpapp02
Rwandafinalpresentation 130419162730-phpapp02Rwandafinalpresentation 130419162730-phpapp02
Rwandafinalpresentation 130419162730-phpapp02Wendy Leonard
 
Customer Complaints Management in Financial Services
Customer Complaints Management in Financial ServicesCustomer Complaints Management in Financial Services
Customer Complaints Management in Financial ServicesRMM London
 
CollaborateMD Webinar Presentation - Improving the Revenue Cycle Begins at th...
CollaborateMD Webinar Presentation - Improving the Revenue Cycle Begins at th...CollaborateMD Webinar Presentation - Improving the Revenue Cycle Begins at th...
CollaborateMD Webinar Presentation - Improving the Revenue Cycle Begins at th...CollaborateMD
 
Promantra RCM Capabilities
Promantra RCM CapabilitiesPromantra RCM Capabilities
Promantra RCM Capabilitiesrussellpin
 
Clinic Workflow Diagram
Clinic Workflow DiagramClinic Workflow Diagram
Clinic Workflow Diagramataveechai
 
HIMSS Investor Briefing
HIMSS Investor BriefingHIMSS Investor Briefing
HIMSS Investor Briefingfinance2
 

Semelhante a 15_Mooney_RevenueCycle_Final (20)

Linked In Conifer Overview
Linked In Conifer OverviewLinked In Conifer Overview
Linked In Conifer Overview
 
Manage the Revenue Cycle
Manage the Revenue CycleManage the Revenue Cycle
Manage the Revenue Cycle
 
Medical Billing - Login Services Profile
Medical Billing - Login Services ProfileMedical Billing - Login Services Profile
Medical Billing - Login Services Profile
 
Proposal for implementing agra nii healthsol
Proposal for implementing agra nii healthsolProposal for implementing agra nii healthsol
Proposal for implementing agra nii healthsol
 
Organization-wide ICD-10 Training
Organization-wide ICD-10 TrainingOrganization-wide ICD-10 Training
Organization-wide ICD-10 Training
 
Healthcare business intelligence
Healthcare business intelligenceHealthcare business intelligence
Healthcare business intelligence
 
Hvantage RCM Capabilities
Hvantage RCM CapabilitiesHvantage RCM Capabilities
Hvantage RCM Capabilities
 
Step-by-step Physician Marketing
Step-by-step Physician MarketingStep-by-step Physician Marketing
Step-by-step Physician Marketing
 
The impact of eHealth on Healthcare Professionals and Organisations: Health I...
The impact of eHealth on Healthcare Professionals and Organisations: Health I...The impact of eHealth on Healthcare Professionals and Organisations: Health I...
The impact of eHealth on Healthcare Professionals and Organisations: Health I...
 
ERP Wellness Solution-TCSiON
ERP Wellness Solution-TCSiONERP Wellness Solution-TCSiON
ERP Wellness Solution-TCSiON
 
Rwandafinalpresentation 130419162730-phpapp02
Rwandafinalpresentation 130419162730-phpapp02Rwandafinalpresentation 130419162730-phpapp02
Rwandafinalpresentation 130419162730-phpapp02
 
K1
K1K1
K1
 
Customer Complaints Management in Financial Services
Customer Complaints Management in Financial ServicesCustomer Complaints Management in Financial Services
Customer Complaints Management in Financial Services
 
CollaborateMD Webinar Presentation - Improving the Revenue Cycle Begins at th...
CollaborateMD Webinar Presentation - Improving the Revenue Cycle Begins at th...CollaborateMD Webinar Presentation - Improving the Revenue Cycle Begins at th...
CollaborateMD Webinar Presentation - Improving the Revenue Cycle Begins at th...
 
Promantra RCM Capabilities
Promantra RCM CapabilitiesPromantra RCM Capabilities
Promantra RCM Capabilities
 
Clinic Workflow Diagram
Clinic Workflow DiagramClinic Workflow Diagram
Clinic Workflow Diagram
 
Cloud9 Primary Care
Cloud9 Primary CareCloud9 Primary Care
Cloud9 Primary Care
 
HIMSS Investor Briefing
HIMSS Investor BriefingHIMSS Investor Briefing
HIMSS Investor Briefing
 
Mobility Platform for Insurers
Mobility Platform for InsurersMobility Platform for Insurers
Mobility Platform for Insurers
 
Mobility Platform for Insurers
Mobility Platform for InsurersMobility Platform for Insurers
Mobility Platform for Insurers
 

Mais de finance42

saic annual reports 2005
saic annual reports 2005saic annual reports 2005
saic annual reports 2005finance42
 
saic annual reports 2006
saic annual reports 2006saic annual reports 2006
saic annual reports 2006finance42
 
saic annual reports 2007
saic annual reports 2007saic annual reports 2007
saic annual reports 2007finance42
 
saic annual reports 2008
saic annual reports 2008saic annual reports 2008
saic annual reports 2008finance42
 
terex Merrill050808
terex Merrill050808terex Merrill050808
terex Merrill050808finance42
 
terex BofA050808
terex BofA050808terex BofA050808
terex BofA050808finance42
 
terex Merrill050808
terex Merrill050808terex Merrill050808
terex Merrill050808finance42
 
terex BofA050808
terex BofA050808terex BofA050808
terex BofA050808finance42
 
terex Sanford053008
terex Sanford053008terex Sanford053008
terex Sanford053008finance42
 
terex Shareholders0508
terex Shareholders0508terex Shareholders0508
terex Shareholders0508finance42
 
terex Shareholders0508
terex Shareholders0508terex Shareholders0508
terex Shareholders0508finance42
 
terex 08_06_04_JP_Morgan_Conf
terex 08_06_04_JP_Morgan_Confterex 08_06_04_JP_Morgan_Conf
terex 08_06_04_JP_Morgan_Conffinance42
 
terex Sanford053008
terex Sanford053008terex Sanford053008
terex Sanford053008finance42
 
terex 08_06_04_JP_Morgan_Conf
terex 08_06_04_JP_Morgan_Confterex 08_06_04_JP_Morgan_Conf
terex 08_06_04_JP_Morgan_Conffinance42
 
terex KeyBanc060508
terex KeyBanc060508terex KeyBanc060508
terex KeyBanc060508finance42
 
terex KeyBanc060508
terex KeyBanc060508terex KeyBanc060508
terex KeyBanc060508finance42
 
terex Wachovia062508
terex Wachovia062508terex Wachovia062508
terex Wachovia062508finance42
 
terex Wachovia062508
terex Wachovia062508terex Wachovia062508
terex Wachovia062508finance42
 
terex Citi072508
terex Citi072508terex Citi072508
terex Citi072508finance42
 
terex Citi072508
terex Citi072508terex Citi072508
terex Citi072508finance42
 

Mais de finance42 (20)

saic annual reports 2005
saic annual reports 2005saic annual reports 2005
saic annual reports 2005
 
saic annual reports 2006
saic annual reports 2006saic annual reports 2006
saic annual reports 2006
 
saic annual reports 2007
saic annual reports 2007saic annual reports 2007
saic annual reports 2007
 
saic annual reports 2008
saic annual reports 2008saic annual reports 2008
saic annual reports 2008
 
terex Merrill050808
terex Merrill050808terex Merrill050808
terex Merrill050808
 
terex BofA050808
terex BofA050808terex BofA050808
terex BofA050808
 
terex Merrill050808
terex Merrill050808terex Merrill050808
terex Merrill050808
 
terex BofA050808
terex BofA050808terex BofA050808
terex BofA050808
 
terex Sanford053008
terex Sanford053008terex Sanford053008
terex Sanford053008
 
terex Shareholders0508
terex Shareholders0508terex Shareholders0508
terex Shareholders0508
 
terex Shareholders0508
terex Shareholders0508terex Shareholders0508
terex Shareholders0508
 
terex 08_06_04_JP_Morgan_Conf
terex 08_06_04_JP_Morgan_Confterex 08_06_04_JP_Morgan_Conf
terex 08_06_04_JP_Morgan_Conf
 
terex Sanford053008
terex Sanford053008terex Sanford053008
terex Sanford053008
 
terex 08_06_04_JP_Morgan_Conf
terex 08_06_04_JP_Morgan_Confterex 08_06_04_JP_Morgan_Conf
terex 08_06_04_JP_Morgan_Conf
 
terex KeyBanc060508
terex KeyBanc060508terex KeyBanc060508
terex KeyBanc060508
 
terex KeyBanc060508
terex KeyBanc060508terex KeyBanc060508
terex KeyBanc060508
 
terex Wachovia062508
terex Wachovia062508terex Wachovia062508
terex Wachovia062508
 
terex Wachovia062508
terex Wachovia062508terex Wachovia062508
terex Wachovia062508
 
terex Citi072508
terex Citi072508terex Citi072508
terex Citi072508
 
terex Citi072508
terex Citi072508terex Citi072508
terex Citi072508
 

Último

ACCOUNTING FOR BUSINESS.II DEPARTMENTAL ACCOUNTS.
ACCOUNTING FOR BUSINESS.II DEPARTMENTAL ACCOUNTS.ACCOUNTING FOR BUSINESS.II DEPARTMENTAL ACCOUNTS.
ACCOUNTING FOR BUSINESS.II DEPARTMENTAL ACCOUNTS.KumarJayaraman3
 
Hungarys economy made by Robert Miklos
Hungarys economy   made by Robert MiklosHungarys economy   made by Robert Miklos
Hungarys economy made by Robert Miklosbeduinpower135
 
20240315 _E-Invoicing Digiteal. .pptx
20240315 _E-Invoicing Digiteal.    .pptx20240315 _E-Invoicing Digiteal.    .pptx
20240315 _E-Invoicing Digiteal. .pptxFinTech Belgium
 
2024.03 Strategic Resources Presentation
2024.03 Strategic Resources Presentation2024.03 Strategic Resources Presentation
2024.03 Strategic Resources PresentationAdnet Communications
 
Stock Market Brief Deck for 3/22/2024.pdf
Stock Market Brief Deck for 3/22/2024.pdfStock Market Brief Deck for 3/22/2024.pdf
Stock Market Brief Deck for 3/22/2024.pdfMichael Silva
 
India Economic Survey Complete for the year of 2022 to 2023
India Economic Survey Complete for the year of 2022 to 2023India Economic Survey Complete for the year of 2022 to 2023
India Economic Survey Complete for the year of 2022 to 2023SkillCircle
 
MARKET FAILURE SITUATION IN THE ECONOMY.
MARKET FAILURE SITUATION IN THE ECONOMY.MARKET FAILURE SITUATION IN THE ECONOMY.
MARKET FAILURE SITUATION IN THE ECONOMY.Arifa Saeed
 
ACCOUNTING FOR BUSINESS.II BRANCH ACCOUNTS NOTES
ACCOUNTING FOR BUSINESS.II BRANCH ACCOUNTS NOTESACCOUNTING FOR BUSINESS.II BRANCH ACCOUNTS NOTES
ACCOUNTING FOR BUSINESS.II BRANCH ACCOUNTS NOTESKumarJayaraman3
 
Buy and Sell Urban Tots unlisted shares.pptx
Buy and Sell Urban Tots unlisted shares.pptxBuy and Sell Urban Tots unlisted shares.pptx
Buy and Sell Urban Tots unlisted shares.pptxPrecize Formely Leadoff
 
RWA Report 2024: Rise of Real-World Assets in Crypto | CoinGecko
RWA Report 2024: Rise of Real-World Assets in Crypto | CoinGeckoRWA Report 2024: Rise of Real-World Assets in Crypto | CoinGecko
RWA Report 2024: Rise of Real-World Assets in Crypto | CoinGeckoCoinGecko
 
Contracts with Interdependent Preferences
Contracts with Interdependent PreferencesContracts with Interdependent Preferences
Contracts with Interdependent PreferencesGRAPE
 
Solution manual for Intermediate Accounting, 11th Edition by David Spiceland...
Solution manual for  Intermediate Accounting, 11th Edition by David Spiceland...Solution manual for  Intermediate Accounting, 11th Edition by David Spiceland...
Solution manual for Intermediate Accounting, 11th Edition by David Spiceland...mwangimwangi222
 
Remembering my Totem _Unity is Strength_ growing in Bophuthatswana_Matthews B...
Remembering my Totem _Unity is Strength_ growing in Bophuthatswana_Matthews B...Remembering my Totem _Unity is Strength_ growing in Bophuthatswana_Matthews B...
Remembering my Totem _Unity is Strength_ growing in Bophuthatswana_Matthews B...Matthews Bantsijang
 
Sarlat Advisory - Corporate Brochure - 2024
Sarlat Advisory - Corporate Brochure - 2024Sarlat Advisory - Corporate Brochure - 2024
Sarlat Advisory - Corporate Brochure - 2024Guillaume Ⓥ Sarlat
 
Lundin Gold March 2024 Corporate Presentation - PDAC v1.pdf
Lundin Gold March 2024 Corporate Presentation - PDAC v1.pdfLundin Gold March 2024 Corporate Presentation - PDAC v1.pdf
Lundin Gold March 2024 Corporate Presentation - PDAC v1.pdfAdnet Communications
 
Stock Market Brief Deck for March 19 2024.pdf
Stock Market Brief Deck for March 19 2024.pdfStock Market Brief Deck for March 19 2024.pdf
Stock Market Brief Deck for March 19 2024.pdfMichael Silva
 
What Key Factors Should Risk Officers Consider When Using Generative AI
What Key Factors Should Risk Officers Consider When Using Generative AIWhat Key Factors Should Risk Officers Consider When Using Generative AI
What Key Factors Should Risk Officers Consider When Using Generative AI360factors
 

Último (20)

ACCOUNTING FOR BUSINESS.II DEPARTMENTAL ACCOUNTS.
ACCOUNTING FOR BUSINESS.II DEPARTMENTAL ACCOUNTS.ACCOUNTING FOR BUSINESS.II DEPARTMENTAL ACCOUNTS.
ACCOUNTING FOR BUSINESS.II DEPARTMENTAL ACCOUNTS.
 
New Monthly Enterprises Survey. Issue 21. (01.2024) Ukrainian Business in War...
New Monthly Enterprises Survey. Issue 21. (01.2024) Ukrainian Business in War...New Monthly Enterprises Survey. Issue 21. (01.2024) Ukrainian Business in War...
New Monthly Enterprises Survey. Issue 21. (01.2024) Ukrainian Business in War...
 
Hungarys economy made by Robert Miklos
Hungarys economy   made by Robert MiklosHungarys economy   made by Robert Miklos
Hungarys economy made by Robert Miklos
 
20240315 _E-Invoicing Digiteal. .pptx
20240315 _E-Invoicing Digiteal.    .pptx20240315 _E-Invoicing Digiteal.    .pptx
20240315 _E-Invoicing Digiteal. .pptx
 
2024.03 Strategic Resources Presentation
2024.03 Strategic Resources Presentation2024.03 Strategic Resources Presentation
2024.03 Strategic Resources Presentation
 
Stock Market Brief Deck for 3/22/2024.pdf
Stock Market Brief Deck for 3/22/2024.pdfStock Market Brief Deck for 3/22/2024.pdf
Stock Market Brief Deck for 3/22/2024.pdf
 
India Economic Survey Complete for the year of 2022 to 2023
India Economic Survey Complete for the year of 2022 to 2023India Economic Survey Complete for the year of 2022 to 2023
India Economic Survey Complete for the year of 2022 to 2023
 
MARKET FAILURE SITUATION IN THE ECONOMY.
MARKET FAILURE SITUATION IN THE ECONOMY.MARKET FAILURE SITUATION IN THE ECONOMY.
MARKET FAILURE SITUATION IN THE ECONOMY.
 
ACCOUNTING FOR BUSINESS.II BRANCH ACCOUNTS NOTES
ACCOUNTING FOR BUSINESS.II BRANCH ACCOUNTS NOTESACCOUNTING FOR BUSINESS.II BRANCH ACCOUNTS NOTES
ACCOUNTING FOR BUSINESS.II BRANCH ACCOUNTS NOTES
 
Buy and Sell Urban Tots unlisted shares.pptx
Buy and Sell Urban Tots unlisted shares.pptxBuy and Sell Urban Tots unlisted shares.pptx
Buy and Sell Urban Tots unlisted shares.pptx
 
Commercial Bank Economic Capsule - March 2024
Commercial Bank Economic Capsule - March 2024Commercial Bank Economic Capsule - March 2024
Commercial Bank Economic Capsule - March 2024
 
RWA Report 2024: Rise of Real-World Assets in Crypto | CoinGecko
RWA Report 2024: Rise of Real-World Assets in Crypto | CoinGeckoRWA Report 2024: Rise of Real-World Assets in Crypto | CoinGecko
RWA Report 2024: Rise of Real-World Assets in Crypto | CoinGecko
 
Contracts with Interdependent Preferences
Contracts with Interdependent PreferencesContracts with Interdependent Preferences
Contracts with Interdependent Preferences
 
Solution manual for Intermediate Accounting, 11th Edition by David Spiceland...
Solution manual for  Intermediate Accounting, 11th Edition by David Spiceland...Solution manual for  Intermediate Accounting, 11th Edition by David Spiceland...
Solution manual for Intermediate Accounting, 11th Edition by David Spiceland...
 
Remembering my Totem _Unity is Strength_ growing in Bophuthatswana_Matthews B...
Remembering my Totem _Unity is Strength_ growing in Bophuthatswana_Matthews B...Remembering my Totem _Unity is Strength_ growing in Bophuthatswana_Matthews B...
Remembering my Totem _Unity is Strength_ growing in Bophuthatswana_Matthews B...
 
Sarlat Advisory - Corporate Brochure - 2024
Sarlat Advisory - Corporate Brochure - 2024Sarlat Advisory - Corporate Brochure - 2024
Sarlat Advisory - Corporate Brochure - 2024
 
Monthly Economic Monitoring of Ukraine No.230, March 2024
Monthly Economic Monitoring of Ukraine No.230, March 2024Monthly Economic Monitoring of Ukraine No.230, March 2024
Monthly Economic Monitoring of Ukraine No.230, March 2024
 
Lundin Gold March 2024 Corporate Presentation - PDAC v1.pdf
Lundin Gold March 2024 Corporate Presentation - PDAC v1.pdfLundin Gold March 2024 Corporate Presentation - PDAC v1.pdf
Lundin Gold March 2024 Corporate Presentation - PDAC v1.pdf
 
Stock Market Brief Deck for March 19 2024.pdf
Stock Market Brief Deck for March 19 2024.pdfStock Market Brief Deck for March 19 2024.pdf
Stock Market Brief Deck for March 19 2024.pdf
 
What Key Factors Should Risk Officers Consider When Using Generative AI
What Key Factors Should Risk Officers Consider When Using Generative AIWhat Key Factors Should Risk Officers Consider When Using Generative AI
What Key Factors Should Risk Officers Consider When Using Generative AI
 

15_Mooney_RevenueCycle_Final

  • 1. Revenue Cycle Stephen M. Mooney Senior Vice President, Patient Financial Services
  • 2. The Story of Measuring, Monitoring, & Collecting • Flashback to 2005 through 2007 • 2008 & beyond • What we‟re doing to improve: – Pre-patient care experience – Collections & Follow-Up • The future of PFS 1
  • 3. Flashback to 2005 Centralization to Improve Scale Integrity & Data Integrity Transparency Business Intelligence 2
  • 4. A Year Ago… • Optimize processes 3
  • 5. A Year Ago… • Optimize processes • Consumer-focused 4
  • 6. A Year Ago… • Optimize processes • Consumer-focused • Shift in focus 5
  • 7. Our Vision is Maturing… Become a full-service, revenue cycle service delivery organization that leads the industry in seven distinct ways. 1. Maximize yield of the revenue cycle in alignment with our customers‟ missions 2. Utilize business intelligence to drive our decisions 3. Drive innovation into the healthcare industry revenue cycle 4. Be an employer of choice for the best talent in the healthcare industry 5. Provide superior service to our customers, on par with the best service delivery organizations in the world 6. Make the patient experience with the revenue cycle as transparent, integrated and easy to navigate as possible 7. Make our services a positive differentiator with physicians for the customers we serve 6
  • 8. We Can Drive Volume and Satisfaction… High Being kept Scheduling informed appointments Ease of Timeliness of billing Supportive Importance to appointments environment physicians in determining Convenience where to send for the patients Ease of patient registration Room Value for amenities money Common areas Aligned on importance Room options Not aligned on importance Low Low High Importance to patients for determining future visits 7 Source: 2007 McKinsey Patient Experience Survey; 2007 McKinsey Physician Survey Regarding Patient Experience
  • 9. Ronald Kelley Senior Director, Revenue Assurance
  • 10. Continued Improvements in Patient Access More focus on Patient Access drives our ability to… • Make it easy to do business with Tenet • Improve the patient experience • Reduce bad debt and increase cash QA & Rapid Online CPAS Pricing Registration Bill Pay Tools 9
  • 11. Center for Patient Access Services (CPAS) Implementations finishing in our new Pre-Service Center 1 Hospital schedules patient 2 CPAS processes the account Center for Patient Access Services Certification & Checks (ABN) Verification & authorization Pre-Register Pre-Service Counseling Insurance Necessity Eligibility Financial Medical Pre- Pre- Payors Payors Payors Patients Payors Payors Payors ™ 3 Patient arrives and goes through an expedited check-in at the hospital QA & Rapid Online CPAS Pricing Registration Bill Pay Tools 10
  • 12. CPAS Progress as of Q1 2008 Percent of Accounts Percent of Accounts 24-Month Change in Pre-Registered Verified POS Collections 60% 90% 25% 80% 50% 20% 70% 40% 60% 15% 50% CPAS 30% CPAS 40% CPAS Non-CPAS 10% Non-CPAS 20% 30% Non-CPAS 20% 5% 10% 10% 0% 0% 0% Source: Corporate Patient Access Scorecard, through March 2008. Comparison of “Y” CPAS vs. “N” non-CPAS hospitals. POS improvement based on Q1-08 vs. Q1-06 change in actual dollars collected at Point-of-Service; Pre-Registration and Verification 11 metrics based on actual number of accounts in Q1-08
  • 13. Quality Assurance (QA) & Pricing Tools Q1-2008 Quality Improvements • New QA tool alerts 100% Registration if inaccurate 90% data is entered 80% 70% • Reduced QA staff by >50% 60% 50% 40% • Standard tools calculate 30% patient-liability balances 20% 10% 0% Insured Name Insured Name Documentation Documentation • Written estimates given to Complete Complete Match Match Auth Auth patients Medicaid HMO Managed Care Medicaid Medicare • Automatic processing of applications for funding QA & Rapid Online CPAS Pricing Registration Bill Pay Tools 12
  • 14. Rapid Registration: Kiosk & e-Signature • 3 sites piloted beginning December 2007 • 87% reduction in paper used during registration West Boca: Desktop Park Plaza: Wall Mount • 30% initial improvement in cycle time • 3 minute average check-in time Lake Pointe: Free Standing All: Tablets QA & Rapid Online CPAS Pricing Registration Bill Pay Tools 13
  • 15. Rapid Registration: Kiosk & e-Signature What patients see when using a kiosk in the pilot 14
  • 16. Rapid Registration: Kiosk & e-Signature Patients can sign forms electronically, which are automatically fed into our imaging system Later in 2008 patients will be able to make co-payments directly at the kiosk 15
  • 17. Online Bill Pay QA & Rapid Online CPAS Pricing Registration Bill Pay Tools 16
  • 19. PFS Segmentation is Gaining Momentum… We are collecting about $9 million more per quarter than our average collections in the pre- redesign period. About $15 million per quarter has been accelerated out of bad debt into collections in active A/R. While net patient billed dollars have declined 34% due to Compact and divestitures. Early Out/CFC Total Cash Collections, 2004 – 2008 Q1 $100 $500 Early Out $90 $450 Growth CFC Q1 2008 Net Patient Bills $80 $400 vs. $70 $350 Q1 2004 Collected $ $60 $300 Billed $ EO $50 $250 +49% $40 $200 $30 $150 Total $20 $100 +11% $10 $50 $0 $0 CFC Q1 2004 Q2 2004 Q3 2004 Q4 2004 Q1 2005 Q2 2005 Q3 2005 Q4 2005 Q1 2006 Q2 2006 Q3 2006 Q4 2006 Q1 2007 Q2 2007 Q3 2007 Q4 2007 Q1 2008 (-44%) 18
  • 20. MicroSegmentation™ • PFS employs an in-house PhD statistician • Unlimited number of custom models can be implemented • Models can be continuously “tuned” with most recent actual data – Easy to identify macroeconomic trends and adjust work processes to compensate – Quick response to shifts in payor behavior 19
  • 21. MicroSegmentation™ MicroSegmentation™ (44 variables) New insurance: - payor variables - Clinical/service details - Denial/dispute details New self pay: Original - Census block data Segmentation - Credit report detail - Prior visits & (8 variables) payments Original self pay: Original self pay: - Credit Score - Credit Score - Visit Variables - Visit Variables - Demographics - Demographics 20
  • 22. MicroSegmentation™ • 99% of payments come from 71% of patients New model much better at identifying the Comparison of Tenet Segmentation Models non-paying Early Out Self Pay accounts 100% 90% Near-perfect prediction for 80% Accounts With Payment 30% of paying population 70% 60% 50% 40% Microsegmentation™ 30% Original Segmentation 20% Random 10% Theoretical Max 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Total Population 21
  • 23. MicroSegmentation™ • Our pilot model was secondary bad debt self pay accounts • Significant improvement in predictive strength Comparison of Tenet Segmentation Models Secondary Bad Debt Placements 100% At the 10th percentile MicroSegmentation™ captures 90% 45.6% of good accounts vs. 25.7% under original model 80% Accounts With Payment 77% Improvement! 70% 60% 50% 40% 30% Microsegmentation™ 20% Original Segmentation 10% Random 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Total Population 22
  • 24. Next Iteration – Managed Care • MicroSegmentation™ is predicting the number of days it will take a commercial or managed care payor to respond to an initial bill • Opportunity is to refocus people resources to spend time following up on claims at the optimal point to accelerate cash and reduce aging 23
  • 25. Distribution of Predicted Follow Up Dates • Modeling shows that about 45% of accounts should be worked by day 28 and 60% by day 34 Predicted Follow Up Date 30000 25000 20000 Claim Volume 15000 10000 5000 0 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Days from Bill Date 24
  • 26. Insurance Follow Up Model Variables • The MicroSegmentation™ Major Insurance Payor (Blue Cross, United, etc.) Payor‟s Zip Code process identified 15 data (regional payor claims processing differences) Category of Services Rendered Hospital elements as statistically Financial Class (contracted vs. non contracted payors; managed government vs. managed care) significant based on regression Expected Reimbursement from Payor Type of Insurance Product (HMO, PPO, etc.) analysis of recent actual Tenet Length of Stay in Hospital Managed Care IPA Group data (IPA may pay managed care bills rather than the payor) Hospital Department DRG Primary Illness Category • Insurance tree has 4,200+ Inpatient or Outpatient Pass Through Flag (contract requires copies of invoices for medical equipment) branches and leaves which are Emergent or Non-Emergent Services Days from Discharge for Initial Bill to Payor different possible outcomes Example MicroSegmentation™ Tree with 1,000 Leaves 25
  • 27. Validating the Model • 22,000 accounts have been modeled and have had enough time to measure accuracy of predictions • ~70% of accounts paid on or before the expected date Actual Payment Date vs. Predicted Date 75% % of Claims Paid 50% 25% 0% or Before 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Paid On + + + + + + + + + + + + + + + Paid On or Before Predicted Date Variance (in Days) between Actual Payment Date and Predicted Date 26
  • 28. What does MicroSegmentation™ Mean? • Optimized use of resources based on scientific models • Ability to focus on resolving billing issues quickly • Patients experience shorter delays in copay/deductible billing when there is an issue to be resolved with the payor 27
  • 29. Continuing the Focus on Physicians and Patients Initiatives Driving High Being kept Scheduling Satisfaction informed appointments • CPAS Ease of Timeliness of • Quality Assurance billing Supportive Importance to appointments environment physicians in • Pricing Estimates & determining Convenience where to send Point of Service for the patients Ease of Collections patient registration • Rapid Registration Room Value for • Online Bill Pay amenities money Common • Segmentation & areas MicroSegmentation™ Room options Low Aligned on importance Low High Not aligned on importance Importance to patients for determining future visits 28 Source: 2007 McKinsey Patient Experience Survey; 2007 McKinsey Physician Survey Regarding Patient Experience
  • 30. Continued Momentum & Efficiencies… Across our hospitals, A/R days Managed Care and Medicare aging are all down, releasing significant incremental cash. Managed Care Medicare A/R Days1 A/R A/R Greater than Greater than 60 180 days2 days2 Q1 Q1 Q1 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007 2008 2008 2008 74 56 58 55 54 54 $63M $40M $28M $13M $15M $34M N/A $481M $357M $324M $247M $217M Overall Reduced Reduced reduction MC A/R by MCR A/R of 20 days $264M or by $29M or 27% 55% or 46% 1 Same store hospital only core acute facilities with prior year cost settlement for all years plus new facilities 2 Same store hospital only core acute facilities plus Rio and Pinecrest Rehab excluding Plaza Specialty, Coastal Carolina, Centennial, Bartlett and Norris Cancer Center for all years; 2003 Managed care data not available – no detail at that level in 2003 29
  • 31. Revenue Cycle Initiatives to Decrease A/R Days, Increase Cash Collections, & Improve Patient Satisfaction • Increase Point of Service (POS) Collection • MicroSegmentation™ • Reduction in Discharged Not Final Coded (DNFC) • Payor collaboration • Legal action when appropriate 30
  • 32. Patient Financial Services Moving forward… 31
  • 33. External Business – Market Maturity: Current Evolution of Three Outsourcing Markets RCO’s market evolution can be best understood by analyzing the evolution of two other outsourcing industries: ITO and HRO I. Proof of Concept II. Growth III. Maturation ITO Adoption HRO Rate RCO Time Few end-to-end offers Offers increasingly SLAs are standard    Offers standardized and industry practices comprehensive Consider „value‟ of offer in Differences in acceptance, View as an accepted,    sophistication and addition to potential cost strategic component of Customers expectations savings their operations Heavily fragmented Rapid consolidation of Few, large players    Providers landscape with no providers dominate market dominant providers 32
  • 34. External Business – Market Opportunity 2004 U.S. Hospital Market 7,000 6,556 6,000 1,146 Number of Hospitals Less Non-Acute Care 746 5,000 Hospitals 195 4,469 Less Military and Less Stand- VA Hospitals Alone Critical 4,000 Access Hospitals 2004 Net Patient 3,000 Revenue (NPR) of addressable hospital market 2,000 baseline ~$536B Remaining Addressable Hospital Total AHA Baseline Baseline 1,000 0 33
  • 35. External Business – Addressable Market: Revenue Cycle Spend Estimate Based on a conservative 4% cost-to-collect estimate, we can approximate the revenue cycle spend for our addressable market as ~$20Bn Estimate of Revenue Cycle Spend by Function Patient Cost-to- Access 2004 2004 Revenue Cycle Operate Billing and NPR ($B) Spend Estimate ($B) Estimate Follow-up 27% Patient 1% to 2% ~$5 to ~$11 46% Access HIM and 1% to 2% ~$5 to ~$11 Coding AR 2% to 3% ~$10 to ~$16 Management Total ~$536 4% to 7% ~$20 to ~$38 27% HIM & Coding Sources: The Monitor Group - 2006-2007 Target Market Survey, Tenet Internal Data, Modern Healthcare, Center for Medicare and Medicaid Services, AHA 34
  • 36. Closing – Roadmap • Continuing our focus on patient and physician satisfaction • Driving performance improvement • Carrying operations momentum forward through innovation and thought leadership • Provides an opportunity to leverage our services in a third party market 35