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!