Presentation at the Revenue Cycle management Conference, World Congress presentation

2. 7 th Annual The Revenue Cycle Management Summit Panel Discussion How to Prepare Providers, Hospitals and Health Systems for Bundling Payments and Pay-For- Performance Contracting

4. We have an app for that….

5. Insurance Premium Breakdown Administrative Fee Profit Medical Costs

11. A real balancing act

15. Data elements consistent in hospital’s information silos which run in different software environments Materials Management Patient Demographics Medical Record Number Third Party Payor Location of Service ICD-9/CPT-4/DRG Provider Information Lawson Data Elements

16. Data Engine DATANEX (powered by proprietary pattern recognition software) ADT, 837, 835, Billing, Collection Charge Master Information Pharmacy Financial & Utilization Information In/Out Patient Clinical Utilization Physician Information, ICD9, CPT etc . Self Building Longitudinal Patient & Physician information Key Information Dash Board & “ Alert” engines Rules, Laws, Regulations, Comparison data Materials Management (medical devises) Sentry Data Systems Current Structure

17. Adopting and accepting new process “ Doing more with less”

21. Examples of critical Information generated by revenue cycle BI applications 1 . Hospital Charge master codes Links charge master to revenue codes Provides a tracking system that alerts missing charge master to revenue codes Example: A service with no charge and consequently not linked to revenue code. 2 . Link Revenue Code to a Claim Assures that all the revenue codes are link to a claim No volume or time limitation for alert system 3. Explanation of Payment (EOP): Links 837 claim to reimbursement form 835 No volume or time limitation for alert system 4 . Provides a way to analysis the service preformed Eg. CPT, HCPC, J Code Links patient and physician and location of service to the ICD-9 codes , Charge master and revenue codes associated with hospital’s intervention Clinical aspect: Performed service, captured the service, billed for service, reimbursed for service, link to physician that performed service, link to patient that received the service and the diagnostic codes. All of the key components are reflected in both physician and patient databases

22. 5 . Provides linkage of diagnostic codes with patient event The system captures both the primary and all secondary diagnosis codes (ICD-9) which will allow institutes to better bill secondary insures 6 . Recognition of utilization patterns: Links specific revenue codes/charges/procedures to a specific third party payor (BCBS plan 123, with employer group 8910) 7. Are we flagging (alerting) change in patient clinical severity eg. Transfer from Med/Surg bed to an ICU bed. eg. How does system recognize death events. 8. Recognition of utilization patterns: Must link specific revenue codes/charges/procedures to a specific third party payor (BCBS plan 123, with employer group 8910) 9. Utilization What are the mechanisms established to link utilization of services other than pharmacy to location, physician, patient, and third party payor?

29. “ Bundling Payments link to performance measures ” promotes linkage of divergent data sets to manipulate and re-compile information into transaction sets that, if applied, will have financial and clinical impact

31. Thinking about “bundled payments linked to performance measures”… requires thinking out of the box