No money. No mission.
--Sister Angela Claire Moran
Our CS&E journey:
•Initial CS&E project: Reduce inappropriate (by ACR criteria) CT and MR imaging studies at the MARC by 10% within three months--Delayed by software interface and acquisition issues.
•Second CS&E project: Reduce turnaround time of MRI reports @ UHS--Derailed by personnel issues
Genesis & Overview
Financial instability of the radiology department
29 FTE radiologists performing the work of 39 FTE
Radiologist compensation well below the academic meanand far below community standards
Substantial opportunities for improved departmental (and SOM) cash flow without increasing the clinical workload
Other clinical departments employing same EPIC billing processes/ASB teams would benefit
Spirit of cooperation (and aligned financial incentives) with UHS partner
Strong support from both UT and UHS administrations
Parallel & Interacting RC PATs:
UTHSCSA SOM (ASB)
UHS
Established & led by Lowell Glassburn, Administrator, Department of Radiology
Team Members:• Marti Pons – Chief Revenue Officer• Roger Valdez – Manager, Department Relations, Provider
Enrollment and Insurance Follow-up• Susan Hilgers – Director of Information Systems• Andrew Krecek – Sr. Director, Information Technology Services• Pam Glasscock – Sr. Director, Clinic Business Operations• Santiago Delgado – Team Leader, Follow-up• Noel Duano – Sr. Medical Record Coder• Lowell Glassburn – Administrator, Radiology• Adam Ratner – Deputy Chair Radiology
Increase revenue for all departments
of the SOM Clinical Practice by a
minimum of 2% by December 31st, 2010.
Aim Statement
$21,127,977
$18,353,313$14,806,746
$11,494,047$8,644,570 $7,515,689
$3,440,021 $3,409,497 $2,993,224
$9,947,196
20.8%
38.8%
53.4%
64.7%
73.2%
80.5%83.9%
87.3%90.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
$0
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000R
ev
en
ue
lo
st i
n $
Categories
Pareto Chart showing categories for Denial
Total Chargeslost due to
denials:$101,732,282
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
Practice
Radiology
Comparison of Denials between UTHSCSA SOM Clinical Practice vs. Radiology
$53,668,248
$10,021,057 $9,224,380 $6,224,316 $3,417,831 $2,960,869 $1,676,875
58.7%
69.6%
79.7%
86.5%90.2%
93.5%95.3% 96.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
$0
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
$300,000,000
$350,000,000
$400,000,000
$450,000,000
Se
p 0
9 -
Ap
r 10
Revenue lost
Pareto chart showing Write-off categories
ControllableWrite-offs = $91,502,142
$0
$10,000,000
$20,000,000
$30,000,000
$40,000,000
$50,000,000
$60,000,000
practice
radiology
Comparison of Controllable Write-offs between Practice and Radiology
Initial Intervention - Timely Filing
• Low hanging fruit
• CareLink
• 42% Radiology
• 21 % Practice
• Not receiving notification of status change
• Automated File Available
• Implemented end of April 2010
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
•Radiology•42%
Practice21%
CareLink Denial Impact
$0.00
$200,000.00
$400,000.00
$600,000.00
$800,000.00
$1,000,000.00
$1,200,000.00
$1,400,000.00
•Practice Denial Charges•Monthly Average
$574,702
CareLink Denial ChargesMonthly Average
$123,042
Monthly Denial Charges
$0.00
$20,000.00
$40,000.00
$60,000.00
$80,000.00
$100,000.00
$120,000.00
$140,000.00
$160,000.00
$180,000.00
Monthly Denial Charges
•Radiology Denial Charges•Monthly Average
$74,335
CareLink Denial ChargesMonthly Average
$31,442
Projected Return on InvestmentTimely Filing
CareLink Only Intervention Data
• 20-Month, Monthly Average Collection on Charges = 20%
• Practice $123,042: 20% = $24,608
• Radiology $31,442: 20% = $ 6,288
• Estimated collection for no other denial categories = 80%
• Practice $24,608 : 80% = $19,686 monthly
• Radiology $6,288 : 80% = $ 5,030 monthly
• Can’t Stop There:
Moving ForwardRevenue Cycle Enhancement
Should Never Stop!
• UHS Revenue Cycle Enhancement
• Already in Place
• Interventions
• Timely Filing
• Pre-Authorizations
• Medical Necessity
• Many other areas to improve
• Communication
• Missing Required Info
• Provider Enrollment
• Credentialing
• Medicare
Questions?
No Money!
No Mission!