Trace Days 2013 | Knoxville, TN

Dave Stridde
Chief Operating Officer
The White Stone Group

Account Management Team
Jo Norris – VP of Account Management
Nichole Harmon – Indianapolis, IN
Debra Holman – Nashville, TN
Aljeana Howard – Atlanta, GA
La Teshia Jones – Houston, TX
Debbie Lloyd – Dallas, TX
Michael Mouton – Dallas, TX
Marcia Patterson – Cincinnati, OH
Deborah Todd – Memphis, TN
Lynda Clay – Nashua, NH
Lauren Bento – Port St. Lucie, FL

Sales Team
Ken Cassell – Senior Vice President of Sales
Blair Wright – Knoxville, TN
Jerry Thomas – Oviedo, FL
Walt Bearden – Knoxville, TN
Lori Forbess – Beaverton, OR
Windell Yancy – Dallas, TX
Phillip McClure – Fort Worth, TX

Our Team - Here to Serve You
Tim Hoskins | Director of Enterprise Architecture & Security
Matt Jernigan | Director of Product Management
Erin McCarty | Director of Marketing
Bill Milam | Director of Software Development
Derek Morgan | Trace Product Owner
Ben O’Brien | Director of Support Services
Nicole Shanklin | Director of Implementation & Training

Our Lofty Goal
To be the very best support organization in the
healthcare software industry.
• High value on genuine relationships with our customers
• High value on responsiveness
• High value on ROI - ensuring that our products bring real
value to your organization
• High value on trustworthiness - we want to be a
company that you can trust to do the right thing

Jeff Peters
President and CEO
The White Stone Group, Inc.

Key Stats
The White Stone Group
has 64 employees –
48 at our corporate
office in Knoxville and
another 16 employees
across the country.

Continuity of Knowledge
The average tenure of a TWSG employee is over
6 years.

0
5
10
15
20
25
30
'99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 10 11 12
TransactionsinMillionsTrace Usage

Where does the growth come from?
Voice
Fax
Electronic

We love to hear from our customers!
We have received over 700 inputs from Tell Us!

Workshop 1:
Is Your Revenue Cycle STILL Suffering
from Communication Chaos?
Rebecca Black, FHFMA, CPA
Vice President of Revenue Cycle
Southern Regional Medical Center
Riverdale, GA

IS YOUR REVENUE
CYCLE STILL SUFFERING
FROM COMMUNICATION
CHAOS?
Rebecca T. Black, FHFMA, CPA | Vice President of Revenue
Cycle
Southern Regional Medical Center | Riverdale, GA

Learning Objectives
What are the signs that you still have
communication gaps in your Revenue Cycle?
What are your key feedback loops?
How did one hospital use Trace to reduce
communication chaos?
How can you track and demonstrate return on
investment (ROI)?

The Cost of Communication Chaos
Hospitals waste $12 billion a year due to poor
communication, approximately 2 percent of national
hospital revenues and more than half the average
hospital margin of 3.6 percent.
Source: Amednews.com. Communication failures over diagnostic tests prompting more lawsuits. 2011.

Why Do We Still Have CHAOS in
the Revenue Cycle?
 Very complex
 Many processes and players
 Broad spectrum of activities
 Departments don’t align under the same area of
oversight
Source: Protiviti. Healthcare Revenue Integrity Strategies: Using High Value Revenue Cycle Assessments to Protect
and Improve the Bottom Line. 2012.
“A provider is at risk every day of losing revenue at
many points in the cycle, especially in routine
areas of operations where inefficiency and a lack
of communication between departments are
common.”

How to Know if You Still Suffer from CHAOS
 Delayed accounts receivables
 Initial denial rate
 Net days in A/Rec – benchmark to standards/best practice
 Collections compared to Net Patient Service Revenue (avg
100%)
 Denied claims
 Technical (administrative) or clinical rate
 Overturn rate
 Data by payer/line of business
 Rework
 First pass clean claim rate
 Volume of required claim edits
 Volume of manual adjustments
 Wasted staff time
 Productivity
 Cost to collect

How to Know if You Still Suffer from CHAOS
 Frustrated customers
 Complaint volume
 HCAHPS scores
 Cancelled procedures
 Last minute scheduling changes
 By procedural area/payer contract
 Wasted materials/resources
 High cost radio therapeutic drugs/chemo agents
 Gaps in schedules (Open rooms in procedural areas)
 Physician dissatisfaction
 Complaints to Administration
 Loss of volume/downward trends
 Patient steerage

Key Revenue Cycle Feedback Sources
• Who owns these functions:
• Scheduling
• Pre Access
• Point of Service
• Case Management functions
• Notification of Admission
• Status Determination
• Concurrent Reviews
• Denials Management
• Trending
• Tracking
• Root cause analysis
Communication
is critical to
solving denials
and harnessing
information to
drive revenue
cycle
performance

Missing Pieces to Your Bottom Line
 Denials “falling through the cracks”
 Reliance on “homegrown” databases and
manual spreadsheets to track performance
 Not prioritizing denied accounts for resolution
 Inconsistent follow-up activity on accounts
 Lack of understanding of root causes of
denials
 Inability to speed account resolution with
payers
 Poor communication among departments and
revenue cycle functions

Denials: Not Going Away
20% of claims are delayed or denied
7% of claims are never paid
Insurance companies return claims an average of two times
to get the information they require to process the claim
Source: PNC. Automated Billing/Payment Process Can Reduce US Health Care Costs Without Sacrificing Patient Care. 2007.

Initial Denials: % of Outstanding AR
50%
19%
31%
0% - 5%
6% - 10%
>10%
31% of hospitals have initial denials greater than 10%
Source: Financial Leadership Council 2011 Revenue Cycle Survey. The Advisory Board Company. 2011.

Initial Denials: Sources of Errors
Nearly 3/4 of errors traced back to the front end
27%
16%
30%
27%
Medical Necessity
Authorizations
Demographic Information
Eligibility

Denied Claims
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
1.6%
National Average Top 25% Benchmark
1.5%
0.6%
Source: Healthcare Business Insights. Solution Provider Academy. 2013

Denial Write-Offs
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
High Performance
Quartile
Median Low Performance
Quartile
0.4%
1.1%
3.9%
Percentage of Net Patient Revenue

Making Sense of the Numbers
Hospital A
 Gross revenue = $1B
 Net revenue (30%) = $300M
 Net operating margin of 3% = $9M
 1.5% lost to denials = $4.5M left on the table
 Losing 50% of margin
 Every year!

Are You Protecting Your Dollars Today…
AND TOMORROW?
• Recoupment reasons:
• Coverage at time of care
• Type of service provided
• Existence of
authorizations
• Retro reviews where
status is changed
Retro
denials
are
costing
hospitals
millions

How Are You Doing in These Areas?
 Denial Prevention
 Authorizations (phone, web or fax)
 Verification that no pre cert was required
 POS Collections/Back-end Follow-up & Collections
 OOP estimates, ABNs for Medicare
 Promises to pay/claim tracking
 Patient Satisfaction/Quality Assurance
 Consistent use of scripting, record of encounter
 Document consistent adherence to Policy/Procedure
 Behavior Modification
 Staff training/retraining
 And much more…

Face-to-Face
Conversations
Printer
Scanner
Memory
Note Pad
File
Cabinet
CD-ROM
DVD
Tape
Recorder
Computer

Bringing Clarity to Chaos
Central
Record
Storage
Web
Tracking
System
Index and
Archive
Date-and-
Time Stamp
System-
Wide
Access
Easy
Retrieval
and Routing
Central Repository

Saint Joseph’s Hospital of Atlanta
410-bed
acute-care
facility serving
metro Atlanta
& surrounding
areas
One of
Southeast’s
top specialty-
referral
hospitals
Challenging
margins due
to high
Medicare
utilization &
tight margins
on managed
care
Objective to
support
revenue cycle
best practices
& achieve
total denial
rate of < 1%
gross

Areas of Technology Application
 Precertification
 Preregistration process
 Payment estimates
 POS collections
 Verification of claim receipt & promise to pay
 Denial & appeal management
 Contract review/payment accuracy
 Staff education & training

Voice Recording Process
Incoming Calls
Outgoing Calls
Outgoing Voicemails
Voice solution
captures, indexes, an
d stores the
conversation or
message
Staff access the
transcription of the
call or voicemail
Hospital then uses
the transcripts to
resolve disputes
with insurance
companies

Real-Life Scenario
Identified large volume of denials for “lack of
pre-certification/notification” from a particular
payer related to outpatient radiology scans
(CT, MRI, PET).
Almost every denied claim appeared to be
pre-certified and had a pre-certification
number.
The payer’s Contracting Department was
contacted and several examples were sent
for “investigation” as to why the claims were
denied.

Details
Patient received 3 CT scans on same
date of service – chest, abdomen, and
pelvis.
All 3 scans were fully authorized.
A recorded conversation clearly indicated
that SJHA obtained the pre-certification and
had explicitly inquired whether a different
precert number was needed for each scan.

Review of Payer’s Research
Recorded conversation between facility & Contracting Manager from Payer
Payer says
that only one
of the 3 CT
scans was
authorized.

Transcript Emailed Immediately to
Contracting Manager
This is the transcript header; it contained the patient’s name, account
number, and time stamps

Transcript Continued…
This is from the body of the transcript where the authorization takes
place; it clearly shows that all three scans were authorized.

A Week Later, Payer Calls Back…
Payer finally acknowledges that they have a core issue between their third-
party radiology vendor and their claims processing system.

Results of Project Implementation
 Implemented Dec. 1, 2009
 Results as of Mar. 31, 2012
 “Cash in the door” = $458,816
 161 accounts, average recoup = $2,849
 Average accounts overturned per month = 6.4
 Prevented denials

Results – Improved Satisfaction
Staff Members
• Listening to
recorded calls
helps staff
members learn
from mistakes
and find ways to
keep improving
customer service
• Staff members
know they have
documented
proof to
substantiate
Patients
• Increased front-
end staff training
leads to more
satisfied patients
• Front-end staff
have more
accountability
and resources at
their disposal to
provide great
service to
patients
Physicians
• Improved
relations between
different
departments
• Less often
assume an error
is the result of
patient access
negligence

Lessons Learned
For SJHA, documentation was invaluable to proving
compliance with prescribed precertification protocols.
Without it, inappropriate denials and cash payment
delays would have continued.
Documentation used to assure mutually agreeable
processes with managed care payers and lessen
administrative burdens for both payer and provider.

Calculating ROI: Scheduling, Orders
 Prevent one cancelled surgery = ___
 Retain one physician = ___
 Reassign one FTE from scanning, filing, etc. = ___
 Prevent one HIPAA violation = ___
 Save one hour per day in managing orders = ___
 Save one hour per day in document scanning = ___
 Eliminate fax machines = ___
 TOTAL savings per month = ___

Calculating ROI: Patient Experience
 Retain one additional patient = ___
 Collect one additional payment at
Point of Service = ___
 Prevent one patient identity theft = ___

Calculating ROI: Revenue At-Risk
 Prevent one denial per month = ___
 Overturn one denial per month = ___
 Reduce cost to collect = ___
 Reduce number of net days in AR = ___

Calculating ROI: Coordination of Care
 Prevent one readmission = ___
 Prevent one medical necessity denial = ___
 Prevent one notification denial = ___
 Prevent one EMTALA violation = ___
 Reassign one FTE from faxing for discharge
placement = ___

Conclusions
Revenue cycle communications are many and varied and far from
perfect.
Misleading and inaccurate information is a significant barrier to
achieving revenue cycle best practices.
Providers can leverage technology to bring clarity to the chaos and
gain valuable ground toward achieving best practices.
Providers need to increase their knowledge and understanding of
what “value” systems such as Trace provide and endeavor to find
additional ROI opportunities.

Which area represents the best opportunity
for growth with Trace at your organization?
1 2 3 4
54%
5%
24%
16%
1. Revenue-at-Risk
2. Physician Orders
3. Care Coordination
4. Patient Experience

Workshops 2 & 5
Session 1: What’s New In Trace
Jo Norris, VP of Account Management
Derek Morgan, Trace Product Owner
Marcia Patterson
Deborah Todd
Aljeana Howard
Debbie Lloyd

My Hospital…
A. Already has an HL7/ADT feed with Trace
B. Does not have HL7 with Trace, but we plan to get it
C. Does not have HL7 with Trace & we don’t really think we need it
D. Thinks it would be awesome if we only had the $$

Annotation…
A. Is great and we will/do use it a lot
B. Is not very useful for us
C. Doesn’t do enough, it needs more work
D. Not sure yet

PixCert XPS
…………It’s fast!

Reports!
A. We need more & better reports ASAP!
B. The reports we already have are good enough
C. We love the existing reports
D. We hate the existing reports with a burning hate
E. We don’t care about reports
F. Reports? I didn’t know there were reports….

Face to Face Recording/ Photo Capture

Workshop 2 & 5
Trace Best Practices & User Stories

HL7 Integration & Indexing
What is HL7 integration?
 It is an interface or communication between your
hospitals patient management system and Trace.
It sends the Patient’s Registration, Pre
Registration, Admission, Discharge or Transfer data to
Trace.
How do you index with the HL7 interface?
 Simply search in Trace by the patient’s
demographics. Then select the correct patient
record from the HL7 results shown.

Downloads Tab
 This feature gives you the ability to “upload and save”
files saved in your documents library or documents
store in other applications on your desktop.
 Once saved, you can choose to PixCert & Fax, Notify
or Print your documents.

Front-End Processes
Patient Access, Central Scheduling,
Registration, Etc.
Nichole Harmon & Lynda Clay

Inbound Faxing
• Physician Order Management
• Indexing, manual or HL7 integration
• Custom Fields
• Reserve Faxes

Front End Processes
• Notifications
• Fax/Image Annotation
• Fax Back Invalid Orders or Confirmations
• Standard Cover Sheet Notes
• Image Export

Inbound Faxing – Best Practice
• Physician Orders
• Pharmacy
• Bed Status Change
• Surgery
• Case Management

Front End Processes
• Value
- Prevents lost orders
- Audit Trail
- Ability to track invalid orders
- Eliminate Paper
- Accessible to other departments to view

Trace Voice
• Why Record Conversations?
– Big Brother
OR
– Capture Prior Authorizations
– Validate Scripting
– Eliminate “he said....she said”
– VOB/VOE
– Quality Insurance
– Scripting

Trace Voice
4 Voice Recording Options -Choice depends on:
• Volume
• Purpose
• Call Type

Trace Voice
• Auto Record
– Seamless
– No end user intervention
– Indiscriminate
Best Practice Scenario – Call Centers to support VOB
and/or VOE, scripting, pre-registration information

Trace Voice
• On Demand
– Requires hardware
– User controlled
– Discriminate
Best Practice Scenario – Collection areas calling on
claim status for multiple claims/patients

Trace Voice
• Anywhere
– Flexible
– User controlled
– Discriminate
Best Practice Scenario – Case Managers for billing
disputes, SNF placement conversations, transfers.

Trace Voice
• Face-to-Face
– In-person
– User controlled
– Discriminate
Best Practice Scenario – Financial Counselors
reviewing patient financial responsibility and
payment plans.

Mid-Cycle Processes
Case Management, Concurrent Review, Etc.
La Teshia Jones & Lauren Bento

Case Management Processes
• Centralized number for incoming faxes
• Case Managers officed all over the hospital
• Paper documentation filed in individual desk
drawers
• Paper shuffling

Fax Management with FaxCert
• Inbound and outbound
• Alternative to scanning documents
• HL7 integration for efficient and accurate
indexing
• Departmental notifications

Fax Management with FaxCert
• Value
– Centralized, electronic storage of faxes
– Improve workflow efficiency
– Enhanced departmental communication
– Paper savings

PixCert
• Capture clinical documentation and fax
• Capture departmental forms and notify or fax
• HL7 integration for efficient and accurate
indexing

PixCert
• Value
– Increased workflow efficiency
– Accessibility
– Electronic audit trail

Downloads Tab
• Insurance specific forms
• Internal documents
– Authorization changes
– Schedules
– Concurrent appeal letters

Downloads Tab for Mid Cycle Process

Downloads Tab
• Value
– Centralized location for frequently used forms and
documents
– Capture and store document without having to
save to PC
– Electronic faxing and combining of documents

Trace Voice for Readmissions Reductions Programs
 Patient Protection and Affordable Care Act (P-PACA)
 Quality indicator versus reimbursement denial
 Record discharge instructions
 Non compliance versus neglect to inform

Back-End Processes
Business Office, Denial Management,
Appeals, Etc.
Debbie Holman & Michael Mouton

Back-End Processes
 Denial, Appeal Management
 Worklists
 Downloads Tab, Tools Tab
 Import Tiff and PDF Feature
 Outbound Faxing

Managing Trace Communication Events
How do I use my Worklists?
 Customize Column data to match your workflow
 Organizes data in an easy to read format when
performing searches on patient transactions
 Quickly access transactions for
printing, faxing, emailing transactions
 Perform batch operations

Download Documents
Do you have a standard form that you can
“edit”?
 Upload to your downloads Tab and complete
with new patient information.

How do you resubmit your denials & appeals?
Answer # 1 - By Fax
Answer # 2 - Print and Mail
Answer # 3 - Phone Call and pleading case

Tools and Utilities for Back End
Import Tiff or PDF documents
 Electronic Medical Records
 Insurance Forms
 Release of Information or Disclosure Forms
Benefits
 Retrieve and complete on any patient
 Index form/document and save in Tracker
 Fax outbound completed documents for denials
management and appeals

Outbound Faxing
 Why Fax Outbound your appeals and claim process?
Benefits
 Easy to locate faxed transactions and
documents
 Merge records and documents into a single
Trace transaction to fax
 Date & Time Stamped - proof that you met the
deadline date
 Fast and easy process to “Resend” faxes
 Saves time- no more running to and from fax
machine

With Trace
Your Hospital is on the
road to recovery!!

Workshop 3
Trace – New & Coming Attractions
Matt Jernigan, Director of Product Management
Debra Holman, Trace Account Manager
La Teshia Jones, Trace Account Manager

Topics
• Trace Integration Options
• Auto Notification of Admission
• Trace Quality & Coaching
• Discharge Instructions

Trace Integration
Trace Integration includes two options…
Image Export
&
Image Import

Do you currently print and scan documents
for the sole purpose of entering into another
system?
1 2 3 4 5
31%
0% 0%
63%
6%
1. No, not in my area.
2. I don’t know.
3. I think so.
4. Yes.
5. No, that’s what
interns are for!

Image Export
Automatically transfers images in Trace to
virtually any EMR or imaging system.
trace EMR

Image Export
Some typical benefits…
• Reduced printing costs
• Instant access to documents in other systems
• Documents backed up within Tracker
• Increased workflow efficiency

Image Import
Highly versatile and provides automatic faxing
indexing and notifications.
traceEMR
Fax
Index
Notify

Image Import
Some typical uses…
• Auto faxing of test results such as radiology or
mammography results
• Consolidate CPOE and faxed physician orders
into a single system for workflow
improvement

Trace Integration
Requirements
• Trace standard HL7 interface
• Technical service call / project plan
• Priced per sending/receiving system

• Auto notification of admission
Next Up

Notification of Admission
Problem
• Payers often require notification of inpatient
admission within 24 hours.
• If missed, the claim will be denied for every
day late.
• Adds pressure on access staff, particularly on
weekends and holidays, to notify payers.

Solution
Automatically fax a notification to the payer on
inpatient admissions and status changes.
trace Payer

trace PayerRegistration
HL7 Fax*
Notification

Advantages
• Trace automates the notification.
• Within Tracker the notifications can be
compared to the patient census.
• In the event of a denial, proof of the
transaction is in Trace.

Would this feature be valuable at your
hospital?
1 2 3 4
57%
0%
14%
29%
1. Yes, this would be
awesome!
2. Interesting, it might be
helpful.
3. I’m not the right
person to ask but I’d
like to tell someone at
my hospital about it.
4. No, I don’t think this is
useful.

Voice – Quality & Coaching
• 70% of hospitals rank patient experience as
one of their top three priorities.*
• The patient’s experience is affected by every
hospital interaction including those within
the revenue cycle.
*“State of the Patient Experience,” The Beryl Institute © 2013.

Revenue Cycle Impact
• Pre-Service communications set the tone for
the entire stay.
• Post-Service communication may be the last
impression made with the patient.

Revenue Cycle Impact
Satisfied with
billing experience
93% Satisfied with
Clinical
Unsatisfied with
billing experience
63% Satisfied with
Clinical
“Study shows link between patient satisfaction with Billing Experience and Clinical
Satisfaction”, Executive Insight © 2011.

Voice – Quality and Coaching will be an add-on
module allowing managers to grade recordings
so that can staff can be coached, quality
improved…
and ultimately the patient experience improved.

Demo

Advantages
• Create a quality and coaching program.
• Grade recordings based on your criteria.
• Identify top performers to use for training.
• Compare team members to identify coaching
opportunities.
• Track quality scores over time.

hospital?
1 2 3 4
43%
3%
26%
29%
1. Yes, this is the coolest
thing since Trace Days!
helpful.
3. I’m not the right person to
ask but I’d like to tell
someone at my hospital
about it.
useful.

• Auto Notification of Admission
Next Up

Discharge Instructions
• The Affordable Care Act established the Hospital
Readmission Reduction Program.
• Requires CMS to reduce payments to hospitals
with excessive readmissions.
• Common drivers of readmission
– Lack of a standard discharge process
– Lack of engagement by patients and families
– Patients did not understand/correctly take
medications

Discharge Instructions
Trace
• Utilize Trace Voice Face-to-Face to capture.
• Evaluate quality with Trace Quality & Coaching
tool.
• Review instructions prior to patient follow-up.
• Provide patients with access to recorded
discharge instructions.

hospital?
1 2 3 4
24%
9%
32%
35%
1. Yes, I think it would be
great!
helpful.
3. I’m not the right person to
ask but I’d like to tell
someone at my hospital
about it.
useful.

Workshop 4
Q&A with Trace Champions
Stephen Hovan
Vice President, Revenue Cycle
University of Tennessee Medical Center
Knoxville, TN

Stephen Hovan
Vice President, Revenue Cycle
University of Tennessee Medical Center
Knoxville, TN

About UHS
• University Health Systems, Inc., Knoxville, TN
• The region’s only academic medical center
• Licensed for 581 beds
• Delivery of care model, Centers of Excellence:
– Brain and Spine Institute
– Cancer Institute
– Center for Women’s and Children’s Health
– Emergency and Trauma Services
– Heart Lung Vascular Institute

The Past Facts for UHS
• Over $16 million in denials consisting of 8.7
million in fatal denials
• Over 35,000 denials
• 2.2% of hospital net revenue lost to denied
claims
• 96% cash to net patient service revenue
• Overturn rate less than 35%
• Less than 20% of all denied claims appealed

Our Plan of Attack
• Define denials
• Measure & monitor
• Establish denials champion
• Tools of the trade

Our Tools of The Trade
• Reporting
• Workflow
• Documentation
• Communication

Our Revenue Cycle Indicators
January 2007 to March 2012
• Aged Accounts greater than 90: 31% to 19%
• 23% increase in Cash Collections
• 99.5% Cash as % of NPSR
• 56% decrease in denials from $16M to $9M
(Jan 2007 – Mar 2010)
• 51% decrease in fatal denials from $8.7M to $4.3M
• 71% success in overturning denials!!!!
• 90% of all denials are reviewed for determination

Trace Voice at UHS
• Scheduling
• Insurance Authorization
• Financial Counseling
• Customer Service
• Business Office

FaxCert at UHS
• Order management
• Medical record requests
• Itemized charges for patients
• Information requests from physicians
• Insurance benefit information
• Notification of admission
• Discharge planning & notification

PixCert at UHS
Documented proof of important online
processes that protects revenue such as:
Verification of Benefits and Eligibility
Claim Status
Prior Authorization
Appeals

Our Results
• Overturning and preventing denials
• Improved revenue cycle productivity
• Renewed staff confidence to fight a battle and win
• Courtesy and customer focus among staff
• Real, live training examples for management team
• Improved relationships within revenue cycle team,
other hospital departments, physician offices,
patients and even with insurance companies

Our Fatal Denials Reduction
$4,000,000.00
$5,000,000.00
$6,000,000.00
$7,000,000.00
$8,000,000.00
$9,000,000.00
2007 2008 2009 2010
Year
YTD Fatal Denials Progress
Tot Charges Fatal Denials

Our Future State
• Continue to streamline workflow
• Expansion of user defined work-lists
• Integration with optical imaging product
• Implementation of face-to-face recording
• Physician order management

How effective are you in using Trace to
address denials?
1 2 3 4
9%
21%
15%
56%
1. We’re doing great!
2. We’re doing
okay, but could be
better.
3. We’ve got a long
way to go.
4. We’re in denial
about our denial
problem.

Workshop 4
Lynn Arrington, CHAM
Manager of Insurance Verification,
Patient Access Intake Center
Texas Health Resources
Arlington, TX

What is your level of interest in using
face-to-face recording at your hospital?
1 2 3 4
43%
10%
3%
43%
1. OMG! I wish I had it
yesterday!
2. It’s sounds cool, but I
have some concerns.
3. Sounds too much like
Big Brother. I can’t
imagine ever doing that.
4. I’d like to use it to record
things my boss says!

Workshop 4
Stuart Schiffman
Vice President of Revenue Management
Catholic Health Services
Lauderdale Lakes, FL

2013
TRACE DAYS CONFERENCE
Stuart Schiffman

CATHOLIC HEALTH SERVICES
 Faith Based Organization
 Mission: “To provide health care and services to those in need;
To minimize human suffering; To assist people to wholeness;
To nurture an awareness of their relationship with God.”
 Vision includes innovative and proactive approaches to:
 Managing care and providing services
 Facilitating transitions across levels of care
 Community partnerships and collaboration
 Advocacy efforts

 Nursing Homes (Skilled Nursing & Long Term Care)
 633 Beds (4 locations)
 Rehabilitation Hospitals (Inpatient & Outpatient Services)
 88 Beds (3 locations)
 Assisted Living Services
 2 locations
 Home Health Services
 2 locations
 Catholic Hospice
 Home Services
 Inpatient Services
 Cemeteries
 Elderly Housing (15 locations; 2200 units)
 Early Education

 8 Service Lines
 30 Facilities
 2,700 Employees
 Total Revenue - $160 Million

Revenue Cycle Management
 Centralized Business Office
 Billing
 Collections
 System Management & Oversight (Net Solutions)
 Technical Support
 Charge Entry
 Cash Posting
 Customer Service
 Policies & Procedures
 Training & Development
 Managed Care Contracting

Revenue Cycle Management
 PAYER MIX
 Medicare – 40%
 Medicaid – 35%
 Managed Care/Commercial – 18%
 Private Pay – 7%

Regulatory Environment
 Medicaid
 State Reform Program
 Mandatory Medicaid Long Term Care Enrollment (Managed Care)
 Contracting (Letters of Intent; Negotiations)
 Staff Education
 Resident & Family Education
 Insurance Industry
 Managed Care Payers
 Individual Requirements
 Payment Issues
 Denials

Accounts Receivable Management
 Denials Management
 Authorization (Extended Stays)
 Level of Care Disputes
 Assertive Approach
 62% Success Rate
 Appeals Process (Labor Intensive; Cash Delays)

ACCOUNTABILITY
 Monitoring Performance
 Reports
 Cash Collections
 Days In A/R
 Bad Debt
 Census
 Payer P & L
 Utilization
 Individual patient service costs (i.e., Physical Therapy;
Pharmacy; etc.)

REVENUE CYCLE TOOLS
 Net Solutions
 RAM (ADT & Billing)
 Clinical (Interfacing)
 SSI
 Electronic Billing (Edits; Transmissions; Confirmation)
 Tract Manager
 Contract Management
 Authorization Process
 NS Plan Authorization Report
 eQ Health (Medicaid)

REVENUE CYCLE TOOLS
 Verification/Eligibility Process
 Passport
 Availity
 Web Sites
 Medicaid Web Portal
 Medicare DDE
 Financial Screening – Charity Care Program
 Search America/Experian
 Trace ***
 Denials Reduction
 Accountability
 Payers
 Staff

OVERALL PERFORMANCE
 Days In A/R (Reduced from 45 to 33)
 Cash Collections (Over Budget by $1.9M & $1.5M)
 Increased Revenue via Managed Care Contracting
 Reduced Bad Debt

Trace Implementation – Key
Components
 Senior Management Support
 ROI Analysis
 References
 Facility Leadership Support
 Key Users’ “Buy – In”

Components (cont’d.)
 Project Management
 Trace Oversight
 Project Charter
 Ongoing Communication
 Accountability & Accessibility
 User Perspective Experience

Components (cont’d.)
 Project Management
 CHS Approach
 Departmental Process Reviews (Admissions; Case
Management; Business Office; CBO)
 Enhancement vs. “More work”
 Pilot Roll – Out
 Assessment/Feedback
 Improvements
 Full Roll- Out
 Assessment/More Feedback
 ROI

Have you been able to quantify the benefit
Trace has brought to your organization?
1 2 3 4
23%
20%
33%
23%
1. Yes, through increased
productivity.
2. Yes, through increased
revenue.
3. Yes, but don’t have the
metrics to show it.
4. No, haven’t been able to
quantify the benefit.

Workshop 4
Jeanette McDowell R.N.C./MSN
Manager of Central Intake and Assessment
Phoebe Putney Memorial Hospital
Albany, GA

What is your interest in using Trace in your
Transfer Center?
1 2 3 4
18%
11%
39%
32%
1. Very interested! It’s a big
problem for us.
2. It sounds great, but it’s
not my area.
3. We don’t have a Transfer
Center.
4. I’d like to share this with
a colleague, but I don’t
think I can say “Phoebe
Putney” without giggling.

What movie/TV show best describes your
evening last night?
1 2 3 4 5
9%
41%
38%
3%
9%
1. The Hangover
2. Good Times
3. Lost
4. Alien
5. Home Alone

Chance to Win $50 Right Now!
Like Us
Facebook.com/TracebyTWSG
or
Use #tracedays in a Tweet
Twitter.com/TracebyTWSG

Workshop 6
Making the Most of Trace
Lori Forbess, Vice President of Enterprise Accounts
Jo Norris, Vice President of Account Management
Nicole Shanklin, Director of Implementation & Training

Is Trace underutilized in your facility?
1 2 3 4
0%
27%
42%
30%
1. I think it’s used to its
maximum potential.
2. There are a few other
areas in which I’d like to
see it used.
3. There are many other
areas in which it should
be used.
4. Don’t get me started!

Optimization
The act, process, or methodology
of making something (as a
design, system, or decision) as fully
functional or effective as possible.

Enterprise Tools – Usage Matrix

Trace Administrator
• Leadership
• Planning
• Configuration
• Preparation
• Compliance
• Follow up

Trace Assessment Purpose
1. Identify current work flow issues
2. Make recommendations for optimizing use of Trace
3. Identify ongoing training and implementation needs
4. Identify opportunities to streamline efficiencies
5. Build and maintain a positive customer relationship

General Workflow Overview
1. What is your department responsible for?
2. How is your work divided?
3. How many physical sites does your department have?
4. What is your biggest source of pain in your workflow?
5. What do you like most in your workflow?
6. How do you communicate internally?
7. How do you document authorization information?
8. What EMR system is in place?

Department Assessment
PATIENT ACCESS / PFS / SCHEDULING:
1. Who handles benefits and eligibility processing?
2. How do you document information from insurance
company websites?
3. Does your department schedule appointments?
4. How does your department receive physician orders?
5. How do you register patients?
6. Do you do upfront collections?
7. Who handles denials?
8. What is your denial rate?

Assessment Summary
• DEPARTMENT: CASE MANAGEMENT – WHITE STONE HOSPITAL
• Contacts:
• Department Contact:
• Trace Administrator:
• Account Manager: Jo Norris
• Reason for request:
• Currently uses Trace – wants to optimize Trace with consistent process and workflow
 Improve consistent usage and workflow
 Determine how to optimally print labels from exported Indexed info
 Assess need for F to F recording and Voice Recording
•
• Recommended Solution:
• Training for employees w/shortcuts (done)
• Label workflow reviewed, recommendations made & implemented (Search Tracker, Export List to csv instead of xls and manipulate
data as desired before merging with label function in MS)
• All Call Solution when White Stone Hospital adopts it as a whole (approximately 10 users)
• Considers Trace implementation for Outbound faxing if / when applicable
• For Rx’s – evaluate Trace Export feature to Prescription system
•
• Costs: $0 Maintenance:$0
• No additional fax volume – already in use. All Call – 10 Seats (when proposal actually done, revisit number of seats in case there has been a
change)
• Metrics:
• Time Savings: Improve Inbound fax processing; Export names to excel for labels
• Save Money: Paper, Time Value associated with time savings
• Increased Efficiency: Consistent workflow process, Increase automation
• Compliance: Audit trails of transactions and workflow, Labels on all documents

Enterprise Tools – Strategic Plan

Roadmap
Q2 2012 Q3 2012 Q4 2012
Discovery
 Test/Training
environment
 Redundancy/Disaster
Recovery
 Prioritize additional
facilities
Implementation
 TBD – some
departments based on
prioritized list
Discovery
 Gap Analysis
Implementation
 Training Environment
 Redundancy/ Disaster
Recovery
Discovery
 Awaiting on
prioritized list of
departments
Implementation
 Outpatient Pharmacy
 HIM
 TBD – some
departments based on
prioritized list

Project Charter
• Purpose
– Identify Key Stakeholders
– Outline Requirements
– Authorize Resources
• Contents
– Strategic Objectives
– Keys to Success
– Risk Factors
– Partnership Team Acknowledgment

Project Management Plan
• Scope Management Plan
o Project charter
• Time Management Plan
o Implementation Schedule
o Project Plan
• Communications Plan
o Stakeholder Register
o Communication methods & frequency
• Risk Management Plan
o Change control process
o Risk Register

Stakeholder Register
Name Primary Role/Designation Title Influence Communications/Strategy wkly call notes risk register updates monthly dashboard
ex. Vicki Moore Project Sponsor
VP of
Operations
Strategy /
Prioritization/Resource
Approval
Regular briefing, solutions,
progress dashboard / Meeting
reports , emails N Y Y
Considerations:
• Peer-to-Peer (Trace to Enterprise) mapping for each stakeholder
• Re-occurring optimization team status meetings

Risk Register
Risk # Date Requestor
Risk
Description
Overall
Impact
(H-M-L)
Probabilit
y (%)
Schedule
Impact
(H-M-L)
Mitigation Risk Owner Notes
1 7/23/2012
TWSG
Hospital
Current enterprise
HIS implementation
is delayed. Technical
team resources must
complete HIS project
prior to engagement
with Trace
Optimization
M 70%H
Team anticipates 3 week delay
if impact is realized. Hospital
and Trace will begin non-
technical / implementation
steps: workflow assessments,
needs analysis, etc. while
project waits for technical
resources to be released.
Hospital PM Lead / IT Director
Team will reconvene weekly to assess probability of impact and will adjust
mitigation steps if necessary.

Workshop 7
H. A. & Enterprise Support
Tim Hoskins, Director of Enterprise Architecture

What Is H.A. And Why Do I Want It?
• Load / Capacity
• Availability &
Resiliency
• Continuity

What does your day look like if you have
downtime with Trace?
1 2 3
66%
19%
16%
1. Running around with
my hair on fire.
2. I hear about it, but it
doesn’t impact me.
3. Business as usual.

Do you use Trace in patient contact or clinical
settings?
1 2 3 4
28%
22%
34%
16%
1. Patient Contact (e.g.
Registration, Financial
Counseling, etc.)
2. Clinical Setting (e.g.
Physician Orders, Patient
Discharge/Follow-
up, etc.)
3. Both
4. Neither

How Trace Looks Today
“I’m the
Database!”
“I’m the
Trace
Storage
System”
“I’m the
FaxCert
Server”
“I’m the
Tracker Web
Server”
“I’m the PixCert
Server”
“I’m the
Trace Auto-
Record
Server”
“I’m the
Trace Voice
Anywhere
Server”
“I’m
also the
....”

How Trace Enterprise Solutions Look
“I’m the
FaxCert
Server”
“I’m the
FaxCert
Server”
“I’m the
Database
Server”
“I’m the
Storage
Server“I’m the Web
Services Virtual
Machine” “Uh Oh – I just
010011’d
myself, someb
ody get me a
towel!”
“I’m
good!”

The Trace Enterprise Solution
• Capacity gain with multiple Trace servers
• The ability to scale as Trace grows
• Minimize and potentially eliminate
unscheduled downtime for all Trace
applications
• Maximize performance by utilizing existing
technology investments
• Enable future cloud based redundancy options

Workshop 7
Support Services
Ben O’Brien, Director of Support Services

Support Services:
How Can We Help You?

Who Is Support Services
Trace Support Services is comprised of
Account Specialists, Product Specialists
and Technical Specialists with
expertise in all Trace products and
knowledge of your specific
environment and needs.

Our Goal
To be the very best support organization in the
healthcare software industry.
• High value on genuine relationships with our
customers.
• High value on responsiveness.
• High value on ROI – ensuring our products bring
real value to your organization.
• High value on trustworthiness – we want to be a
company that you can trust to do the right thing.

Contacting Customer Support
8 AM-8 PM EDT
(Mon-Fri)
Available 24x7x365
Phone:
877-864-2378
Email:
Support@twsg.com
TellUs!
(Right from trace)

Support Process
Account Specialist Product Specialist
Technical Specialist
Implementation and
Support Engineering
You
Account Specialist – Your first contact for any issues
Product Specialist – Cross functional team to manage your needs
Technical Specialist – Your technical server team
Implementation and Support Engineering – Dedicated to setup, security and code
support

2012
• We closed over 19,000 Cases,
80% of which were closed in less than 1 hour.
• The average wait time for a Trace support
agent was 40 seconds or less.
• Created several new roles for our support
team to better serve your needs.

2013
• Close 90% of cases in less than 1 hour
• Continuous improvement of server monitoring
• Cut down average queue wait time
• Continue to put together focused teams of
dedicated people to raise the bar on our level
of support
• Provide you with more self service options

Today’s Customer Portal
• Download help documents
• Request training
• Submit a support case
• Submit new users

A Note About Self Service
Our goal is to provide you as many opportunities
as possible to get the information, access and
support that you need, as efficiently as possible
in order to make trace successful in your
organization.

Self Service
What features would you like to see in 2013?

Would you like the ability to manage your
cases online?
1. Interested
2. Not Interested

Would You Like the Ability to Have Remote
Support from Tracker?
1. Interested
2. Not Interested

Would You Like to Be Able to Chat With Trace
Support?
1. Interested
2. Not Interested

How Interested Are You in “Ideas”?
1. Interested
2. Not Interested

How Interested Are You in Improvements
to User Submission?
1. Interested
2. Not Interested

Thank You!
I want to hear your ideas
on how we can continue
to improve your support
experience. Email me at
ben.obrien@twsg.com
with thoughts or ideas.
THANK YOU!

Final Wrap-Up
• Surveys
• Boxed Lunches
• Rides to Airport
• Rides to Corporate Office
• Room Key is Parking Pass

Trace Days 2013 | Knoxville, TN

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