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OCHIN Billing Workshop II

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1 OCHIN Billing Workshop II
Jessie Janota, Tech Lead, Revenue Cycle Team OCHIN Jane Speyer, Senior Billing Manager, OCHIN T.J. Bauer, Enterprise Account Executive, TeleVox Software, Inc.

2 Recap from Friday’s Session
Charge Router functionality Router Review Charge Handler Functions Billing WQ Routing and Automatic Activities Automated Credit Matching Auto Follow-up Activities Remittance Code Mapping

3 Today’s Topics Optimizing Self Pay Collections
Automated Patient Notifications T.J. Bauer from Televox Partnering with the Revenue Cycle Team JIRA Success Billing and Claims JIRA meetings

4 Self Pay Collections: Simplify and Optimize
Jane Speyer Senior Billing Manager, OCHIN

5 Optimize Self-Pay Collections
Self Pay Aging Date Account Workqueues: Advantages of Drop Cycle Statements Small Balance Write off and Statement Suppression Sending Accounts to a Collection Agency Statement Intervention Automate Patient Collection Calls

6 Self-pay Collections Lots of variation between clinics
We have the ability to customize but what seems to work best? OCHIN continuously looks for ways to optimize, automate and simplify the work Here are our recommendations:

7 Self Pay Aging Date There are 3 options for setting the self-pay aging date: Service Date Reflects actual age of service Patient can get a statement saying service is 60 days past due when it was just NRP’d to patient Post Date  Item doesn’t age until it is posted to self-pay Statement Date Item ages when statement is accepted

8 Account WQ Settings: The Basics
No Rules Insurance WQ Returned Mail WQ Payment Plan WQ Can set up a insufficient payment WQ Confidential, Contested and Hold Statement WQ Self Pay WQ – 30 days and older Can split by guarantor last name to split the workload between collectors

9 Self-Pay over 30 days WQ This is where the bulk of your collection activity occurs Important Settings: Exclude Account Status of Returned Mail Hold Statements Contested Accounts Payment Plan Exclude Confidential Accounts Self pay Aging of 30 days or more One or more statements sent

10 Drop Cycle Statements Accounts qualify for statements when charges drop to self-pay Ensures that patients get a statement sooner Decision points If patient incurs new charges, should they get a new statement right away? When should their next statement be sent? When should you remove them from the cycle?

11 Drop Cycle Recommended Settings
What to ask for when you request Drop Cycle: First week after you switch, you will have high volume of statements go out at once Prepare patients and customer service staff for change

12 Statement Suppression
Do you really want to send statements on low dollar accounts? Cost of collecting isn’t worthwhile Consider suppressing statements for accounts under a certain amount Industry recommendation is under $5.00 You can also set up the system to automatically write off these low $ accounts at the time of statement processing

13 Automatic Collection Workqueues
If using a collection agency, make sending accounts to collections easy! External Collection Workqueue can: Send a data file to your collection agency with new accounts to be added Send an update file with information about accounts removed from collections Send a payment file showing payments taken at clinic on accounts sent to collection agency Make sure your agency integrates with Epic Professional Credit Services (PCS) is fully integrated

14 External Collections WQ
Accounts placed in External Collection WQ will be: Written off to Collection Agency Bad Debt Given an Account Status – your choice: Collections Bad Debt Cash at time of Service, etc. Will enter an Account Note (clinic can decide what it says)

15 Statement Intervention
Stops statements from going out Useful when there is retroactive Sliding Scale Discount eligibility Programming point looks at charges that qualify for slide, but no slide applied Prevents statement from going out and drops it into a Statement Intervention WQ Allows you to correct error and if there is a balance, account will qualify for next statement run if you use Drop Cycle Other uses?

16 Televox Automatic Patient Balance Notification
OBS piloted this service at one of our clinics: Self pay collections increased $5,000/month This represented a 40% increase! In sample review of accounts that received a Televox call: 41% made a payment 16% called to report insurance or apply for Sliding Scale Discount

17 Patient Balance Notification
T.J. Bauer Enterprise Account Executive TeleVox Software, Inc.

18 Benefits for OCHIN Members Increase Self Pay Collections
Patient Balance Notifications Simple Communications – Significant Results Benefits for OCHIN Members Increase Self Pay Collections Maximize Resources Effectively move from outbound to a mostly inbound call center Increase touches Direct to on-line payments Fewer statements Decreased A/R life Increased focus on more severely delinquent accounts Reduce bad-debt write-offs Identify need for assistance Strategy Options High balance vs. Low balance Logic Get paid after hours using Inbound Payment Options Voice tone changes based on account aging OCHIN

19 3 Strategies for Maximizing Results
Patient Balance Notifications Simple Communications – Significant Results 3 Strategies for Maximizing Results 1. Courtesy: Simple alert & offer of convenience 2. Interactive: We’re here to help 3. Final Notice: Action required 0-60 Days Courtesy Tone Neutral Firm Friendly Call Back Number or Live Transfer Live Transfer / Pay-by-Phone Call Attention / Online Bill Pay Day or Night Night Strategy Time of Day Days Final Notice 60-90 Days Interactive OCHIN

20 Patient Balance Strategy Scripts (No Payment Option)
Patient Balance Notifications Simple Communications – Significant Results Patient Balance Strategy Scripts (No Payment Option) Courtesy: Simple Alert and Offer of Convenience “Hello, this is Central Health Clinic calling with an important message for (Patient Name). Did you check out our quick online bill pay option at If you have recently mailed your payment, thank you. Please call us at if you have any questions about your bill. To replay this message, press 2.” Interactive: We’re here to help “The Central Health Clinic has an important matter to discuss with you. You can reach us Monday through Friday from 8 a.m. to 5 p.m. by calling If you would like to speak to a representative at this time, please press 1. To repeat this message, please press 2.” Final Notice: Action Required “Good evening. This is Central Health Clinic calling with important information about your outstanding balance. To speak with a staff member about your balance or make a payment, please press 1 now or call between the hours of 8:00 a.m. and 5:00 p.m. at your earliest convenience. Thank you for your attention to this important matter. To repeat this message, please press 2.” OCHIN

21 Outreach Sample: PaymentIVR (Outbound + Inbound)
Patient Balance Notifications Simple Communications – Significant Results Outreach Sample: PaymentIVR (Outbound + Inbound) Live Answer (Outbound Call): “Hello, this is Central Health Clinic calling with an important message for <Sherrie>. If we have reached the correct party, press the 1 key now... For right party verification, please verify we have reached the correct party by entering your date of birth (or SSN). Thank you! This is a courtesy call to advise your balance in the amount of <$250> is outstanding. Press the 2 key to speak to a member of our staff or press 9 now to make a payment via our automated payment attendant. Answering Machine [With Inbound Call Option]: Hello, this is Central Health Clinic calling with an important message regarding your account. For more details, please contact us at during regular business hours. [To make a payment after hours, please call <800-PAY-MENT> and enter the 5 digit PIN number of <12345>]. Thank you! OCHIN

22 Processing vs. Non-Processing
Patient Balance Notifications Simple Communications – Significant Results Processing vs. Non-Processing All IVR Messages Calls Delivered Message Plays RPV DOB/SSN Press 9 to Pay Now Enter into IVR Data File Processed Method (Automated) Validated by Processor Payment Options Enter CC Data Payment Processed $ Deposited to customer Non-Processed Method (PCI Vault Storage) PCI VAULT Storage Customer decrypts file Customer Manually processes payments Payment Options Enter CC Data OCHIN

23 Patient Balance Notifications Simple Communications – Significant Results
Case Studies OCHIN

24 Patient Balance Notifications Simple Communications – Significant Results
Case Studies OCHIN

25 Patient Balance Notifications Simple Communications – Significant Results
Why TeleVox? Trust of the Industry Serve over 140,000 providers 750+ enterprise healthcare clients, including U.S. News “Honor Roll Hospitals” Recommended by over 100 industry partners, including GE, Epic, Cerner, NextGen and Allscripts Zero Risk Proactive data security approach (external SSAE 16 and HIPAA audits) Dual Data Center to ensure system resiliency Trusted OCHIN partner for over 5 years Commitment to Service Implementations within 30 days Over 80% of support issues resolved within 24 hours Industry-leading 99.97% call completion rate OCHIN

26 Partnering with the Revenue Cycle Team
Jane Speyer Senior Billing Manager OCHIN

27 JIRA Secrets All these great improvements require a JIRA
What can I do to get my JIRA’s worked faster? Chocolate might work, but these tips will work even better:

28 JIRA Tips and Tricks When reporting a problem, always include multiple examples. If it’s a claims issue, use invoice #, not account #, MRN or patient or account name When listing payors, include the payor ID (not the name) Find the payor ID by clicking on “Coverage Summary” when in Account Maintenance Check registration for User Errors for claim rejections Claim Edit WQ Companion is truly a great companion!

29 JIRA Tips and Tricks Keep separate issues in separate JIRA’s
Can be confusing to follow and might lead to your JIRA being closed without every issue being addressed. You can link JIRAs if information is related or relevant to the other issue you are reporting Only reopen the JIRA if the original resolution did not work If a new issue or enhancement to the original issue is needed, open a new JIRA Link the closed JIRA if it’s relevant

30 More Tips and Tricks Use CPT codes and ICD-9 codes or ranges of codes, not descriptions when requesting charge rules Avoid delays in requests for info by being as specific as possible in your first entry If asked for info, respond right away You want your fix, and your analyst wants to close the JIRA Give them what they need so you both get what you want!

31 Billing/Claims Issues Meetings Making the most of them
Get the right people in the room: The biller who requested the JIRA The person who enters them The person with system knowledge This person may or may not be the site specialist This will allow your analyst to get the questions they have answered so they can implement the changes you need right away

32 Billing/Claims Issues Meetings Making the most of them
Prepare for the meeting by reviewing your JIRA list Know going in, which JIRAs are most important to you Review JIRA’s to make sure your answered any requests for info Test early and often Or you might lose your build! Pay attention to REL refresh dates Report that the Test is done so your fix can be moved into Production

33 Billing/Claims Issues Meetings Making the most of them
Use this time to ask your analysts about new problems that the system might be able to resolve for you This is how system improvement happens The Revenue Cycle Team needs to know what areas in the Rev Cycle are inefficient, difficult, or repetitive Together you may be able to create an elegant solution to an inelegant workflow

34 Questions? May we answer any questions? Thank you for your time!
Please remember to complete your survey!

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