rca showcase and performance analytics - crowe

Nurture Your NetworkUpskill. Connect. Grow.

Crowe Healthcare Summit 2019

Presented by:

Smart decisions. Lasting value.™

September 18

Brad HeatonAlex Garrison

RCA Showcase and Performance Analytics

© 2019 Crowe LLP 2

Simplify your busy workday. Register today to continue the

Healthcare Summit conversations: crowehive.com.

Being successful in your role today looks different than it

did even a few years ago. Engage with a network of

those who have been there before you:

• Ask and answer community questions

• Seek validation and gain support through crowdsourcing

• Connect with peers and Crowe specialists

• Earn rewards for your engagement and shop the Hive store

Introducing Healthcare’s Trusted Community:

The Crowe Hive Network

http://crowehive.com/

© 2019 Crowe LLP 3

• History of RCA

• Where are we going?

• Performance Analytics

Agenda

© 2019 Crowe LLP 4

Your presenters

Jay Sutton

Principal

Brad Heaton

Senior Manager

Alex Garrison

Senior Manager

© 2019 Crowe LLP 5

History of RCA

© 2019 Crowe LLP 6

Crowe® RCA Client Installations 2005

Hindsight Analysis

© 2019 Crowe LLP 7

Crowe® RCA Client Installations 2006 - 2008

RCA 2.0

MRA Module

Revenue Cycle Monitor

© 2019 Crowe LLP 8


Variance Analysis Module

© 2019 Crowe LLP 9


350 Hospitals

RCA Budget Module

Automated Close Module

© 2019 Crowe LLP 10


500+ Hospitals

Hindsight Trending Template

New reports & enhancements



750+ Hospitals

RCA Ad-Hoc

VA Themes Reporting

Crowe Benchmarking

GL Mapping & Reporting



RCA “Hosting”

New User Interface

RCA SOC1

850+ Hospitals



900+ Hospitals

RCA Charge Detail File



1000+ Hospitals

Automated upgrades

Physicians module

Recoveries logic update


Where are we going?


Summary Product RoadmapQuality, Scalability, and Client Experience

RCA 2019• New upgrade process • Bug fixes • Performance improvements• End to end code review

Net Revenue• Simplifying the net revenue reporting process • Automating daily maintenance • New net revenue reporting • Sensitivity analysis

Feature Sets• Updated VA themes • Stats \ volume & charge level reporting • Service line reporting

Monitoring• Alerts and Subscriptions• System Health • Dashboards• Nightly Job Validation

Artificial Intelligence• Predictive Analytics• Machine learning • Bad debt, charity, and denial • Net revenue analysis

Modules• Budget Module• Physician Enhancements• Projections


How can you help?

• Pass your ideas along to your RCA point of contact

• Email [email protected]

mailto:[email protected]


Performance Analytics


Crowe Performance Analytics Infrastructure

PERFORMANCE

ANALYTICS

PAS Feeds

Cloud-Based

Reporting

Raw 835/837

Files

RCA

Revenue

Cycle

Platform

Client-based Applications

& Reporting Tools


• Quantify Opportunity

• Identify Root Cause

• Prioritize Improvement Efforts

BENEFITS

Attending physician,

diagnosis and

procedure data

PAS

Denials and patient

responsibility data

835

Financial realization, time

to payment/resolution,

service location

837

Link data at the account level

Utilize Available Data to Create Insightful KPIs and Analytics


Performance Analytics Program Summary

Executive-level revenue cycle dashboard ranking facilities

based on an 11 metric score

Director & Manager-level KPI monitoring tool leveraging

40+ KPIs by facility, IP/OP, & Financial Class

Holistic denials reporting on initial & subsequent claims tied

to the PAS. In addition, KPI dashboards at the I-plan level

allow for increased payor-specific data discovery

KPI Module

Denials & Payor

Scorecard Modules

Ad Hoc Dashboarding Support

Index Score

Module

Utilizing Crowe’s analytics resources clients can configure

report views to suit their particular organizational needs

KPI Module Revenue Cycle Index

Score Module

Payor Scorecard

Module

Denials

Reporting

Module

Ad Hoc

Dashboarding

Support

1 2 3 4 5


Volumes• IP Net Revenue Per Case

• OP Net Revenue Per Case

• IP Admissions (Volume)

• OP Visit (Volume)

• Medicare Net Revenue per IP Day

Accounts Receivable• Cash/60 Day Lagged Net Revenue

• Six Months Cash Lag to Net Revenue

• TRUE AR days

• Net AR Days

• TRUE AR > 90 Days

• % AR > 90 Days Medicare

• % AR > 90 Days Medicaid

• % AR > 90 Days Commercial

• % AR > 90 Days Self-Pay

• % AR > 90 Days Other

• Late Charge % of GPSR

• Credit Days

• Credit Liability % of Credit AR

HIM• DNFB Days

VOLUMES Payment Compliance• Time to Insurance Payment - Overall

• Time to Insurance Payment - Medicare & Managed Medicare

• Time to Insurance Payment - Commercial Managed Care

• Time to Insurance Payment - Medicaid & Managed Medicaid

• Time to Insurance Payment - Other

• Time to Insurance Payment Gap - Denied vs. Non-Denied

• Insurance Payment Gap - Denied vs. Non-Denied

• Final Denial Write-Offs

• Final Denial & Administrative Adjustments

• Initial Denial Rate

• Initial Denial Rate - Medicare & Managed Medicare

• Initial Denial Rate - Commercial Managed Care

• Initial Denial Rate - Medicaid & Managed Medicaid

• Initial Denial Rate - Other Payor

• Initial Denial Rate - Auth/Precert

• Initial Denial Rate - Billing/Claim Issue

• Initial Denial Rate - Coordination of Benefits

• Initial Denial Rate - Coverage/Eligibility

• Initial Denial Rate - Duplicate

• Initial Denial Rate - Medical Necessity

• Initial Denial Rate - Non-Covered Services

• Initial Denial Rate - Request for Information

• Initial Denial Rate - Timely Filing

• Initial Denial Rate - Other

Registration• Patient Responsibility % of GPSR

• Patient Collection Rate – Managed

Care/Commercial

• Patient Responsibility – Managed

Care/Commercial (% of allowed amount)

• POS Cash Collections % of Patient Cash

• Inpatient Self-Pay Conversion Rate

Uncompensated Care• Uncompensated Care % of GPSR

• Bad Debt % of GPSR

• Charity % of GPSR

• Charity % of Uncompensated Care

• Self-Pay After Insurance Bad Debt % of

Total Bad Debt

• Self-Pay After Insurance Uncompensated

Care % of Total Uncompensated Care

Crowe Performance Analytics Metrics List

ACCOUNT RECEIVABLES

HIM

PAYMENT COMPLIANCE REGISTRATION

UNCOMPENSATED CARE

© 2019 Crowe LLP 23© 2019 Crowe LLP

Bed Size Groups

BENCHMARKING PEER

GROUPS

Urban vs. Rural

Medicare Payor Mix

Acute vs. CAH

Net Revenue Per Day

Medicaid Expansion

Net Revenue Per Day


Crowe Index Module

Identify site

performance

disparity,

favorable, and

unfavorable

trends

Track index

performance

over time for

the system and

individual

facilities


Crowe Index Module (continued)

See key metrics driving index score and

associate with current performance


Crowe Index Module (continued)

DEFINITION:

• Numerator: Total accounts receivable at current

account balance (excluding credits), includes

account balance plus contractual allowance if

insurance payment has not posted.

• Denominator: Average daily GPSR from

previous 3 months

True AR Days

Ma

rch

20

16

120

110

100

90

80

70

60

50

40

30

20

Ju

ne

20

16

Se

pte

mb

er

20

16

De

ce

mb

er

20

16

Ma

rch

20

17

Ju

ne

20

17

Se

pte

mb

er

20

17

Identify performance band improvement

thresholds and trace KPI performance

over time


KPI Module

Track metric

comparisons to

user-

determined

peer group

Compare

performance

by key payor

groups to

benchmarks

User flexibility

for peer group

determination

from a variety

of factors


Payor Scorecard Module

Custom payor

grouping

features allow

for i-plan

groupings to

payor and

product

defined fields

for analysis

KPI tracking at

the i-plan level

Comprehensive

metric tracking

for all supported

metrics


Denials Module

Track detailed

remittance

information by

denial category

and compare

to national

benchmarks

Identify trends by a

variety of fields

including but not

limited to: ANSI

code, Remark Code

service type, DRG,

CPT, and more


Simplify your busy workday. Register today to continue the

Healthcare Summit conversations: crowehive.com.

Being successful in your role today looks different than it

did even a few years ago. Engage with a network of

those who have been there before you:

• Ask and answer community questions

• Seek validation and gain support through crowdsourcing

• Connect with peers and Crowe specialists

• Earn rewards for your engagement and shop the Hive store

Introducing Healthcare’s Trusted Community:

The Crowe Hive Network

http://crowehive.com/


Thank you

The information in this document is not – and is not intended to be – audit, tax, accounting, advisory, risk, performance, consulting, business, financial, investment, legal, or other professional advice. Some firm services may not be available to attest clients. The information

is general in nature, based on existing authorities, and is subject to change. The information is not a substitute for professional advice or services, and you should consult a qualified professional adviser before taking any action based on the information. Crowe is not

responsible for any loss incurred by any person who relies on the information discussed in this document. Visit www.crowe.com/disclosure for more information about Crowe LLP, its subsidiaries, and Crowe Global. © 2019 Crowe LLP.

http://www.crowe.com/disclosure

rca showcase and performance analytics - crowe

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