USCIPP Sunbelt Summary Slides

Webinar Discussion Outline & Summary January 15, 2026 FromEDtoDischarge:Innovating theInternationalPatientJourney ACollaborativeModelBetweenSunbelt HealthPartnersandAdventHealth MEET OUR SPEAKERS Ira Arnan Executive Director, CBO AdventHealth West Florida Matthew Vines, Esq. Executive Vice President Sunbelt Health Partners Introduction to Sunbelt Health Partners ⚬Headquartered in Fort Lauderdale, Florida ⚬Established in 1980 as a family owned and operated physician/urgent care practice catering to international travel ⚬1994 launched early-out international billing and collections for hospitals xx AdventHealth Overview 1973AdventHealth was established 9+ million Patient encounters 105,000+Team members 4,500+ Employed providers 56 Hospital campuses operated in nine states 17 Home health and hospice agencies 58 Urgent care facilities 27Offsite EDs 56 Campuses 9 States 10,900+Licensed beds xx 15Hospitals 1,231,672Outpatient visits 125,157Inpatient visits 485,714Outpatient ED registrations 2,698Beds West Florida Division Source: December 2024 YTD Finance Summary Hospital locations updated March 2025. Are unflagged international patients presenting through the emergency department (with no prior contact with your international program) included in your international department’s KPIs and reporting metrics once identified? How does your emergency department identify and manage international patients upon arrival? 1. Patient Arrives in ED •No standardized international screening process 2. Intake & Registration •Staff not consistently trained •Key questions not asked •Information frequently missing 3. Patient Classification •International vs. U.S. resident unclear •New staff may default to “international” •Some patients state “no coverage” expecting charity care What are the greatest challenges your hospital experiences related to intake of new international patients who come through the emergency department? 4. Epic/EMR Workflow •No formal ED workflow for international patients •No real-time flag at arrival •Patient appears in work queues after admission 5. Reactive Follow-Up •International/Access teams catch issues late or when patient is scheduled for procedure •Coverage verification delayed •Missing documentation and records •Patient defaults to self-pay What you’ll take away SESSION FOCUS •Why international ED encounters break standard revenue-cycle workflows •The partnership model (roles, handoffs, accountability) •Front-end identification + Epic configuration patterns •KPIs that mattered most (yield, cycle time, AR follow-up) •Field-tested recommendations you can implement this quarter Baseline challenges (before the model) Patient experience •Unclear ownership during an ED visit •Communication gaps after discharge Payment & reimbursement risk •Highly variable international benefit designs •More denials + longer adjudication cycles Verification complexity •Eligibility + “medical necessity” definitions differ •Language/documentatio n barriers Why this partnership model works DIFFERENTIATORS CALLED OUT IN THE DISCUSSION Sunbelt (partner) •End-to-end international claims management •International payer relationships + negotiation support •Legal and clinical expertise for tough reimbursement scenarios •Eligibility/coverage research for unknown plans AdventHealth (provider) •Owns patient care + internal workflows •Configures Epic for earlier identification/tagging •Releases claims; monitors AR, cash, and yield targets •Creates training artifacts (quick guides/tip sheets) Operating principle: “specialized discipline” + early identification + shared accountability Workflow: identify early → handoff cleanly A PRACTICAL FLOW FROM ED ARRIVAL TO PAYMENT RESOLUTION ED registration + intake Capture country, address, policy details International flag/tag Known contracted plans + “umbrella” tag Eligibility & coverage research Real-time verification + exclusions Claim release + follow-up Provider releases; partner follows up Resolution Payer payment + patient balance options Roles & accountability Provider (AdventHealth) •Owns Epic build + intake training •Claim release + AR governance •Revenue integrity for disputes Partner (Sunbelt) •Eligibility/coverage research + guidance •International payer follow-up + negotiation •Patient communication for balance resolution Results: yield improved and work got “cleaner” A KPI IRA EMPHASIZED: YIELD (PAYMENTS AS % OF CHARGES) Yield improvement (closed inventory snapshot) 0 10 20 30 40 50 60 BeforeAfter What improved •Yield increased by ~16 points (40% → 56%) •Cleaner accountability with reporting cadence •Faster path to billing by engaging research earlier •Reduced back-office friction on follow-up Payer dynamics: why “wild west” is a fair description WHERE COMPLEXITY SHOWS UP Common patterns •Non-contracted payers seeking contracted rates •“Silent PPO” behavior (rate access without transparency) •Different medical-necessity definitions and exclusions •Longer adjudication cycles + more back-and- forth Operational response •Benchmark yield targets; monitor by payer cohort •Hold the line on reimbursement (legal leverage helps) •Document and escalate when network repricing occurs •Engage follow-up early so billing isn’t delayed 30+ days Key takeaway: measure, identify early, and don’t let non-contracted repricing go unchallenged Patient communication & seasonality WHAT SHOWS UP IN TOURIST MARKETS (EXAMPLE: FLORIDA) Communication tactics •Capture international phone + address early •Use phone/text/email more than postal mail •Coach patients on home-country documentation needs •Offer clear options to resolve patient balance (when allowed) Seasonality pattern Oct–Mar: higher volume (“snowbird” / tourism season) Plan staffing + follow-up capacity accordingly. •Tourist overflow to “outskirts” facilities •Canadian retirees are a recurring cohort •Technology gaps can distort outreach Implementation checklist (next 30–60 days) A PRACTICAL, LOW-DRAMA PATH TO BETTER PERFORMANCE Front end (ED + access) •Define “international” criteria (don’t confuse with LEP) •Hardwire intake: address, phone, payer, travel policy •Tag/flag early in Epic and route to the right workqueue •Publish quick guides + tip sheets for staff Back end (PFS + vendor) •Set yield benchmarks; review by payer cohort •Engage eligibility research early to avoid 30+ day delays •Create an escalation playbook for repricing / silent PPOs •Track cycle time + AR aging; share a weekly scorecard If you can’t staff specialization internally, partner early—and treat the partner like part of your AR governance. ⚬Map the full international-patient ER journey end-to end and identify bottlenecks ⚬Leverage external partners where internal capacity or specialization is lacking ⚬Continuously improve by tracking, verification rates, collections, etc. using a simple dashboard and cross-department reviews to drive ongoing optimization Best Practices 1. Where in your ER or hospital workflow do international patients experience the biggest delays today: registration, verification, or discharge? 2. If you could improve just one metric for international receivables, which would have the biggest impact for your organization: speed to bill, collections rate, or staff workload? 3. What type of support would most accelerate your own international-patient process: technology, training, and/or an external partnership? Pulse Check: Ask the Audience ⚬https://international.sunbelthealthpartners.com/wp- content/uploads/sites/2/2025/08/Sunbelt-Case- Study_Deidentified_DIGITAL.pdf ⚬https://www.itij.com/latest/long-read/perfect-partnership ⚬https://nchl.member365.org/sharingnetwork/documentLibrary/view/145 6 Additional Resources SunbeltHealth MattVines MattV@sunbelthp.com AdventHealth IraArnan ira.arnan@adventhealth.com USCIPPTe am uscipp@nchl.org Questions for the speakers? THANK YOU!