Best Practices in PO$ Collections

1. Best Practices in PO$ Collections • Reach for more.... Presenter: Jonathan Hendricks Revenue Cycle Consultant Recondo Technology

2. Overview • Industry Statistics • Compliance Issues • CASH principle • Opportunity Areas • Scripting • Reach for more

4. Industry Statistics *Bureau of Economic Analysis - Personal Consumption Expenditures by Major Type of Product and Expenditure

5. Industry Statistics-Cont’d • Self Pay is the fastest growing payer class • 47million Americans are uninsured (15%) • 80% of the uninsured patients are employed or have a spouse who is employed • Fastest growing population of uninsured aged 25-34 with income >$70K • Growth of HSA/HDHP from $1M in 2005 to $6.1M in 2008

6. HSA/HDHP - purpose • HSA – Health Savings Account What are the benefits? • HDHP – High Deductible Health Plans How do these work? What major impact/process flow does this have for healthcare providers? • End result – more work on provider to collect from patients with HSA/HDHP

7. Increasing PO$ Collections: Why the Focus? Significantly improve the bottom line of your organization through: • Reducing cost to collect • Reducing uncompensated care • Reducing self-pay receivables • Reducing bad debt • More timely cash flow • Improving patient satisfaction

8. Interesting PO$ Collection Facts • The overall cost to collect is typically reported between 2 and 3 percent of revenue. • The more time that passes following the patient’s discharge, the cost to collect on that account continues to go up while the chance of actually collecting payment goes down. • Therefore, any payment that can be collected early in the patient encounter is more valuable in the long term. • Educating the patient of their financial obligation in advance improves patient satisfaction and can build confidence.

9. Compliance issues - • EMTALA - Collections ONLY AFTER medical screening exam and stabilization • HIPAA - Potential risks while engaging in financial activity • Med Nec - Potential patient liability vs (ABNs) hospital write-off • Red Flags - Fraud alerts and identity theft

10. Where do you start?? • C – Communication • A – Access • S – Support • H – Huddle time

11. C - Communication Providing patient financial responsibility to patients is new to many people regarding healthcare services. EVERYONE has to be educated on the “why it is important”. Education starts with your own hospital staff • Senior mgmt – CEO, CFO, CNO and VPs • Clinical ** • Non-clinical • Directors and Managers at all levels Others to be educated: • Physicians, Physician office mgrs/staff, etc.

12. Communication Who are some of the worst offenders of not paying their financial responsibility to you yet is closest to the organization? You got it……..your own employees!!! • Implement and push payroll deductions • Get organization leadership buy-in and require new employees to sign auto-deduct at point of hire (if allowed/able)

13. C – Communication (continued) The next step is to determine the best and most effective ways to communicate your plans to patients. • Publish your plans on your website, brochures, pre-admission packets, etc. • Inform patients of possible financial responsibility during scheduling/pre-reg. If patients are informed they will respond!

14. A – AccessCollection Technology Enablers Must have: • Accurate eligibility process • Financial responsibility calculator • Systems to maintain information (i.e. hospital or vendor) Nice to have: • On-line payment option • Integrated credit card authorization system • ATM accessibility • Demographic verifier (RED flags) • Credit scoring (propensity to pay)

15. Get educated on what’s out there • Eligibility tools Traditional 270/271 Payer portals Systems with “rules based” architecture • Financial responsibility calculators Historical claims data (pros/cons) CDM and Contract mgmt info Automation, Automation, Automation

16. HIPPA transactions • Some payers are better at sharing/providing • Do you know any of the following? 270 – Eligibility request 271 – Eligibility response (many are lacking) 278 – Precert/Authorization notification

17. What about Service location detail? • How good are you and your staff at selecting the correct service? Hospital Inpatient 48 MRI/CT 62 Hospital Outpatient 50 Maternity 69 Amb Surgery 53 Phys Office visit 98 Emergency Accident 51 Phys Office IP 99 Emergency Medical 52 Phys Office OP A0 General Benefits 60 Nursing Home A1 Emergency Services 86 Skilled Nursing A2 Diagnostic X-ray 4 Well Baby 68 ………..and on…..and on……and on………

18. Get educated…continued • Systems to maintain information Host system vs Vendor system retainer Integration vs non-integration • Other points of interest Price transparency options On-line pre-registration options Automated authorizations status Automated claims status On-line scheduling Call center (HUB environment with phone queue) Automated work lists and go paperless when possible Automated call reminders for appointments and pre-register Automated cash tracking tools Secure pay-by-phone tools

19. S – Support Does the staff have the right knowledge base around – • Insurance terminology • Medical terminology • Collection best practices • Appropriate scripting • Are you supporting staff efforts when disgruntled patients complain? • Do the key players such as your CEO, CNO, CFO and VPs support your endeavors? • Does your staff know and feel the support?

20. H – Huddle timeconstantly reassess your situations

21. Things to consider • What types of patients are you going to collect from? Outpatient Radiology, Outpatient Surgery, ER, Maternity, Inpatient, etc. • Are your various scheduling areas going to obtain the needed insurance information? • Do you have staff willing/able to perform? • Do you need to recruit new people? • Etc…..etc…..etc…..

22. Collection Readiness • Scripting, scripting, scripting • Training (role playing is very effective) • Policies and procedures (don’t preach) • Set expectations and accountability • Communicate goals and expectations • Measure potential vs. actual cash • Incentive plan (if needed)

23. PO$ Collection Opportunity Areas Scheduling Financial In-house/ Discharge Pre-Registration Counseling Registration/ED

24. Pre-Registration Why is pre-registration so important? Although scheduling should be obtaining limited insurance information, pre-registration gives you another chance to obtain complete insurance details. On-line pre-registration is encouraged so upcoming visits are allowed lead-time for verification and pricing. Web page reminder – This also gives another avenue to remind patients that there may be financial expectations for their visit.

25. Financial clearance • 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 • Service rendering/deferral policies • Previous bad debt assessments in relationship to new visits

26. In-House Discharge • Make in-house visits to patient rooms for third party coverage, collect patient financial responsibility, and/or payment arrangements (courtesy discharging) • You have a captive audience….what more could you ask for???

27. Tips to Motivate Payment • Avoid • I want you to… • I need… • We require… • Our policy states… • Use • Here are some options for you… • Did you know you could • May I suggest… • We have always encouraged

28. Overcoming Excuses #1 Patient Excuse • “I’ve never been asked to pay before.” • Registrar Response • “Depending on what service you had last time, you may not have had to pay a co-pay/co-insurance at that time. If the service was in a previous benefit year, maybe you had already met your deductible and/or OOP max. Maybe you also had a secondary policy that picked up where the primary left off. As you can see, there could be several reasons why you were not asked to pay at that time of service. I can, however, offer you these options today.

29. Overcoming Excuses #2 • Patient Excuse • “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 of their portions due. However, your Insurance handbook should detail for you the portions you are responsible for when receiving healthcare services. I apologize that you were not notified before your date of service. If you are not in a position to pay the total amount in full today, I’d be glad to go over several payment options we have…”

30. Overcoming Excuses #3 • Patient Excuse • “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”

31. Reach for more……..

32. To do list: • Get excited about it!!! • Find someone that has the right drive and motivation and have them take the lead • Do an assessment of your current state and determine where you want to go. • Don’t forget your “Huddle time” – constantly reassess your situations • Stick with it……it really does work and can greatly impact your organizations bottom line! • Get started…….what are you waiting for????

33. Thank you • Questions/Answers • Happy Collecting!! Jonathan Hendricks, RC consultant Recondo Technology www.Recondotech.com Jonathan.Hendricks@recondotech.com 270-256-8129