Denver Health A case history in recovering uncompensated dollars

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1 Denver Health A case history in recovering uncompensated dollars A Chamberlin Edmonds Customer Success Story At a glance: Partner Company Name Denver Health Company Profile An acute care hospital The only academic level 1 trauma center in the area Part of the 10th largest public sector employer in Denver area Operating Statistics 398 licensed beds More than 150,000 patient encounters annually 4,288 employees Key Challenge County employees screened potential adult disability cases, but had little motivation to strive for favorable determinations. When Denver Health assumed this responsibility from the county in mid 2004, this function became an added burden on their staff Solution Chamberlin Edmonds was retained to screen cases for eligibility, to serve as patient advocates in applying for government assistance and to aggressively pursue funding approvals. Chamberlin Edmonds is easy to work with, and their people seem very dedicated. The fact that they have excellent skills, education and experience made a real difference, - Peg Burnette, Chief Financial Officer, Denver Health. Key Achievements after Retaining Chamberlin Edmonds Accepted more than 24,800 patients for benefit applications Over 20,200 cases approved Over $378 million in gross charges approved Recovered more than $111 million in cash to the hospital More than $20 million in projected cash for 2012 Estimated $20 million cash recovery per year ongoing

2 Background Denver Health is the Rocky Mountain Region s academic Level 1 trauma center and the safety net hospital for the area. A key part of its mission is to serve the needs of special populations, including the poor, uninsured, mentally ill, pregnant teens, homeless people and addicts. Consequently, the 398 bed hospital treats a disproportionately high percentage of indigent cases. Like most U.S. hospitals, Denver Health Medical Center screens uninsured patients to determine which cases are eligible for reimbursements through government-subsidized programs. Payers include Medicaid, Medicare, the Social Security Administration and various state and community-funded programs. In early 2005, Denver Health retained Chamberlin Edmonds to seek governmental reimbursement of uncompensated care for patients potentially eligible for disability benefits. Chamberlin Edmonds places full time healthcare representatives at hospitals to screen uninsured patients and determine which are eligible for government programs and expedite their applications. The Challenge Until 2004, the County of Denver had provided several caseworkers to Denver Health to help screen patients for Medicaid eligibility. When the county positions were eliminated, the hospital s social workers assumed responsibility for eligibility determination. The opportunity to collect more money for the hospital had a downside: it added to the heavy workloads of social workers. Our social workers were successful in helping some patients qualify for disability, but there are never enough social workers to do all the tasks in their job descriptions, said Peg Burnette, Denver Health s chief financial officer. Chamberlin Edmonds does a rigorous review and follow-up on disability cases that is beyond the scope of what we can do internally. They also have good relationships with the government agencies. They know what Social Security needs to approve a case and they know how to make the application process more efficient. Denver Health learned of Chamberlin Edmonds through its association with University Health Consortium. According to Burnette, several UHC hospitals reported that the Atlanta-based firm had demonstrated strong results for them in the unique niche of revenue recovery. I would rate Chamberlin Edmonds performance on this project as outstanding. Their people came in with the expertise to do the job; they knew what they needed to do, and they dealt with issues swiftly. And the cash is coming in. - Peg Burnette, Chief Financial Officer, Denver Health

3 Solution: Bringing in outside help To begin the engagement, Chamberlin Edmonds regional implementation team conducted meetings with various groups in the hospital, such as social workers, nurses, medical records and patient accounting. The meetings established mutual expectations and gave Chamberlin Edmonds insight into the hospital s policies, processes and culture. At the same time, the implementation team began recruiting the permanent on-site team members. Process: Implementing a dedicated support team Chamberlin Edmonds full-time team at Denver Health now includes five health care representatives, three resolve application specialists, two claims processors, a team leader and an assistant district manager. Chamberlin Edmonds is easy to work with, and their people seem very dedicated. The fact that they have excellent skills, education and experience made a real difference, Burnette noted. They have real credibility when they are dealing with doctors, nurses, executives and social workers. And they have excellent demeanor with patients. According to Burnette, the implementation project was successful in spite of early under-staffing. Chamberlin Edmonds bases its staffing on caseloads, which are estimated by assessing a sample of cases. In practice, however, Denver Health had more self-pay cases than the sample indicated. The staffing situation was quickly rectified once Chamberlin Edmonds and Denver Health recognized that the volume of clients to be assisted as part of the engagement had blossomed into something bigger than both parties had anticipated. Carol Lovseth, director of enrollment services, noted that increased staffing and refinements in procedures have paid off. The district manager and her staff have been attentive to our needs, she said. We have collected a lot of revenue, and they have met our expectations. We have a great relationship, and we are working together to address our common challenges.

4 Results: A lasting service to patients At the beginning of the project, Burnette set a goal for the remainder of the year: generate a cash impact to the hospital of $2 million. We exceeded that and got more than $3 million collected in the first year. I m quite impressed with the results. They are higher than I expected. Burnette said. Each month, Chamberlin Edmonds screens about 600 inpatient self-pay cases at Denver Health. Of these cases, approximately 24 percent are accepted for disability applications. Historically, 70 percent of Medicaid applications and 67 percent of Supplemental Security Income program applications submitted by Chamberlin Edmonds are ultimately approved. As submitted applications work their way through the approval process, remittances are soaring. By the end of December 2011, Chamberlin Edmonds had brought in more than $111 million for Denver Health during its first seven years. The value of Chamberlin Edmonds work is reflected not only on the balance sheet, but also in the faces of patients. The team is extremely proud of the revenue they bring in and their roles in the success story here, but their real reward is the difference they are making in the lives of these patients, said Jill Smith, Colorado district manager, Chamberlin Edmonds. We re helping them to get assistance they have never had before. We have collected a lot of revenue, and they have met our expectations. We have a great relationship. - Carol Lovseth, Director of Enrollment Services, Denver Health

5 About Chamberlin Edmonds Chamberlin Edmonds, an Emdeon company, serves as a patient advocate and provides custom-tailored eligibility and enrollment services to hospitals nationwide. Our comprehensive services examine a wide spectrum of uninsured and underinsured patients,including inpatient, outpatient and emergency department cases. Emdeon is the leading provider of intelligent revenue cycle solutions that combine advanced technology with highly trained professionals, enabling hospitals and health systems to maximize revenue and profitability. With growing bad debt and increasing pressure on reimbursement rates, our full suite of solutions and technology-enabled services help ensure healthcare businesses succeed. Please visit to learn more. Medicaid Eligibility (Inpatient, Outpatient, ED) Social Security Disability (SSDIB) Supplemental Security Income (SSI) State Disability Charity Care Crime Victims Assistance SCREEN APPLY ENROLL 2012 Chamberlin Edmonds. All rights reserved. CEAA rev 04/