Up-Front Collections and Today’s Top Collections Technologies

1. Up-Front Collections and Today’s Top Collections Technologies The Technologies that are Transforming Up-Front Collections in Access Management October XX, 2011

2. Learning Objectives • Learn the real costs of up-front collection avoidance • Learn how to move the collections process from customer disaster to customer service • Learn the key collections technologies and the application integration required to develop a comprehensive “collections management system”

3. The Cost of Collection Avoidance • The out-of-pocket (self-pay) share of health care costs has increased significantly for patient in recent years • The cost-to-collect has also risen sharply as self-pay dollars have increased: • It is less costly for healthcare organizations to collect self pay dollars prior to service, at the point of service or at discharge. • If self pay dollars are not collected at the point of service or discharge, the cost-to-collect can be 4.75% - 10% of the balance.

4. The Cost of Collection Avoidance • Failure to collect “self pay” dollars reduces your ability to improve services or invest in new programs to meet community needs. • Research has shown: • Most patients (68%) prefer to know about their financial obligations at or prior to discharge. • Over one-third want to know about financial obligations prior to admission. • Uncertainty and confusion about financial obligations are a frequent source of customer dissatisfaction.

5. Setting Expectations Is Customer Service Patients may know very little detail about their health coverage. This is particularly true for healthy patients who haven’t had to use their coverage. Patients often have 2 expectations that can lead to anger and dissatisfaction when they are not met: • 1st Expectation:Having insurance means they are “covered” and won’t have to pay (much!) • 2nd Expectation:Doctors and other providers have checked for coverage before referring them to healthcare organizations.

6. Setting Expectations Is Customer Service Uncertainty and confusion about financial obligations are a frequent source of customer dissatisfaction. This uncertainty can cause confusion between: • The healthcare organization and the doctor • The patient and the doctor • The patient and the healthcare organization Effective healthcare organizations understand that communication is the key to decreasing this confusion and improving customer relations.

7. When does a patient’s responsibility for payment begin? A patient’s responsibility for payment begins on the date that services are rendered. Successful organizations establish this expectation during the registration process before services are delivered. Setting Expectations Is Customer Service

8. Setting Expectations Is Customer Service • Let Patients Know that Payment is Expected! • While this may seem to be an obvious point, far too many healthcare organizations begin the care process without letting patients know how or when they expect to be paid. • Organizations that are effective in up-front collections manage patient’s expectations by: • Notifying patients that payment is expected when services are delivered • Explaining uncovered amounts to patients before services are delivered • Asking for remaining balances and uncovered amounts

9. Setting Expectations Is Customer Service • Up-Front Collections Today: • Ideally moves all appropriate patient collections from the back-end (Patient Accounts) to the front-end (Patient Access Services) of the Patient Financial Services customer service cycle. • Solidifies our commitment to customer satisfaction, service excellence and performance improvement. • Reflects a practical way for us to demonstrate our organizations values in action.

10. Setting Expectations Is Customer Service • Demonstrate Your Values: Let Patients Know that Payment Options are Available! • Most organizations want to provide services to every patient. • While payment is expected at the time of service, financial assistance is available in the form of: • Payment deposits with payment plan arrangements • Discounted services based upon ability to pay • Payment assistance via government or other sponsored programs

11. Setting Expectations • Pre-service is the best time to communicate to the patient his or her financial responsibilities. This is the time to let insured patients know if there is a deductible, co-payment or co-insurance amount required and to discuss your facilities expectations for payment of services rendered. • This advance communication with the patient helps alleviate possible future misunderstandings when payment is later expected from the patient, and also helps expedite payment to your facility. It can also help east the patient’s anxiety regarding financial issues associated with healthcare services by enabling you to……

12. Setting Expectations • Inform patients up-front of non-covered services and charges. Let them know that they will be obliged to pay these charges if they choose to go forward with the services. • Request the full amounts that the patient is obligated to pay when requesting payment.

13. Setting Expectations • Uninsured patients may be responsible for the entire bill. Whether the patient is insured or uninsured, we begin setting expectations by informing the patient of the self-pay portion of our charges so they understand their responsibility for payment. • Effective organizations establish financial policies to address these collection situations.

14. Setting Expectations Financial Policies Financial Practices policies of healthcare organizations should clearly state that: • Payment is expected on the date of service • Emergency care will be provided without regard to a patient’s ability to pay and • Financial assistance is available for those who cannot afford services

15. A New Day • In the current healthcare environment providers constantly look for ways to enhance revenue and reduce cost. • As the patient out-of-pocket portion of health care costs has increased significantly in recent years, provider bad debt has also risen sharply.

16. A New Day • Today, more healthcare organizations recognize that an effective up-front collections program is an important way to reduce those costs. • While new technologies have emerged to facilitate this effort, leading organizations are increasingly learning that the thoughtful integration of these technologies can be a key driver of collection efficiency and customer satisfaction.

17. A New Day • Healthcare organizations are using a plethora of collections technologies to reduce costs and improve service delivery. When implemented as stand-alone applications, these organizations are realizing impressive results. However, when implemented as components of a thoughtful “collection management system”, the overall results can be greater than the sum of the individual parts.

18. Transformed Level 4 (Integration leveraged between all applications) Application Evolution Integrated Level (Integration improves with ADT Application Applications have evolved along a fairly predicable path Batched Level (Some Batch and Direct Processing) Niche Application Level (Application Silos are formed) While progress has occurred at every level, transformation of work processes has been elusive

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20. Top Collections Technologies Contact Verification Eligibility Verification Payment Estimation Communication Management Propensity-to-Pay Scoring E-Cashiering Financial Assistance Automation Rule based Document Imaging Self-Service Kiosks Rule-based Process Automation

21. Contact Verification Contact Verification

22. Contact Verification • Benefits • Improves billing and statement delivery, thus increasing cash flow • May detect multiple identities or possible fraud - including the identification of social security numbers for deceased persons • Increases staff productivity • Optional batch features often offered (as options)

23. Contact Verification • The Old Approach • Focus on address verification only • Batch address checking done after the fact • Features To Look For Now: • Phone Number Integration • Verify non-traditional phone numbers e.g., wireless, non-listed • ADT / Practice Management System Integration • System highlights real-time discrepancies between verification and host system • System allows user to accept or reject changes after real-time discussion with patient

24. Eligibility Verification Eligibility Verification

25. Eligibility Verification • Benefits • Verify coverage benefits prior to service delivery • Submit patient information and receive real-time coverage response • Reduce or eliminate timely telephonic verification • Reduce or eliminate cumbersome website verification • Increase upfront collections • Reduce rejections and denials • Increase efficiency and staff productivity (reduce data entry) • Improve patient satisfaction

26. Eligibility Verification • The Old Approach • Proprietary, payer-specific eligibility formats • Un-integrated website and telephonic verification prevalent • Features To Look For Now: • Normalized Benefit Formats • Ability to design “standard” and “detailed” benefit screens • ADT / Practice Management System Integration • Eligibility and benefit information is mapped in X12 and HL7 formats to ADT application • Ability to send real-time HIPAA 270 eligibility transactions and receive 271 responses

27. Patient Payment Estimation Payment Estimation

28. Payment Estimation • Benefits • Reduce bad debt • Increase collections • Accelerate payments • Cut costs for patient collections • Ensure payment accuracy • Increase payment certainty

29. Payment Estimation • The Old Approach • Collection of co-payments and self-pay deposits only • “Guestimates” rather than estimates • Features To Look For Now: • Charge Master/Eligibility System Integration • Ability to apply benefits to real charges • Charge Master/Contract Management Integration • Ability to apply contractual allowances before developing estimates

30. Communication Management Communication Management

31. Communication Management • Benefits • Increase productivity • Reduce denials • Increase successful appeals

32. Communication Management • The Old Approach • No electronic record of payer communications • Features To Look For Now: • Call Management • Automated calls, monitored calls, PC calls • Fax Management • Inbound and outbound faxed documents • Web & Electronic Image Management • Web-eligibility, e-mail, other electronic documents

33. Propensity to Pay Scoring Propensity to Pay Scoring

34. Propensity to Pay Scoring • Benefits • Streamline self-pay approvals • Limit unnecessary outsourcing • Identify risky elective encounters • Proactively identify financial assistance candidates

35. Propensity to Pay Scoring • The Old Approach • Subjective approvals by financial counseling staff • Understated charity care on financial reports • Features To Look For Now: • Self-pay Funding Sources • Available credit on credit cards • Lines of credit and home equity • External finance solutions offered by banks and other lenders. • Segmentation Analysis • Customize scoring profiles to community characteristics • Workflow Management • Electronically forward accounts to financial counseling process

36. Electronic Cashiering Electronic Cashiering

37. Electronic Cashiering • Benefits • Accelerates and increases collections • Increases speed of payment capture • Saves time by automating manual payment posting • Increases staff efficiency by enabling more employees to accept payments • Improves customer service leading to enhanced customer satisfaction • Provides dashboard reporting of payment activity (ability to track, audit and control all customer payments)

38. Propensity to Pay Scoring • The Old Approach • Payments collected at only at time of service • Reconciliation manual and cumbersome • Features To Look For Now: • Accept payments real-time from any location • Any user desktop • Patient payment web-portals • Accept all forms of electronic payment • Credit card, debit card, e-check, ACH transactions • Cash Posting and Management • Audit, track and control payments • User/Department collection efficiency reporting

39. Financial Assistance Automation Financial Assistance Automation

40. Financial Assistance Automation • Benefits • Proactively identify eligibility to entitlement programs • Reduce unnecessary outsourcing to self-pay vendors • Improve charity/bad debt classification • Improve customer service and community benefit reporting

41. Financial Assistance Automation • The Old Approach • Manual application and subjective approval processes • Reconciliation manual and cumbersome • Features To Look For Now: • Pre-populate applications from ADT information • Medicaid applications • Financial assistance applications • *Integration with propensity-to-pay systems and e-pay systems • Pre-define payment plans • Presumptive eligibility and approvals • Automate financial assistance rules and workflows

42. Rule-Based Document Imaging Rule-based Document Imaging

43. Rule-based Document Imaging • Benefits • Reduce unnecessary copying and scanning costs • Reduce denials related to missing referral/authorization forms • Improve customer service

44. Rule-based Document Imaging • The Old Approach • Repetitive copying and scanning of same documents • Features To Look For Now: • Rule-based Scanning • Prompt users to scan required documents • Drive prompts by document type, last date scanned, etc. • Optical Character Recognition Mapping • Compare insurance card information to ADT system fields and correct data entry errors

45. Patient Self-Service Kiosks Seated Kiosk Self-Service Kiosks

46. Self-Service Kiosks • Benefits • Reduced staffing • Reduced check-in time • Improved cash flow and collections • Reduced errors • Improved customer service

47. Self-Service Kiosks • The Old Approach • Staff check-in areas with increasing FTEs • Inconsistent collection compliance • Features To Look For Now: • Date/time stamping of arrival • Automated printing, armband generation • Real-time payment processing • Real-time eligibility verification • Debit and Credit Card Processing • Electronic signature capture

48. Contact Verification Communication Management Rule-Based Document Imaging Financial Assistance Automation Eligibility Verification Payment Estimation Rule-Based Process Automation Propensity to Pay Scoring Electronic Cashiering Self-Service Kiosks Rule-based Process Automation

49. Rule-based Process Automation • Benefits • Transformation of workflow • Technology acceleration • Vastly increased efficiency • Expanded financial counseling • Improved cash flow and collections • Improved customer service • Eliminate whole categories or errors

50. Rule-based Process Automation • The Old Approach • Each application functions as a silo • Information is copied or re-keyed into other systems • Features To Look For Now: • Full integration between all applications • Ability to use multiple integration modes, HL7, scripting • Ability to display scripts or registrar guidance • Ability to build “action rules”- rules that execute actions based on data from other applications – without registrar intervention or prompts