Presented by: Reid Mellott and Brandon Childs

Overview
• Industry Statistics and Trends
• Upfront Collection Facts
• Compliance Issues
• POS Collection Technology
• Opportunity Areas
• Success Factors
• Scripting
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Current Trends
• The losses for many hospitals’ investment income has caused their executives to look for additional ways to increase net revenue, reduce bad debt and lower cost.
• Point of service collections no longer an emerging trend – it’s now mainstream for Patient Access best practices
• Maximizing point of service collections rank in top 10 CFO priorities
– Advisory Board Company 2011
Result: rising bad debt and less cash on hand; especially with the continued growth of HSA & High Deductible Health Plans
(more financial responsibility put on the patient)
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Growth of HSA / HDHP Enrollment
12 000 000
10 000 000
8 000 000
6 000 000
4 000 000
2 000 000
0
3 168 000
1 031 000
2005 2006
4 532 000
2007
6 100 000
8 013 000
10 009 000
11 400 000
2008
Year
2009 2010 2011
Source: AHIP Center for Policy Research, June, 2011
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Population Trends
• Self Pay is the fastest growing payer class
• 50+ million Adult Americans are uninsured (18.7% )
• 25 million Adult Americans are underinsured
• 75 million working-age adults uninsured or underinsured
 Fastest growing group of uninsured aged 25 – 34 with income > $70K
 Figures increase significantly when including children or undocumented individuals
• Employer-based health coverage continues to decrease
2008
49.2%
2009
46.8%
2010
45.8%
2011
45.0%
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Unemployment and the Uninsured impact
12,00%
10,00%
8,00%
6,00%
4,00%
2,00%
0,00%
Rising Unemployment
*
*1% increase results in 1M new
Medicaid/CHIP enrollees and 1.1M uninsured
* окт.07 янв.08 апр.08 июл.08 янв.09 апр.09 июл.09 окт.09 янв.10 апр.10 июл.10 окт.10
Ряд1 4,80% 5,00% 5,70% 6,50% 7,60% 8,90% 9,40% 9,50% 9,70% 9,90% 9,50% 9,60%
Bureau of Labor and Statistics and the Kaiser Family Foundation
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Increasing patient out-of-pocket
Percentage of Covered Workers Enrolled in a Plan with a General Annual Deductible of $1,000 or More for Single Coverage
Note: These estimates include workers enrolled in HDHP/SO and other plan types.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006-2010 .
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Increasing PO$ Collections: Why the Focus?
Significantly improve the bottom line of your organization through:
• Reduce cost to collect
• Reduce uncompensated care
• Reduce self-pay receivables
• Increase overall cash flow
• Improve patient satisfaction
• Reduce call volumes
• Reduce patient confusion about their bills
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PO$ Collection Facts
• Cost to collect is typically reported between 2-3% of revenue
• Front-end processes are important … due to increase in patient out-of-pocket
• Post discharge, cost to collect increases, likelihood of collection decreases
• Educating the patient of their financial obligation in advance improves patient satisfaction
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Example
• Medium size hospital
• Radiology department with 5,000 visits
• Average liability $389
• Potential to collect $1,945,000
Result: Without collecting at POS, the hospital can typically lose up to 60% of the potential amount, or $1,167,000
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PO$ Collections – Best Practices, is this possible?
Total Annual Visits
% Commercial Visits
Annual Commercial Visits
Average Patient Responsibility
Total Collection Opportunity at
POS
Annual Net Patient Revenue
Current Annual Collections at
POS
Current Monthly Collections at
POS
Current Collections as % of Net
Patient Revenue
Current Collections as % of
Total Collection Opportunity
Outpatient
52,200
31%
16,182
$169.00
$2,734,758
$57,015,738
$480,000
$40,000
0.84%
5%
Inpatient
4,500
31%
1,395
$1,225.00
$1,708,875
Outpatient
Surgery
13,800
31%
4,278
$798.00
3,413,844
ED
(not admitted)
27,000
31%
8,370
$122.00
Total
Annual
97,500
30,225
Total
Monthly
$1,021,140 $8,878,617 $739,885
HFMA Best Practice 2-3% of
Net Patient Revenue
POS Collections at 1%
POS Collections at 2%
POS Collections at 3%
Best Practice
Monthly
Collections at POS
47,513
$95,026
$142,539
Current
Monthly
Collections
$40,000
$40,000
$40,000
Monthly Increase from Current
Annual
Increase from Current
7,513
55,026
102,539
$90,156
$660,312
$1,230,468
% Total
Opportunity
5%
11%
16%
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Compliance
EMTALA
HIPAA
Compliance
Hurdles Medical Necessity
ABN
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HIPAA
Health Insurance Portability and Accountability Act
• Disclosure of information must be limited to the minimum necessary for the purpose of the disclosure
PO$ IMPACT
Potential compliance risks while engaging in financial activity
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EMTALA
Emergency Medical Treatment and Active Labor Act
• The hospital cannot delay in providing a medical screening examination or stabilization services in order to inquire about the individual payment method or insurance status.
PO$ Impact
Collection activity ONLY AFTER medical screening examination and stabilization
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Medical Necessity
Social Security Act 1862(a)(1) is defined as:
• Consistent with symptoms or diagnosis of the illness of injury being treated and not for the convenience of the patient, attending physician, or supplier
• Within generally accepted professional medical standards (not exploratory or investigational)
PO$ Impact
Potential patient liability if not medically necessary
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ABN / Notice of Non-Coverage
Advance Beneficiary Notices or Notice of Non-Coverage
• Before services are provided
• Medicare/select commercial payers will not pay for some or all of the services because they may not be reasonable and medically necessary
• Patient/representative must be informed of non-coverage and liability in the event Medicare does not pay
PO$ Impact
Potential patient liability
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Collection Technology
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•
•
•
•
•
•
•
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Detailed eligibility – 271 data is not enough
Medical necessity verification
ABN notification
Financial responsibility estimator
On-line payments
Integrated credit card authorization system
ATM accessibility
Propensity to pay score
Scripting
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Collection Readiness
• Training
• Scripting
• Policies and procedures
• Set expectations and accountability
• Communicate goals and expectations
• Measure potential vs. actual cash
• Develop incentive plan
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PO$ Collections Opportunity Areas
Other ancillary departments
Registration/ED
Preregistration
In-house/
Discharge
Scheduling
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Scheduling / Pre – Registration / Registration
• Potentially the first point of contact with the patient!
• Verify eligibility
• Consistent pre-registration process
• Obtain benefits (coverage, co-pay, co-insurance and/or deductible, YTD accumulators)
• Inform patient of liability in advance
• Offer debit/credit card payment option
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Financial Counseling
• Plays key role in protecting the hospital’s cash flow and exposure to bad debt and collection expense
• Medical assistance screening
• Alternative state funding application process
• Charity care screening
• Credit scoring (propensity to pay)
• Establish financial arrangements
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In House / Discharge
• Make in-house visits to patient rooms for third party coverage, collect patient financial responsibility, and/or payment arrangements
• Implement financially focused discharge control process for all point-of-service areas
• Ensure every account is financially evaluated prior to discharge
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Success Factors
• Hospital PO$ collections policy
• Financially focused Patient Access Department
• Financial Counseling best practices
• Medicaid eligibility vendor
• Physician and physician office manager education
• Staff education and incentive program
• Consistency in front end process
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Key Contributors to Success
• Senior Management buy in; CEO, CFO, CNO
• CIO supporting integration of technology
• Physician communication
• Clearly defined policies and expectations
• Training program
• Consumer education and satisfaction
• Establish goals and measure performance
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Best Performers – Hospital wide
• CFO/CEO communicates organizational efforts to hospital directors
• CNO adopts organizational efforts and level set clinical depts
• CIO provides access to currently technology and provides resources to implement
• HR incorporates cash collection responsibilities in job description
• Patient Access documents Policies and Procedures
• Scripting and role playing
• Discuss and publish goals and expectations
• Track and publish actual vs goals
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Best Performers – Non ER
• Relationship with physician community
– Provides specific information at scheduling
– Provides insurance information at scheduling
– Provides maternity list
• Strong Preadmission dept
– Insurance eligibility
– Medical necessity evaluation
– Generates patient liability
– Access to propensity to pay data
– Access to prior balances
– Communicates and collects patient liabilities
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Best Performers – Non ER cont.
• Strong Financial Counselor dept
– Evaluates ER admits, direct admits and transfers
– Established relationship with case management
– Generates and communicates patient estimates
– Access to prior balances
– Access to propensity to pay information
– Access to financial assistance resources
– Established prompt payment guidelines
– Established uninsured discounting
• Decentralized dept adopt and implement existing polices and procedures
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Best Performers - ER
• ER:
–
Clear and timely communication of MSE completed
– Clinical team assisting with acuity level
– Financial Counselors and Discharge Process
– Calculate and collect patient liabilities
–
Insurance letters with self addressed envelopes
–
Established prompt payment and uninsured programs
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Tips to Motivate Payment
• Use
– Here are some options for you…
– Did you know you could
– May I suggest…
–
We have always encouraged
• Avoid
– I want you to…
– I need…
– We require…
– Our policy states
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Overcoming Objections #1
Patient Objection
“I’ve never been asked to pay before.”
Registrar Response
“Historically we have encouraged patients to pay their patient responsibility upfront. We now have a program in place that helps patients know their expected patient responsibility upfront. What payment method would you like to use to pay your responsibility?
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Overcoming Objections #2
Patient Objection
“Why wasn’t I told in advance that I would have to pay today?”
Registrar Response
“We do our best to try to inform patients prior to their arrival. If you are not in a position to pay the total amount in full today, we will set up a payment arrangement for the remaining. How much will you be paying today?
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Overcoming Objections #3
Patient Objection
“I don’t have any money.”
“I can’t afford it right now.”
“I am not working. How can I pay if I don’t work?”
“I’m going to file bankruptcy.”
Registrar Response
“I understand. Why don’t I have you talk with our Financial Counselor and complete a Financial Analysis Statement. This will help us determine how we can assist you in resolving your account balance”
**Although we want to collect from this patient, it is equally important to help the patient understanding other funding mechanisms. Ensure that all critical data elements are verified and document your account to help the business office.
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Overcoming Objections #4
Patient Objection
“I like to wait until my insurance pays, then I’ll pay.”
“My insurance pays first and then I pay when I receive the bill.”
“I don’t even have a Deductible/Co-Pay –my insurance is wrong.”
Registrar Response
“As a service to you, we’ve contacted your insurance company and confirmed your eligibility and current. We verified that your annual deductible is $____ and you’ve already met $_____. Your co-insurance percentage is ___% or $____, etc, etc. The great news is, we have a contract with your insurance company which means you receive a discount.
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Overcoming Objections #5
Patient Objection
“I don’t have my checkbook/cash/credit cards with me today.”
“They told me not to bring valuables with me so I left my purse/wallet at home.”
“I just wrote my last check.”
Registrar Response
We’d like to have your payment method identified prior to your procedure.
What method do you expect you’ll be able to use? Is there a way we can obtain that today or later in the week?
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Overcoming Objections #6
Patient Objection
“It’s not right to pay for a service before you have it done!”
“I’ll stop back at discharge.”
Registrar Response
“I understand this may be something new for you. We have found that it is best to discuss this upfront so that there are no surprises later on. Also, once you’re finished with your test/procedure, you’ll be ready to go home and you won’t have to worry about stopping back here.
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Overcoming Objections #7
Patient Objection
“My ex-spouse is responsible for paying these bills.”
Registrar Response
“I understand. Unfortunately we cannot become involved in divorce decrees. As the presenting parent you are the responsible party for this account. We do have several payment methods available.”
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Overcoming Objections #8
Patient Objection
“I’m always overcharged and it takes forever to get your money back.”
Registrar Response
“I understand how frustrating that can be. We’ve done our very best to make sure we’ve verified and estimated correctly. If you find that you are due a refund, please call me directly and I will follow up and ensure your credit balance is promptly refunded. My name is ______ and my direct line is _____.
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Who to Contact:
For additional information regarding today’s presentation please contact
Terry Truman
303.974.2815 terry.truman@recondotech.com
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