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Data AnalysisThis data represents overtimeutilization over the last 12 months.It clearly indicates a significantincrease in overtime utilization bySusan Peters. It appears that she hasalready exceeded the 2014 OT in thefirst quarter of 2015. Sue Petersappears to be wearing many hatsand is controlling processes thatneed reconsideration in design andflow. The OT trend indicates thatcurrent work flow is not efficientand/or realistic for this employee.10 s c h e n c k s c . c o m

Data AnalysisThe accounts receivableaging is indicating a needaddress the current claimsand billing processes.There are significantaccount balances over 60days.11 s c h e n c k s c . c o m

Data AnalysisThe accounts receivable aging isindicating a need to address thecurrent claims and billing processes.There are significant accountbalances over 60 days.12 s c h e n c k s c . c o m

Improvement Ideas - Schenck Identified 20 consolidated opportunities for improvement categorizedas strategic, operational, HR and ITRed Primary focus / High ROIYellow Secondary focus / Moderate ROIGreen Long-term or optional focus / Lower ROINumberDepartmentTypeWashington County Health and Human Services5/1/2015IdeaRecommendationOwnerChildren and Families would like Accounting team to complete client financial analysis based Collectively review between department and accounting to determineon poverty levelwhere most appropriate to be performed.TBDTo improve the billing/collection process and the patient experience, werecommend a weekly meeting between accounting and social work. Thegoal will be to discuss client activities that impact the process and theclient. This information sharing will help the processes supported by bothteams.Communication between social workers and accounting team needs to improve.TBD1Children & FamiliesOperations2General Accounting (3rdFloor)Human Resources3General Accounting (3rdFloor)OperationsBetter way to do billing for supervision fees? Reduction in postage and frequency?Collectively review between department and accounting to determinewhere most appropriate to be performed.TBD4General Accounting (3rdFloor)OperationsCalls from parents questioning financial responsibilityAdd this responsibility to a centralized Patient Accounting team.TBD5General Accounting Technology7HHSOperations8HHS/County-WideStrategyTo support the county LEAN and organizational improvement initiatives moving forward, aninternal champion should identified that can be educated/trained/mentored. This individualcan be actively or passively involved in all study's and implementations.Assign Eric as internal LEAN champion to work with Schenck onimplementation of required changes.TBDStrategyImplementation of a dashboard containing metrics and associated key performanceindicators (KPI's) related to cost, service, quality and operations, etc. Ideas (related to andoutside the scope of this review) include collections aging, re-admissions, productivity, billedcodes, CCS revenue, budget/actual for programs and departments.n/aTBDOrganizational Structure and associated locale of individuals can be modified to provideimproved customer service, efficiency, accuracy and departmental effectiveness.Develop a transition plan and new organizational structure incorporating ashared services model. Divide accounting into 2 teams including a generalgroup and a patient accounting team.TBDEnsure utilization of uniform fee system and consistency of fee scale.Additionally, consider utilizing WIDHS for collections per the policy.Additionally, the Schenck Medical Billing team could review records andprocesses.TBDTBD9HHS/County-WideCollectively review between department and accounting to determine ifwhat is performed is necessary.Billing tracking and invoicing being completed in Excel - alternative option?TBDDevelop an onboarding process and training guide for new employees,Through process analysis and review of job descriptions, several areas for basic training, over determine cross training opportunities for key/critical accountingfunctions and develop a training plan for Lytek MD and JD Edwards.use of Excel and cross functional training became apparent.TBDConsideration and implementation for obtaining cell numbers and emailBased on the data provided for April 2014-April 2015, 31% of appointments are cancellations, addresses to remind patients should be evaluated. Overall, the process ofscheduling, rescheduling and management of cancellations should beno-shows or reschedules. Reduce this number to improve the patient clinical outcome andimproved/tracked.the billing process.TBD10HHS/County-WideStrategy11Outpatient Billing (2nd Floor)Operations/StrategyOutstanding collections need to be addressed and a process for future collectionsestablished.12Outpatient Billing (2nd Floor)OperationsImprove process of obtaining information from clients on the day of appointmentKick-off a team to improve the intake process.13Outpatient Billing (2nd Floor)OperationsImprove identification of claims errorsKick-off a team to improve the most error prone locations and implementa plan to mitigate.TBD14Outpatient Billing (2nd Floor)OperationsCredentialing processes need to be documented to ensure future compliance.Kick-off a team to improve the credentialing process.TBD15Outpatient Billing (2nd Floor)OperationsImprove client registration process on the day of appointmentKick-off a team to improve the intake process.TBD16Outpatient Billing (2nd Floor)OperationsImplement front desk staff take payments from clientsKick-off a team to improve the intake process.TBDStuffing of envelopes appropriate for Sue?Collectively review between department and accounting to determinewhere most appropriate to be performed.TBDCarol using Excel spreadsheets for payment receipts - alt system option for tracking?Determine whether the functionality already exists within the majorapplications currently utilized.TBDStatements processed and printed in off hours by Sue - appropriate?Collectively review between department and accounting to determinewhere most appropriate to be performed.TBDStatement issues still identified at point of stuffing envelopes - appropriate?Kick-off a team to improve the most error prone locations and implementa plan to mitigate.TBD17181913 s c h e n c k s c . c o mPriority20Outpatient Billing (2nd Floor)Outpatient Billing (2nd Floor)Outpatient Billing (2nd Floor)Outpatient Billing (2nd Floor)OperationsOperationsOperationsOperations

Improvement Ideas – Eric/Internal Reviewed and discussed 38 opportunities for improvementNumberPriorityDepartmentTypeWashington County Health and Human nsHospitals send paper invoices, which is checked against utilization (entered daily services),signed by program supervisor, and sent to financial staff, where it is checked again andentered to additional R process is unclear and there are concerns that this is not being done accuratelyPrimarily relates to mental health, which would fall under Dave'sresponsibility, per Mary.3TBDACSOperationsNo monthly reporting that identifies external provider costs, utilization, trends, etc.Phase 2 Project4TBDAODA ResidentialOperationsNeed to assure that clients are connected with Economic Support workers to identify benefitoptions, eligibility for MAPhase 2 Project5TBDAODA ResidentialOperationsMonthly, financial staff need to assure clients have MA - communicate with staff when issuesarisePhase 2 Project6TBDCCSStrategyCurrently not billing for initial contact and assessment - leaving money on the tablePhase 2 ProjectSue says we cannot bill for this service7TBDCCSOperationsService facilitators are unsure regarding what services are in provider network, what theiravailability and rates are, how to sign providers up for services - service auth and contractingprocess is deficient and unmanagedPhase 2 Project8TBDCCSOperationsLeigh and Eric get services on line and contracted which disconnects local supervisors fromprocessPhase 2 Project9TBDCCSOperationsMonthly progress notes from external providers arrive via paper copies which are thenscanned into folder - invoices and service notes often do not arrive at same timePhase 2 Project10TBDCCSOperationsPaper invoices are processed manually by financial staff; support staff enter billing units intoLotus BHSF which then flows to Lytec billingPhase 2 Project14 s c h e n c k s c . c o m

Key Action Items Begin interviewing for an Accounting Manager position reporting to Finance with dottedMove to the entireline to HHS and seated in HHS offices. Owners: Josh, Sue and Maureencompany including Sales,Marketing, Accounting, Appoint Eric as internal LEAN/Process Improvement Champion to work directly withSchenck step by step through various implementation efforts. Owners: Sue and MaureenMove to the entire orderto backMove third floor (and potentiallyprocesssecondfromfloor)frontfunctionsto “Corporate” Finance using a lowrisk/high impact approach starting with highly transactional functions. Develop a planfocused on functions, who will perform, by when and who will review. Funding sources,Begin to expandin thegrant reporting, collections, reconciliation,etc. Ensurea formalized transition andotherprocessandcommunication plan occurs. Goalis torelatedfocus oncentralizationof functional andeducatewhileimplementingtransactional roles and decentralize strategic and advisory roles. Owners: Sue, Maureen,EricStart small withLytekMD – Re-focus and vendor management: Coming to agreement from a contractualoneproject,standpoint on what has been completedandthe open items. Clarification, scheduling andeducatemovingthe teamtraining planning and success measurementforward to ensure appropriateandimplementfunctionality/knowledge of user base.Owners:Maureen and Ericquickly15 s c h e n c k s c . c o m

Key Action Items Implementation of a dashboardMovecontainingmetrics and associated keyto the entireperformance indicators (KPI's)relatedincludingto cost, Sales,service, quality and operations,companyetc. Ideas (related to and outsidethe scopeof this review) include collectionsMarketing,Accounting, aging, re-admissions, productivity, billed codes, CCS revenue, budget/actual forprograms and departments. Owners: Maureen and Eric with Sue’s oversightMove to the entire orderprocess from front to backGo-forward plan: Due to excessive unfiled claims and high patient receivables,further analysis of HS billing and collections processes is necessary to establishto expandtheis compliant with regulatorya revenue cycle that supports Beginthe goalsof HS inandother andrelatedand oversightrequirements. Owners: MaureenEricprocesswith Sue’seducate while implementing Clean-up Effort: Address through a concerted improvement effort to closepreviously billed accounts. This willclaims to be processed, denials toStartaddresssmall withbe reviewed and patient balances onecollectedor written off. Train, evaluate,project,. Owners:review, provide clarity and accountabilityeducate theteam Maureen and Ericand implementquickly16 s c h e n c k s c . c o m

Key Action Items Significant billing issues are caused by an inconsistent intakeprocess. Patient-facing registration/reception staff roles need tobe evaluated to improve patient onboarding to minimize backend billing clean-up and improve the patient experience.Owners: Maureen and Eric Based on the data provided for April 2014-April 2015, 31% ofappointments are cancellations, no-shows or reschedules.Consideration and implementation for a more disciplined andeffective approach including but not limited to wait timereduction, obtaining cell numbers and email addresses toremind patients should be evaluated. Overall, the process ofscheduling, rescheduling and management of cancellationsshould be improved/tracked. Owners: Maureen and Leigh17 s c h e n c k s c . c o m

Step 4 - Implement Improvement Plan Implement:––––18 s c h e n c k s c . c o mNew process methodsNew ProceduresNew TrainingNew metrics

Step 5 – Sustain The Improvements Sustain:– New process methods: Process clarified and linked to procedures and training.– New Procedures: Updated and sustained– New Training: Training conducted as assignmentsor personnel changes Effectiveness audited– New metrics: Retained metrics and new metrics in-place– Ownership responsibility assigned– Posted and understood by those impacted.19 s c h e n c k s c . c o m

Recommended Next StepsRecommended Projects (Can select any/or all items as desired)On-siteTimelineCost Not toExceedProject 1 – Staff transition to Corporate Finance and associated integration plan5 days 8,000Project 2 – LytekMD re-focus and vendor management2 days 3,000Project 3 – Development of managerial dashboard and metrics7 days 13,000Project 4 – Go-forward billing and collections process7 days 13,000Project 5 – Clean-up effort on open billings and collections (contingent on #4)TBDTBDProject 6 – Transformation of roles and responsibilities of Registration personnel4 days 7,000Project 7 – Patient cancellation and reduction of reschedules effort2 days 3,000Total not to exceed 47,000 (excludes project 5)20 s c h e n c k s c . c o m

COMMITTEE REPORTTo:Human Services Board and Administrative Services CommitteeFrom: Maureen Murphy, Human Services AdministratorDate: June 11, 2015Re:Approve Creation of a Billing Supervisor PositionPOLICY QUESTION:Should the Human Services Board and the Administrative Services Committee approve creationof a Billing Supervisor position?DISCUSSION:The past few years have seen tremendous transition within the Human Services Department(HSD). At the beginning of 2014, the long-serving HSD Director retired. At the same time, anAccounting Assistant who handled the medical billing also resigned. An internal InterimDirector was appointed to manage the department throughout 2014. An external permanentDirector was appointed on December 1, 2014. The transition continued into 2015. TheAccounting Manager resigned on February 28, 2015. With all of the staff turnover that hadoccurred, especially within and affecting the Accounting Division, the County Administrator,Finance Director and current Human Services Administrator brought in Schenck to perform atop-to-bottom review of the Accounting Division. In both March and April of this year, theSchenck Business Optimization team performed their review of the HSD Accounting Division.The Division currently has seven positions: one Human Services Accounting Manager, oneAccounting Supervisor and five Accounting Assistants. As mentioned in the previous paragraph,the Accounting Manager position is currently vacant. The Accounting Manager positionmanaged six employees and was responsible for the financial affairs of the entire HSD as well ashandled the day-to-day fiscal affairs of three Divisions within HSD, Administration, Accountingand Behavioral Health Divisions. The Accounting Supervisor position oversees the financialaffairs of two Divisions within the HSD, Children and Families and Economic SupportDivisions. Two Accounting Assistants handle accounts receivable and accounts payable for theentire HSD. The remaining three Accounting Assistants process medical billing for theBehavioral Health Division.Schenck issued its report on May 4, 2015. The Schenck Team’s recommendations includedseven recommended projects that required immediate attention. As the management team beganto dig into project 5 – Clean up effort on open billings and collections, it was determined thatthere currently is not a person within HSD that has the extensive knowledge necessary toefficiently and timely work within the two systems (George and Lotus) and three databases(Vern, BHSF, Checkbook) that constitute the HSD billing network. Since much of HSDs

revenue must be billed within one year of service, each day that billing goes unprocessed isrevenue uncollected.Also as part of the report, Schenck recommended moving forward with centralized financialmanagement. Given this recommendation and the need to have a hands-on Billing Supervisor tomaximize revenue collection, the management team is requesting that the Accounting Managerposition be downgraded into a Billing Supervisor at this time.FISCAL EFFECT:The position will be created by under-filling the already budgeted Accounting Manager position.ATTACHMENTS:Billing Supervisor Position DescriptionRECOMMENDATION:Staff respectfully requests approval to create a Billing Supervisor position at Pay Grade 8 of theWashington County Staffing Plan within the Human Services Department.

WASHINGTON COUNTY, WISCONSIN12Date of enactment:Date of publication:3452015 ORDINANCE678910AN ORDINANCE to amend Sections 7.02 and 7.03 relating to: Washington County StaffingPlan – Human Services Department – Administration and Washington CountyClassification and Compensation Plan.111213The people of the County of Washington, represented in the Board of Supervisors, do ordain asfollows:141516171819202122232425SECTION 1. Section 7.02 of the code is amended to read:7.02 WASHINGTON COUNTY STAFFING PLAN. (AM 15- ) Washington Countymaintains a Countywide Staffing Plan listed by department. Such plan shall indicate the type andnumber of positions currently authorized by the County Board together with the existing pay gradefor said position. County departments are authorized to fill only those positions listed in theCountywide Staffing Plan. Any changes to the staffing plan shall be determined by theWashington County Board upon review and recommendation of the Administrative ServicesCommittee consistent with sec. 7.04(9) of this chapter and sec. 2.44 of this Code. Position titlechanges with no fiscal impact and Fair L

Human Services Board May 13, 2015 Page 2 of 2 1 ORDINANCE: WASHINGTON COUNTY STAFFING PLAN - HUMAN SERVICES DEPARTMENT -2 BEHAVIORAL HEALTH 3 Presented by M. Murphy, Human Services Administrator, E. Diamond, Client Services Director, 4 and J. Moglowsky, Behavioral Health Manager. An overview was given on medical 5 improvements proposed for the HSD Behavioral Health Division.