Revenue Cycle Patient Access

BARRY R. DALTON

***** ****** ******, ********, ** 92301

951-***-**** ************@*****.***

REVENUE CYCLE LEADER IN INTERIM AND PERMANENT ENGAGEMENT

Experienced healthcare leader with revenue cycle management skills proven to drive results in turning

around operational challenges.

• Revenue Cycle Specialist in both front-end and back-end processes

• Corporate Medical Consulting Business Management

• HIPAA Compliant Expert In-Patient and Out-Patient UB-04 procedures.

• CMC/EDI submitters to Medi-Cal/Medicaid/Medicare.

• Workers’ Compensation Claim/Lien Recovery.

• Commercial Billing/Recovery/HMO & PPO Billing & Recovery

• System familiarity: Eclipsys, SSI, MDX, Cerner, HMS, CPSI/Evident

PROFESSIONAL EXPERIENCE

MEMORIAL HOSPITAL-SEMINOLE, TEXAS

25 Bed CAH with 7 Beds OB/GYN

• Revenue Cycle Director: Business Office, HIM, and Patient Access 10/01/23-Present

• The only CAH that I know of that delivers 80+ babies per month

• The Hospital was in dire straits, no continuity of care, and constant turn-around in the “CSuite”

• Hospital was not utilizing Method II Billing so I corrected that situation in the first 90 days, which

should produce an additional revenue of +$300,000

• Updated several items in the CDM

• Hospital Billing and Coding outsourced. Worked on better communications between the Hospital

and the Billing/Coding Company. (If I had my way, we’d bring Billing/Coding In-House within the

next 18 months.)

• Brought on a new Collection Agency and another Firm to work our >60 Days Insurance Claims

• Working to Reduce days in Discharged Not Final Coded, and Discharged Not Final Billled

NORTH PLATTE VALLEY MEDICAL CENTER: Saratoga, WY

23 Bed Acute Hospital: 18 Extended Care, 5 Acute Care

Revenue Cycle Director, Charge Master Developer: 10/01/22-Present

• 1st 6 months reviewing Policies and Procedures

• Working with Meditech for Implementation of Revenue Cycle, Registration, and HIM

• Go-live with Meditech scheduled for November 1st, 2023

• During the interim, I developed a Hard-copy Face sheet which resides on a shared-drive for Patient

Access to utilize. I also had to create additional fields so that we could incorporate fields needed for

UB-04 billing.

• Hospital opened doors 05/01/23

• All of our HIM and Coding is being done by hand; claims charges manually calculated by reviewing

all ER and Ancillary tests performed

• I worked with our clearinghouse, Quadax, to set-up a template that would allow us to DDE claims

into their system to upload to the various payers

• I helped with getting our Part B Medicare Certification with NPPES

• We cannot have our State Survey performed until after we have had 30 Acute care In Patients which

we should reach by the end of August. Once the survey is done and approved, then we can finally

receive our Part A Medicare credentialing from Noridian

NON-HOSPITAL WORK DURING THE PANDEMIC: 11/15-21-08/30/22

• I WORKED AT AN Amazon warehouse for 9 months just to provide for the family

Interim work during the pandemic: 04/10/21-09/15/21

• 2 Interim Revenue Cycle Positions: 1) Glen Rose, TX and 2) Sonoma County Regional Hospital

in Sonoma, CA

FRIO REGIONAL HOSPITAL: Pearsall, TX

25 Bed Critical Access Hospital with 5 Swing Beds serving Frio County

Interim Director Patient Financial Services: 01/25/21-03/25/21

• Hired as an emergency replacement to fill in the gap as previous director had left his position

unexpectedly. This was a 2 month engagement.

• Created an update to Tables so that Admission/Registration Codes would allow for more accurate

completion of the UB-04.

MICHIGAN ORTHOPEDIC CENTER: Lansing, MI

Multi Physician Ambulatory Surgical Center

Revenue Cycle Consultant (thru Trubridge Outsourcing Company): 02/15/20-08/28/20. 2 month

contract extended three times.

• Assisted on-site personnel in Accounts Receivable reduction in processing patient

payments.

• Balanced ALL Over The Counter payments and placed on Spreadsheet.

NORTH SONOMA COUNTY HEALTHCARE DISTRICT: Healdsburg, CA

Dba: HEALDSBURG DISTRICT HOSPITAL 25 Bed Critical Access Hospital with 5 Swing Beds

Director Patient Financial Services/Revenue Cycle: 01/10/19-01/20/20: Manager position eliminated

• Cleaned up staffing and now there is a group willing to work and communicate well with each other.

This hadn’t happened in 5 years

• Replaced 4.0 FTE staff in first 2 months

• Managed billing of delinquent Skilled Days resulting in first ever $6.1 Million month

• Improved billings allowed for increased Cash Collections of $4.8 Million over 2018 totals

• Assumed taking on TAR preparations.

• Hospital uses SSI as our Clearinghouse. Wrote numerous SSRs which have reduced front-end Edits

by over 90%

KLICKITAT VALLEY HEALTHCARE: Goldendale, WA

25 Bed Critical Access Hospital with 6 Swing Beds

Director, Patient Financial Services: 01/14/17-11/10/18-C-Suite Reorganization

• Took over Business Office that essentially had no Director for 5 Years

• First major project: Former Director had reduced items in the Charge Master, some by as much as

900%. CFO questioned why her AR dropped $550,000 in one month. Had to reverse all the

reductions and restore charges to their previous rates ensuring that our monthly charges were

restored.

• Discovered that Hospital had been applying Method II Billing to all Financial Classes rather than

just Medicare Out Patient. Had to correct billing strategies and processes.

• Hospital had MAJOR AUDIT BY HCA (MEDICAID WASHINGTON): Had to unbundle Pro Fees

from Facility Fees, not only in Surgical Claims, but also unbundle Anesthesia and CRNA charges.

• Major effort in restoring relationships within the office; employees felt disrespected by upper

management, and there were also some intra-office relationships that needed mending

Interim Director, Patient Financial Services: 2016

• 3 Short Term Assignments, 2 in Arizona and 1 in Illinois

UNION COUNTY GENERAL HOSPITAL: Clayton, NM

25 Bed Critical Access Hospital

Interim Business Office Manager: 05/11/14-12/15/15

• Oversaw ALL Business Office Functions: Business Office, Patient Access, and HIM Manager

• Successfully completed 855A for renewing Hospital’s Medicare agreement with Novitas

• Successfully completed 855 for DME which had been suspended for 3 years

• Twice within 6 months, exceeded the $1 Million Cash Receipts for first time in Hospital’s history

• Hospital had to replace our HIM Supervisor which created a 6 week delay in Coding and

Transcription. The Agency we brought in to temporarily bridge the gap in our HIM Department

helped transition us to ICD-10 readiness. While coordinating this project our time from discharge to

final coding went from 30 days to less than 5 days.

• Prepared test claims using ICD-10 codes. All our tests were successful

• Set up systems so that all live ICD-10 claims have paid successfully with all payers

• Acting member of our Meaningful Use Committee

• Due to careful monitoring of current patients, the hospital has been able to upload coding to our

outsourced Coding Partner; in conjunction with this, the hospital has been able to reduce Total

Unbilled Accounts to less than $500,000

HEART OF THE ROCKIES REGIONAL MEDICAL CENTER: Salida, CO

25 Bed Critical Access Hospital with 6 Swing Beds

PFS Director

• Oversaw staff of 24 FTEs: Business Office functions: Billing, Collections, Access

• First PFS director to successfully set-up new 855-R for new clinic. Able to work directly with the

Claims Processing Manager at Novitas (Medicare) and get them to agree to process claims dating

back over 1 year from date-of-service. This effort brought in over $200,000 to the Hospital.

• Following the same criteria used for Medicare, Able to get Colorado Medicaid to agree to the same

terms, processing claims going back over 1 year from date-of-service. This effort netted the hospital

another $89,000 in payments.

• Sat in on ICD-10 steering committee

• In the process of developing a better tool for Patient Charge Estimator for Surgeries, CT Scans, etc.

The Hospital was using software developed by Craneware, and we were still ironing out some of the

technical problems

• Produced monthly statistics for Clinics using Nextgen Report writer

• Successfully helped in the process of getting 2 of our Physicians who did an internal medicine clinic

within the Hospital set-up to do Provider – Based Medicare Billing

SAINT VINCENT HOSPITAL: Leadville, CO

25 Bed Critical Access Hospital

Business Office Manager: 04/18/11-11/14/12

• Oversaw all Business Office functions: Billing, Collections, Access

• Chairman of Revenue Cycle Committee

• Co-Chairman of IT Steering Committee: We are in the process of doing our EHR build, and also

pursuing an entire HIS build.

• Responsible for getting 855-B, 855-I, and 855-R approved by Trailblazer, Medicare.

• In working closely with HIM Director, have been able to reduce our DNFB days from 23.5 days in

December, to a current 2.57 days!

EVEREST COLLEGE: Rancho Cucamonga, CA

Instructor: Medical Insurance, Billing, & Coding: 03/01/10-01/31/11

• Instructed students in proficient usage of ICD-9, CPT, and HCPC Coding

• Instructed students on the basic bodily structure and body systems

GOOD SAMARITAN HOSPITAL: Santa Barbara, CA

Business Office Manager: 06/24/09-11/30/09

2 Campus Facility divided between Acute Care and Behavioral Health

• Directed staff in ALL initial Billing

• Coordinated follow-up and collections

• Coordinated efforts with the Access Manager for admissions, and in working closely with HIM

Manager for Medical Records and TARs.

HEARTLAND REGIONAL MEDICAL CENTER: Saint Joseph, MO

450 Bed Acute Care Community Hospital

Billing Manager: 03/07-06/09

• Managed staff of 25 Employees—All up-front billing and Follow-up

• Led hospital in increasing annual Gross Billings to almost $1 Billion

• Billings include Facility-based, Acute, Mental Health, and now LTAC & Professional billing for

over 115 Physicians

• Monitored Average AR days to run between 49-53 days

• Developed Billing System is Eclipsys and Registration System is Cerner

• Employee satisfaction has improved over 200% since hire as Manager

• Sat on Revenue Cycle Committee where we discussed NDCs, CCI edits, etc.

• Worked closely with Team Leaders in Access, HIS, and Revenue and Reimbursement, & Care

Management using good Inter-Departmental collaborative Team approach

• Set-up a worksheet utilized by Care Management, HIS, and PFS to track TARs

• Set-up Committee with Access Leaders and Clinic Coordinators to improve Up-front registrations.

This teamwork has helped reduce registration errors

• Established good networking with the State’s Director processing TARs and Pre-Certifications,

Appeals Director & Over-1-Year Supervisor

• Taught Medical Coding and Billing at Maric College

MARIC COLLEGE: Pomona, CA

Instructor: Medical Billing and Coding: 10/05-03/07

• Instructed students in proficient usage of ICD-9, CPT, and HCPC Coding

• Instructed students on the basic bodily structure and body systems

Dalton’s Medical Consulting Services: Rialto, CA

California Regional services specializing in Accounts Receivable Recovery for Hospital & Facilities.

Company’s area of expertise has been working aged Receivables over 120 days post-discharge date and

consisting of Medi-Cal/Medicaid, Medicare, and other Insurance/HMO follow-up.

Principle and Senior Consultant: 1987-2006

During the past 23 years led Company to helping Clients reduce their outstanding Accounts

Receivables by over $55,000,000.00 Dollars, bringing in actual Cash Revenues of over $30,578,000.00.

Applied knowledge of the guidelines and regulations of Healthcare and maintained Compliance with

HIPAA mandates. Attention to detail in working aged claims has kept Dalton’s Medical Consulting

near the top of the Consulting Industry’s percentage leaders in recovery of assigned claims. Successfully

completed over 90% of all billable assigned claims.

Partial Listing of Past/Present Client

• Children’s Hospital Los Angeles: March 1997-April 1999—Reduced Accounts Receivable

by $49,090,062.24 bringing in Net Revenues of $10,201,959.82.

• St. Bernardine Medical Center: April 1999-April 2003—Billing Contract for Out-Patient

Managed Care and Cross-Over Claims—Billed over 32,000 Claims with a Billed Amount of

over $13,400,000.00

• Coastal Communities Hospital: March 1993-August 1995—Medi-Cal Follow-up and Billing

Project—Reduced Accounts Receivable by $18,035,111.01, bringing in Net Revenues of

$7,610,150.92.

• City of Hope National Medical Center: June 1996-April 1998—Medi-Cal Follow-up

Project—Reduced Accounts Receivable by $8,125,305.76, bringing in Net Revenues of

$1,951,902.71.

• Pacific Alliance Medical Center: April, 2003-2006—Ongoing assignments in working aged

Accounts Receivable claims in Medi-Cal and Medicare.

• Community Hospital San Bernardino: December 1998-2006—Cross-over Billing only—

9,500 Claims with Total Charges over $2,091,918.94.

• Chino Valley Medical Center: September 2002-February 2005—Medi-Cal Follow-up

Project, with Up-Front Billing for Medi-Cal and Medicare—Up-front In-Patient Billing: 684

of 701 Claims Billed have Paid—97.57% Success Rate—Accounts Receivable Reduced

$9,656,421.21 with Net Revenues of $2,149,651.54. Follow-up Project has reduced

Accounts Receivables by $4,957,951.99 with additional Net Revenues of $756,460.90.

Medicare Payments have exceeded $5,450,000.00.

EARLY BUSINESS EXPERIENCE

Business Office Manager for a 70 bed Hospital in Los Angeles, CA. Responsible for all Business Office

Operations including Patient Access. 1979-1980

Consultant for Professional Financial Services, a Collection Agency specializing in Hospital Accounts

Receivables. Responsibilities included various on-site assignments working for Business Offices

contracted with Professional Financial Services: 1980-1987

EDUCATION

BA, Bachelor of Arts, 1973, Michigan State University, East Lansing, MI

AA, Associates of Arts, 1970, Lansing Community College, Lansing, MI

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