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Anthelio Healthcare Solutions Inc.Looking At Your Revenue Cycle Through Another Lense15 Years of Innovation and Service Excellence

Objectives1.Discuss Revenue Cycle Optimization and how it aligns with integrated Revenue Cycle functions2.Define the KPI’s for Patient Access and Patient Financial Services3.Learn a process that will help identify waste and opportunities for improvement through the use of analytics4.Utilize best practices to streamline processes and increase revenue and patient satisfaction5.Apply analytic reports with case studies to identify issues within the entire Revenue Cycle continuum6.Determine next steps as a result of the case study findings 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv2

Outline Understanding each level of the Revenue Cycle and the role it plays is important to physician financial viability. If the wrongprocess is in place at any given step or if an individual is in the wrong role it will impact revenue. Critical activities to financialmanagement include knowing what reports to monitor, how to drill down to identify the issue and the steps to take to correctthe process. Why is this important to your practice? Ongoing reduction in reimbursement for drug, services, diagnostic imaging, with an increase in prior authorizations / referralsIncreasing number of underinsured and uninsured patients resulting in a significant increase in bad debtOngoing regulatory changes at local, state and national levels are difficult to interpret and implement in daily processesInability to effectively identify and monitor claim submission errors increases risk of improper or no paymentPayers moving to a value based / episodic care reimbursement model Knowing the risks a practice may face and how to identify them through analytics and reports will ensure your physician(s)can concentrate on providing quality medical care while you focus on providing quality financial care to the patient.Interpreting the reports are just half the equation, realizing the proper steps to put in place to minimize risk, decrease denialsand/or delayed reimbursement and capture collections is the rest of the story. 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv3

Presentation Content This presentation is divided into three key topics. First - Integrated Revenue Cycle functions defined into three areas - Patient Access Services, ChargeIntegrity and Patient Financial Services. How they interact with each other and impact the revenue cyclecontinuum from the time the patient walks through the door until the claim is paid. Second - Reviewing the benchmarks that correspond to PAS, Charge Integrity and PFS helps theparticipant understand how the analytics can help pinpoint a problem. Introduction of "Best Practices"will allow the participant to develop an action plan based on what they see - not just what they hear. Third - Case Studies with analytics for hands-on review to include developing a plan of action tochange a process and implement "Best Practices" in the areas identified by the reports. 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv4

Audience Benefits To often I hear "the Revenue Cycle is broken" without an explanation as to why. Throughthis session the participant will learn how to identify the why through analytics andreports. As a participant you will be able to apply the take aways at your practice and help othersunderstand how they are a part of the integrated Revenue Cycle functions. Have ahands-on approach to case studies and how to distinguish where the issues are at byreviewing the analytics that accompany them.You will also learn how to identify nextsteps and design a plan to change the process and implement "Best Practices' asoutlined in the discussion. Most importantly - by the end of the session the participant will understand how theycan ensure patients at their practice receive quality financial care from the time they walkthrough the door until their claim is paid. While the providers know they can focus ondelivering quality medical care without worrying about their practice financial viability. 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv5

Revenue Cycle – Another View 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv6

Effective Financial Management Understanding each level of the Revenue Cycle and the role it plays Financial Management includes patient satisfaction, without it your practice is in trouble If the wrong process is in place at any given step it will impact the financialsIf the wrong individuals are in the wrong role it will impact the financialsPatient surveysReferring physician surveysRealizing service drives the data you read Patient financial carePayer relationshipsReferring physiciansHospital relationshipsDays to collect 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv7

Integrated Revenue Cycle Functions Scheduling Pre-Registration Insurance Verification Pre-Authorization/PreCertification Registration Financial Counseling/POSCollectionsPASChargeIntegrity Clinical Documentation Charge Capture Medical Coding Charge Entry Billing EDI Reporting Third Party Follow-Up Payment Posting Denial Management A/R Follow-up Reporting AnalyticsPFS

Most Common Indicators of Value to Monitor Standard Report Aging Report Should consist of total charges, dollar amount submitted forpayment, amounts paid/adjusted/written off with a breakdown byphysician, specialty, location, CPT, HCPCS code, and payerShould consist of accounts receivables at 30, 60, 90, and 120days and beyond, variance report to identify difference betweencontract pricing and what was actually paidOverhead Cost Review on a quarterly basis – don’t reduce headcount beforeassessing your metrics 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv9

Revenue Cycle Performance Measures Patient Access Metrics Metric: % of patients with complete and accurate preregistration informationFormula: Complete pre-registration / total registrationMetric: % of patients with complete and accurateinsurance verificationsFormula: Total number verified accounts / totalregistrationMetric: % of patients with complete and accurate priorauthorizationsFormula: Total number completed authorizations / totalnumber requiring authorizationsCompliance with Physician Authorization Requirement Benchmark: 96-98% compliance 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv10

Best Practices Ensure PMS is set up correctly and maximize the practicemanagement features Train staff for the manual processes, automate as much aspossible Accurate demographics, insurance verification, claim scrubbing,coding and charge captureEligibility verification, appointment scheduling, claims scrubbing,integrate your EMR and PMS to minimize charge entry lag daysIncrease self-pay accounts receivable with written policies onpatient financial responsibility Time of service collections, communicate expectations, paymentoptions 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv11

Billing Metrics Charge Lag Time Clean Claims Submitted Formula: Average number of days from date of service to posting dateBenchmark: 7 daysFormula: % clean claims/total # claimsBenchmark: 95%Appeal Success Rate # of appealed claims paid / # of claims appealed and finalized/closed Benchmark: 95%Initial Zero-Pay Denial Rate Formula: Total Zero-Paid Claims Denied / Total Number Claims Remitted 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv12

Best Practices Prepare your metrics to measure your success within critical areasof the revenue cycle Monitor your aging accounts and A/R days Develop your KPI’s, trend performance and have an action plan whennegative trends appearPrioritize outstanding accounts by balance due, payer and age, crosstrain staff to ensure performance targets and complianceKnow your data and make decisions to improve key areas in therevenue cycle Monitor your denied claims – know who is denying and why,percentage of denied claims, days in A/R and aged accounts 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv13

Accounts Receivable/Collection Posting of Cash & Contractual Allowance Average Payment Period Formula: Current liabilities (total expenses – depreciation) / 365Average Collection Period or Days in Patients Accounts Receivable Benchmark: 24 hoursFormula: Net patient account receivable or Net patient service revenue / 365Benchmark: Median 47.1 daysAccounts Receivables Formula: 90 daysBenchmark: Median 22.3% 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv14

Cash Management Metrics Point of Service (POS) Collections Gross Collection Ratio Formula: Cash received from payers and customers / Gross chargesMonth’s Revenue in Accounts Receivable Formula: POS Collections / Expected POS CollectionsFormula: Accounts receivable / Average monthly gross revenuesNet Collection Ratio Formula: Cash received from payers and customers / Net fees 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv15

Best Practices Timely payment posting to ensure accurate accounts – must be posteddaily Identify coding concerns, monitor medical policy updates,documentation issues and update appropriate individuals Payments, discounts, denials, recoups, patient responsibility must becompleted on a daily basis with follow-up of all unpaid/denied claimsAudit documentation and conduct coding auditsCreate standards for coding and charge entry, understand your lag timebetween when the service was provided to when it was billed Typical standards are 24-48 hours for office services, 72-120 hours forinpatient procedures (if pathology is required), monitor missing chargeticket report 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv16

Expense Metrics Cost to Collect Bad Debt Expense Formula: Total cost of all business related functions / Total collectionsFormula: as % of gross or net revenueBenchmark: 5%Overhead % Formula: Total non-physician expenses as % of total Total non-physicianexpense / Cash collections or net revenueKnow your pain points – have strategies in place to addressunderpaid/zero paid claims, put policies and procedures in place, knowwhen to appeal, know when to write-off 2015 Anthelio Healthcare Solutions Inc.; Proprietary and Confidential. All Rights Reserved.vv17