POS Collections Case Study Session

POS Collections Case Study Session PowerPoint PPT Presentation

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Agenda. Background on Riverside and our Revenue cycle structureStages of Acute care POS journey2002

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POS Collections Case Study Session

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1. POS Collections Case Study Session S. Richelle Fleischer, CPA, MPH Vice President, Revenue Cycle For Acute Care and Physician Practices

2. Agenda Background on Riverside and our Revenue cycle structure Stages of Acute care POS journey 2002 –2009 2010 and beyond POS at Riverside Medical Group (RMG) Just beginning Future Goals and Benchmarks

4. Riverside Revenue Cycle 5 acute care hospitals – 710 beds $1,047,390,000 gross revenue 2009 1 newly acquired hospital Merged into CBO July 1, 2010 350 employed physicians plus 50 NP/PAs Responsibility began March 1, 2010

5. Acute Care Revenue Cycle Functions Transfer Center Inbound to IP Find a Doctor, Find a Bed, Find a Ride Central Scheduling OP diagnostics For 6 hospitals and all offsite diagnostic campuses Operators Insurance Verification All acute care scheduled appointments and surgeries Collect POS monies

6. Acute Care Revenue Cycle Functions Patient Access Collects POS Monies Bed Control Health Information Management All at home coders and transcriptionists Imaging since May 2006 Transition center – outbound Facilitate transition to post acute care Transportation Center Centralized Patient Accounting office

7. Acute Care Revenue Cycle Technologies Invision (registration) Registration scrubber Electronic signature capture Online credit card processing Next Generation tools to be discussed later…

8. Physician Revenue Cycle Functions Pre-Service Unit Fully registers patient prior to arrival during call to schedule appointment Collects POS monies Coding Compliance Fee Schedule Maintenance Central Business Office

9. Acute Care POS Journey So how do you REALLY feel about your current POS collections?

10. Maybe if I don’t look, POS will go away.

11. Bored, because you’ve been there, done that.

12. We are SOOO good, I just have to strut!

13. Our Journey Cashier window boarded up Scripting POS - not illegal

14. Our Journey Fixed Copays and deductibles Bonuses for staff for hitting POS goals Prompt Pay discounts to patients Clinical urgency on self pay patients

15. Our Overall Progress Stalled in 2009 even though Gross Charges grew by 11% from 2008 to 2009

16. Insured Bad Debt Climbing as Coinsurance and Large Deductible Plans Grew

17. Time To Stick My Neck out for a New Strategy

18. What Tools I Found Price Quote Software Brings in actual hospital contract terms to accurate calculations If discounts didn’t work, why would a piece of paper? Credit Scoring Software Would distinguish charity from bad debt Segregate those who have ability to pay with available credit

19. Final Solution Both paper based price quoting and credit scoring in 1 tool. Price Quote as Phase 1 Run in Insurance verification Contacted patients by phone before service date Handed paper copy to patient in Patient access Credit Scoring as Phase 2 Charity determination Likelihood of payment

21. Phase 1 - Quotes On all scheduled procedures Lead to calls being made on all patients owing more than $100 Hard copy quotes handed out Patient and physician push back Legal requests Starting to use in ER

22. Phase 2 - Red Light/Green Light Charity eligibility For self pay only per hospital charity policy Likelihood to pay Available credit We require using up to 80% of available credit

23. Phase 2 – FPL and Credit Scoring Instant charity determination Patient and physician satisfier Less paperwork and FTE savings Separating good paying insured patients from those at risk of bad debt Ready for Admin buy in Will not upset good paying patients

24. Our Results of March Install

25. Another Goal of POS Collections Bad Debt reduction Increase in Charity by POS determination Turning away non-stat diagnostic testing for nonpayment when patient chooses not to use their available credit Won’t see impact for 5 months

26. Observations Less resistance to pay large patient liabilities when it’s “in writing” and appears “formal”. Increased patient satisfaction on real time awards of charity at POS. Credit Scoring and available credit information strengthens staffs willingness to engage in a potentially confrontational conversation over payment. Not surprising - Patients not providing “full disclosure” of their available credit when saying “they can’t afford” their patient responsibility.

27. Just the “Nudge” We Needed to Get over the Hump

28. Physician POS Journey Just Beginning Only able to see their practice balances Opened up visibility No incentive to collect at POS Reducing centralized billing fee by the amount of POS collections including any collected for other practices Charging practices outside collection agency fees No decent reporting of Cash collections

29. Physician POS Journey Just Beginning Practice managers have started coordinating with hospital Insurance verification on patient quotes and financial clearance for hospital based procedures. Working to provide price quotes to combine hospital and physician charges into 1 quote for the patient Practice managers excited about: Ability to determine charity at POS Ability to see ability to pay and available credit

30. Goals FTI indicated POS should be 0.52% of gross revenue for acute care 10% ROI on software has already been met in first 3 months


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