Best of the 2022 Crowe Healthcare Summit

The first Healthcare Summit breakout session featured a new topic: how to use existing and customized reports in Crowe RCA to analyze the connection between cash and net revenue. During the breakout, presenters Brett Butts and Abby Susko of Crowe shared three tips for building custom themes, or topics, that assist in that analysis. Examples of custom themes include large-balance accounts, interim bill accounts, and time-of-bill contractual issues. First, establish a hierarchy so that each account is assigned to one theme. Second, pick and prioritize scenarios custom to the hospital or health system. And third, create a catchall theme that represents accounts that don’t fall into a standard or custom theme.

Watch a rebroadcast of this breakout session

A number to remember

4

The number of reports in Crowe RCA available for cash to net revenue analysis.

Source: Crowe

Insight 

“Breaking down payment activity into different themes can help identify shortfalls in the reserve model or incorrect reimbursement from payors.”

– Brett Butts, Healthcare Consulting, Crowe

A perennial attendee favorite at Healthcare Summit is this breakout session updating attendees on Medicare and Medicaid reimbursement statutory and regulatory changes for the fiscal year. Changes for FY23, which started Oct. 1, can dramatically affect how much Medicare and Medicaid pay hospitals and health systems for patient care. The trio of Amy Duncan, president of Collaborative Data; Nick West of Crowe; and Liz Elias, attorney and shareholder at Hall Render, walked in-person and virtual attendees through the new laws, regulations, and compliance challenges in the areas of Medicare bad debt payments, key provisions in the final Medicare inpatient prospective payment system rules for FY23, updates to the 340B Drug Discount Program, Medicare and Medicaid audit activities, and much more.

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A number to remember

10

Number of additional new technology add-on payments (NTAPs) available for Medicare payments to healthcare providers for inpatient care for FY23, raising the total of Medicare NTAPs to 25

Source: Crowe, Centers for Medicare & Medicaid Services (CMS)

Insight

“As this [NTAPs] ramps up, and more things become eligible for payment, that’s another thing you just have to make sure you’re keeping an eye on – making sure you’re availing yourself of the opportunities where they exist and making sure all your documentation with respect to claiming those NTAPs is in line in case that comes up in some kind of audit.”

– Liz Elias, Attorney, Hall Render

Adrianne (Maxie) Friemel, senior director for pharmacy revenue cycle services at Visante, and Joe Cesarz, vice president of hospital and health system services at Visante, led this sponsored breakout session on how hospitals and health systems can reimagine and reposition their pharmacy operations as strategic assets to their entire enterprise rather than cost centers that gobble up revenue and drag down financial performance. Transformational pharmacy change, not incremental ancillary department change, is the key to success. The presenters urged hospitals and health systems to realize their pharmacy’s full value in three critical areas: revenue enhancement, nonlabor cost savings, and business integrity. They recommended that in revenue enhancement, providers should focus on revenue cycle improvement, specialty pharmacy growth, and site of care and infusion strategies.

This live, sponsored session was not recorded. A rebroadcast is not available. To learn more, contact Visante.

A number to remember

24-48 hours

The elapsed time from the receipt of a prescription to the delivery of the medication at a large academic medical center specialty pharmacy compared with two to 12 days at a leading mail-order specialty pharmacy

Source: Visante case study

Insight

“Hospitals and health systems should consider embedding a pharmacist or pharmacy technician in their revenue cycle departments to support the departments’ drug-related function.”

– Maxie Friemel, Senior Director for Pharmacy Revenue Cycle Services, Visante

What’s next for Crowe RCA Next? This breakout session provided attendees with a detailed timeline for the rollout of Crowe RCA Next, the cloud-based platform version of the on-premises software version of Crowe RCA. Bryan Rector, Andrew Obaseki, and Derek Ellis of Crowe shared their thoughts and experiences with the launch of the next generation of Crowe RCA a year away. The go-live is tentatively set for September 2023. The scheduled launch doesn’t mean the group is done soliciting feedback from users on how to make Crowe RCA Next the best it can be. The trio said they are actively seeking feedback from users until launch and beyond.

Give us your feedback on Crowe RCA Next.

Get the feedback form.

A number to remember

4

The number of things current Crowe RCA users can do to prepare for Crowe RCA Next. Those are:

1. Have a road map discussion with Crowe contact.
2. Research Rackspace Technology™ migration.
3. Compile Crowe RCA Next data specs.
4. Complete Crowe software as a service agreement.

Source: Crowe

Insight

“We really love the opportunity to get in front of our clients and really show what we’ve been working on. But the feedback is what we get the most out of, especially with our products – being able to solicit feedback. We really want to make sure that we’re getting it right.”

– Bryan Rector, Partner, Healthcare Consulting, Crowe

The title of this breakout session begs the question, “That would be great, but how?” The answer: Crowe Financial Control Analytics, a new financial statement data solution from Crowe. Eric Jolly and Brad Heaton of Crowe walked attendees through the features of Crowe Financial Control Analytics that collectively add up to more accurate, faster, and more compliant internal and external financial statements and reports designed for both internal and external stakeholders. The cloud-based platform system automates data collection, surveillance, and analysis in five areas that can be prone to data and reporting errors: trial balance, general ledger, accounts payable, payroll, and supply chain.

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A number to remember

5

The number of high-impact areas that Crowe Financial Control Analytics can monitor. Those areas are:

1. Trial balance
2. General ledger
3. Accounts payable
4. Payroll
5. Supply chain

Source: Crowe

Insight

“Crowe Financial Control Analytics is what I would call a pretty good sister product [to Crowe RCA] in helping speed [up] financial statements.”

– Eric Jolly, Partner, Healthcare Consulting, Crowe

No one likes to leave money on the table – not in poker, and certainly not in hospital or health system revenue cycle departments. Charging and collecting for all billable services rendered was the topic of this sponsored Healthcare Summit breakout session from Streamline Health. Jawad Shaikh, president and CEO of Avelead, a Streamline Health company, talked to attendees about charge capture: the ability to capture all billable charges for an episode of patient care and support them through clinical documentation. Shaikh said automation is the secret to effective charge capture as it takes human error out of the equation and speeds and reduces the cost of the charge capture process. Effective charge capture powered by automation technology also reduces claim denials and improves cash flow, he said.

Watch a rebroadcast of this sponsored breakout session

Numbers to remember

1% to 3%

Average percentage of hospital net revenue left on the table because of missed charges

Source: Avelead estimate

Insight

“If charges are not being accounted for at the charge line-item level, a hospital is losing money.”

– Jawad Shaikh, President and CEO, Avelead

Is a hospital’s or health system’s revenue cycle performance better, worse, or on par with its peers in its market, in its region, or nationally? It’s impossible to know without objective, credible, and verifiable data. That’s how Crowe revenue cycle key performance indicator (KPI) benchmarking data can help. The data is based on actual statistics from more than 1,700 hospitals in 47 states with a combined annual gross revenue of nearly $825 billion. In this breakout led by Matt Szaflarski, whose focus is revenue cycle intelligence, and Colleen Hall, Crowe healthcare managing principal, attendees learned how they can use Crowe benchmarking data to compare their revenue cycle performance with their peers based on dozens of metrics and data points.

Give us your feedback on our revenue cycle KPI benchmarking report and analytics.

Get the feedback form.

A number to remember

11.2%

National average initial claim denial rate in June 2022

Source: Crowe benchmarking data

Insight

“We leverage our benchmarking data to measure the market. We also leverage this data to help inform many of our revenue cycle clients who are very interested in their performance versus the market.”

– Matt Szaflarski, Healthcare Consulting, Crowe

Nearly every hospital and health system claims it wants to be a data-driven organization that makes data-driven decisions using data-driven insights in real time. However, that state of nirvana is impossible to attain without one thing: the data. That’s why data-starved hospitals and health systems need to power on the Crowe healthcare suite. More than 200 data elements make up the Crowe healthcare suite, which itself is supported by Crowe RCA net revenue reporting software. During this breakout hosted by Jenna Haworth, Cailynn Holm, and Joe Ravotto of Crowe, attendees learned how they might harness the power the of the Crowe healthcare suite to say goodbye to intuition, guesstimates, and hunches and hello to smart and informed decision-making.

Watch a rebroadcast of this breakout session

A number to remember

200+

The number of individual data elements that make up the Crowe healthcare suite

Source: Crowe

Insight

“The Crowe healthcare suite can be utilized as the single source of truth to build applications, create custom reporting, and make fast, informed, data-driven decisions.”

– Jenna Haworth, Healthcare Consulting, Crowe

This interactive breakout session showed attendees how the Crowe RCA Next platform can reduce the number of steps – and clicks – required of users to complete their month-end close process. The talk, by Bryan Rector and Andrew Obaseki of Crowe, was a deep-dive follow-up session to their Crowe RCA Next overview breakout the previous day. They explained the three concepts supporting Crowe RCA Next month-end close capabilities: scenarios (logical containers that include all the configurations, overrides, and reserve model adjustments), configurations (month-end close configurations and thresholds that are applied to a scenario by default), and reserve modeling and analysis (the ability to override default configuration for the respective scenarios in which the user is working).

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A number to remember

10

The number of clicks (followed by one manual calculation) required by Crowe RCA Next users to complete the month-end close process, down from 100 or more previously

Source: Crowe

Insight

“How do we make this simple for our users? How do we get them from point A to point B in analyzing the results as quickly as possible so they can focus on the high-value activities?”

– Andrew Obaseki, Healthcare Consulting, Crowe

Andrew Holloway of Crowe led the panel discussion in this morning breakout session that featured Dawn Davidson, vice president, national net revenue management, at Ascension; Andrew Walker, vice president, accounting and financial reporting, at WellSpan Health; and Elizabeth Ward, vice president of finance at Beth Israel Lahey Health. The healthcare finance leaders shared their thoughts on the Great Resignation and remote work (it’s here to stay), outsourcing finance and revenue cycle functions (weigh what you might gain against what you will lose before you sign), automation (expect more, pursue more), talent acquisition (look beyond the traditional), payor-provider relations (they’re unpleasant at the moment), environmental, social, and governance reporting (healthcare is positioned well), and more.

Watch a rebroadcast of this breakout session

A number to remember

486,000

Number of employees who quit their jobs in the healthcare and social assistance industry in August 2022

Source: U.S. Bureau of Labor Statistics, preliminary data, accessed Oct. 21, 2022

Insight

“We really are still remote. All of our back-office functions are still remote. I don’t see that changing. Definitely not in the next three to six months. We’ll see how it plays out over time, but people like it.”

– Dawn Davidson, Vice President, National Net Revenue Management, Ascension

Hospitals and health systems are struggling to reconcile key patient, payor, and affiliated provider accounts and accurately report the financial results of those accounts in a timely manner. One solution to the problem is to automate as much of a hospital’s or health system’s general ledger and reconciliation process as possible. That was one of the many important takeaways from this breakout facilitated by Tracey Coyne, Eric Proctor, Matt Swafford, and Ryan Herr of Crowe. They also offered a few tips for “smooth credit card reconciliations,” as many patients are now putting their co-pays and deductibles on their credit cards. One tip: Standardize merchant processors and eliminate as many merchant processors as feasible.

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A number to remember

45.2%

Percentage of breakout session attendees who said they spend 21 to 60 hours per full-time employee per month to reconcile their organization’s general ledger

Source: Crowe

Insight

“Volume has come back after COVID, but reimbursement is still down. Yield is still down. It is more important than ever to get your arms around that visibility into the reporting on all of your entities – visibility into the reporting and the reconciling of all of your accounts. You don’t want an ‘oops.’”

—Tracey Coyne, Partner, Healthcare Consulting, Crowe

Scrutiny of community benefits and charitable activities performed by not-for-profit hospitals and health systems in exchange for their tax-exempt status has never been higher. As a result, tax-exempt hospitals and health systems must be meticulous in reporting their charity care and bad debt expenses in annual Medicare cost reports. How they can do that was the topic of this breakout session led by Nick West and Jill Fusco of Crowe and Amy Duncan, president of Collaborative Data. The trio shared best practices for Worksheet S-10 completion, Medicare bad debt reporting, bad debt audit management, uncompensated care cost reporting, Health Resources and Services Administration COVID-19 claim handling, and financial assistance policy creation. One financial assistance policy tip: Maximize collection efforts but minimize time with third-party collection vendors.

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A number to remember

37.8%

Percentage of breakout session attendees who said CMS currently is conducting four or more audits of their hospitals

Source: Crowe

Insight

“You always want to make sure that your charity and your bad debt per the GL ties to the data that you’re putting in your Worksheet S-10. You want to make sure the data that you’re using is complete and accurate. You don’t want to get to the end of preparing your Worksheet S-10 and come to find out that your data doesn’t tie to the GL, and then you have to completely redo all of your work.”

– Jill Fusco, Healthcare Consulting, Crowe

“I’ll take Crowe RCA concepts for $600, please, Derek.” That’s Derek as in Derek Ellis of Crowe, who hosted this lively and attendee-favorite breakout session with Olivia Sarsfield, also from Crowe. The hosts challenged in-person attendees with progressively difficult – and increasingly lucrative – Crowe RCA trivia in six categories à la the famous game show format. The six categories were “Name that report,” “Healthcare finance,” “Functions of Crowe RCA,” “Crowe RCA concepts,” “Month-end analysis,” and “Acronyms.” The co-hosts awarded prizes to the three player-attendees with the highest Crowe RCA trivia scores. An example: The MRA9 report pulls stored detail from calculated ranges on this data. What is ZBA (zero balance account)?

This live session was not recorded. A rebroadcast is not available.

A number to remember

4

The number of differences between the MRA4 and the MRA5 reports in Crowe RCA. The MRA5 includes:

• Unapplied discounts
• Out-of-model adjustments
• Additional reserves on large-balance accounts
• Recovery and takeback estimates

Source: Crowe

Insight

“Playing Crowe RCA trivia is a good way to prepare for the CNRA [certified net revenue analyst] exam.”

– Olivia Sarsfield, Healthcare Consulting, Crowe

Bryan Rector and Andrew Obaseki of Crowe were back at this second interactive breakout session as a follow-up to their Crowe RCA Next overview breakout the previous day. This time the topic was Crowe RCA Next, the upcoming cloud-based platform version of Crowe RCA, and its powerful analytics capabilities, which, they said, must be on par with the analytics capabilities of the current on-premises software version of Crowe RCA. But the goal is to expand those capabilities in Crowe RCA Next. For example, not only will Crowe RCA Next enable users to design their own net revenue analytics reports, but it will allow users to share those anonymized custom reports with other users.

Watch a rebroadcast of this breakout session

A number to remember

3

The number of different types of reports that will be available in Crowe RCA Next. The three report types are:

1. Standard Crowe reports
2. Edit and save-as client user reports
3. Client-verified reports

Source: Crowe

Insight

“I’ve met CFOs who want all the details, and I’ve met CFOs who just want a paragraph and say that’s all I want to know. With Crowe RCA Next, we’ll be able to tailor a report to a persona or to a user.”

– Bryan Rector, Partner, Healthcare Consulting, Crowe

The final breakout session of the 2022 Crowe Healthcare Summit was a tutorial by Brad Heaton and Ryan Herr of Crowe on how to parlay data generated by Crowe RCA into decisions and actions that will improve the net revenue performance of a hospital or health system. They shared a few recommendations on how to develop a deep and detailed understanding of all the data elements in Crowe RCA, including these: Familiarize yourself with the data elements on the account-level reports, understand how data migrates from the patient accounting system into Crowe RCA, develop expectations for drivers of net revenue results, and know which data elements best capture those drivers.

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A number to remember

3

The number of primary goals of the pre-close process. They are:

1. Confirm that the reserve model is consistent and that fluctuations in reserve rates are well understood and agreed upon.
2. Correct any known errors or mistaken postings that are affecting the reserve model and/or net revenue.
3. Develop an understanding of key trends in the underlying business.

Source: Crowe

Insight

“Pre-close we see people typically starting around day minus five or so. A huge piece of that pre-close analysis is leveraging that time frame to check our rates, check our assumptions, do our analysis to get us to a place where when we get to day one we’re ready to go.”

– Brad Heaton, Healthcare Consulting, Crowe